Bipap on the way,now what

[Pugsy]

PS is (according to the guide) what we use mainly for the centrals so I tend to trust the machine to sort that out.

Only thing I am wondering about is what is happening when that EPAP max of 11 gets hit...if it gets hit and is that maximum in some way (with the PS) somehow preventing the machine from doing a good job holding the airway open and thus preventing the hyponeas (assuming they are indeed obstructive in nature).

I wouldn't increase min PS though. I would still look at EPAP.

As for pressure graphs...I think maybe look at the EPAP line to see if it wants to go higher than 11 when those hyponeas are flagged...plus see what IPAP is when those hyponeas are flagged.
This is a situation where maybe uploading the entire SD card contents so that all the data is available so you could plug the data into SleepyHead and even Encore would be better than asking for screen shots.

Of course we are only at night 2...
I could not read the statistics column on last nights report...too tiny and I couldn't make it bigger.

EDIT: just noticed that the report where he says he switched to the P10 (that we can't read well) and posted this morning appears to be the same report from the night before unless both reports had same AHI of 9.09

So to OP....did you link to the wrong report? Where is last night's report?

[Hornnumb2]

Not sure how that happened, I changed it. Here is the encore report.

[Pugsy]

When you are at imgur do you see a little box with various url addresses and a selection of thumbnail sizes at the bottom?
We can't enlarge your screen shot with the url address you are using.

I think you have to be logged in to get the box with the various url choices and the one to choose is the bottom address AFTER you click on "Large thumbnail"....if you do that we can click on the image to enlarge it to make it easier to read the tiny stuff.

I can tell you what I would do if it were me. I would be more aggressive with the EPAP minimum and maximum and leave all the other stuff the same.
I am basing those thoughts on the fact that some snoring is still showing up and some flow limitations...both which point to obstructive.
Based on this report...and it's a big jump...9 or 10 minimum EPAP and 16 for maximum EPAP (it won't go there unless it thinks it has to).
At least that's what I would do and it's based on my past experience and a little bit WAG.
If your AHI was a bit closer to 5.0 I wouldn't be so aggressive but I think you are likely going to need it.
It's your therapy though and if you want to go up more slowly you can certainly do that.

[Sleeprider]

Pugsy, I'm still seeing obstructive signs like VS that suggest you're probably right on EPAP min. My direct experience is limited to the 760 and it also loiters near the minimum EPAP. We are in a bit of cause and effect mode right now, so experimenting with higher EPAP is not a huge risk.

I like the Encore chart better for this troubleshooting. The H events are closely associated with more machine triggered breaths, and look more like incomplete centrals the machine stops, but not before flow volumes drop to score a hypopnea. Increased EPAP may help with that.

[OkyDoky]

It would be really helpful if the screenshots were where we can enlarge them. To do this you need a free Imgur acct. Study this thread https://sleep.tnet.com/reference/tips/imgur especially down where it says New Stuff. His pictures show what we are talking about.

[Pugsy]

Pugsy, I'm still seeing obstructive signs like VS that suggest you're probably right on EPAP min. My direct experience is limited to the 760 and it also loiters near the minimum EPAP.

If we mentally remove the centrals and pretend we are just dealing with just obstructives then think of the EPAP minimum on the 960 being like your 760 EPAP minimum and the maximum EPAP being like your IPAP max for obstructive prevention.
EPAP is used for obstructive stuff and IPAP is left open with the PS to deal with the centrals.
Kind of an over simplification I suppose but that's essentially what we end up with.

I found that the settings needed to deal with my obstructives on my 960 were pretty much what I used on my 760. I had hoped that I could use a little lower EPAP on the 960 but I ended up needing min 10 EPAP just like I did on the 760.

[Hornnumb2]

Sorry on the images, I was clicking on the wrong link box. They should be fixed now. If I bump the epap min up I don't need to mess with the PS right? Leave epap max at 11?

[Pugsy]

I would also increase EPAP maximum...the machine won't go up unless it thinks it has a good reason to.
That's the way auto adjusting works...just because it can go somewhere doesn't mean it will go there.

And yes...I would leave PS alone.

I would increase max EPAP from 11 to 16...give it some room to roam if it needs to. It may not go anywhere near where it can go.

So increase minimum EPAP to 9 or even 10
and increase maximum EPAP to 16
leave everything else the same.

[Hornnumb2]

todays results

[Sleeprider]

Looks much better. What settings does this represent (we can't rely on what Sleepyhead reports). You're getting pretty close, and probably no changes for a while however the presence of VS still suggest some obstruction.

[Hornnumb2]

epap min 9
epap max 16

[Sleeprider]

Thanks for the settings. I only see one break in therapy, leaks are good and you appear to have better ventilation and fewer events. So, how do you feel at this point (besides less wealthy)?

[Pugsy]

How would you rate your sleep quality from last night?
It's not all about the numbers.....how you slept and feel has to be taken into account.

Probably should keep these settings for a few nights to see if they hold consistently or not.
May need to increase that EPAP minimum to 10 but need to see a few nights at these settings first.
You are getting close and while last night's report is "acceptable"...with the snores and still perhaps a few more hyponeas than we would really like to see...if subsequent night's at these settings don't improve, a little more EPAP might just be the trick.

[Hornnumb2]

Down to one break instead of 3 or 4, wife says she doesn't hear a peep from me so must be on the right track. I have noticed any difference in feeling but obviously its working to only get up once during the night. We give it through the weekend at the pressure and see what it does. Thanks for everybody's help. Michael

[Hornnumb2]

Last 2 days have jumped up. Should I bump it up again?