Need Help with tuning machine for better therapy charts incl

[bigjig1]

I believe I have it figured out now click on graph to enlarge. It looks like I need to make changes and my resp rate seems high
any suggestions would be great!

[TASmart]

I would try lowering your max pressure to 13 or so. It looks to me like at higher pressure you have all kinds of stuff going on, none of it good. In my titration study they noted that at higher pressures I got increases in both OA and CA and so I have a cap of 12 on my pressures.

[Pugsy]

I would try lowering your max pressure to 13 or so. It looks to me like at higher pressure you have all kinds of stuff going on, none of it good. In my titration study they noted that at higher pressures I got increases in both OA and CA and so I have a cap of 12 on my pressures.

Bad advice in this person's situation.
This person isn't having any CAs/Centrals....and the machine wants to go higher to better deal with the OAs and Hyponeas but it can't. Only way to deal with the OAs and hyponeas...more maximum so the machine can better hold the airway open.
Now if the bulk of the AHI was central...then yeah we would lower the pressure but not everyone who uses higher pressures will have a problem with centrals.
Don't assume that because you do that most people will...in fact most people don't. Last statistic I read was that only about 10 to 15% of the people who start cpap will have problems with cpap pressures causing centrals.

It looks like I need to make changes and my resp rate seems high

You need to increase the max to 20 and see what the machine does...you may need to increase the minimum also but I would want to see what happens with the max set to 20 before I would change the minimum.
Your respiration rate is fine. About normal in fact.
95% numbers...mean that you were at OR BELOW that number for 95% of the time. People often don't know about or forget the "or below" part of the definition.
The max of 50...disregard because we don't know how long or what may have caused it or even if it is all that accurate.
Maybe a bad dream pulse spike or something.
Might also have been the ugly cluster of OAs causing you to speed up your respiration in an effort to get more air moving.

Fix what is known to need fixing and then see what the respiration rate does once the clusters are broken up.

[TASmart]

You may well be correct Pugsy. My thinking is that the mess of OA/HO?? do not start until after the pressure is ramped up to it's maximum. In my case, I get more CA/OA and HO at higher pressures, or so says my titration report. At any case, the OP can certainly put the Pmax at its highest and look at the charts and see what is happening. At most they may lose some sleep over it.

[palerider]

I believe I have it figured out now click on graph to enlarge.

you completely ignored this page: https://sleep.tnet.com/resources/sleepyhead/shorganize
please review it.

the posting on imgur, you got right, reviewing the first page, and arranging things properly, means you'll only need to post one screenshot per day.

[palerider]

In my case, I get more CA/OA and HO at higher pressures, or so says my titration report..

I'd like to see a titration report showing more obstructives and hypopneas at higher pressure, I'm not saying that's impossible, just the opposite of the norm.

as usual, pugsy is correct, most people don't have pressure induced centrals, and it looks like the OP is rolling on his back and needing much more pressure, and without examining the breath trace, you can't assume the centrals are pressure induced, they may be because of the severely disturbed sleep caused by the obstructives.

[TASmart]

I post the clip but I cannot seem to add a pic to my post! Anyway what it said was "pressure above 12 or below 8 induced hypopnea"

And indeed the one night I used the auto feature I got loads of hypos at the higher pressures.

[LSAT]

I post the clip but I cannot seem to add a pic to my post! Anyway what it said was "pressure above 12 or below 8 induced hypopnea"

And indeed the one night I used the auto feature I got loads of hypos at the higher pressures.

Bad information...Hypopneas usually need higher min and max. Find the clip and learn how to post it.

[TASmart]

I post the clip but I cannot seem to add a pic to my post! Anyway what it said was "pressure above 12 or below 8 induced hypopnea"

And indeed the one night I used the auto feature I got loads of hypos at the higher pressures.

Bad information...Hypopneas usually need higher min and max. Find the clip and learn how to post it.

If you believe it's bad information then posting it makes no difference. I posted a direct quote. As for it being bad information, may be, but at this time I will take the opinion of a board certified sleep doctor over an unknown internet voice pretty much every time.

http://i.imgur.com/Pg3V7Nl.png

[palerider]

I will take the opinion of a board certified sleep doctor over an unknown internet voice pretty much every time.

then why are you here?

let's see the rest of the data. also, you're ... fooling yourself if you think a sleep study is the end all/be all of information.

they may be "The GOLD Standard", but they are, in many ways, woefully inadequate if you think about it.

you're in an artificial environment, all wired up and less comfortable than normal.it's *one night* and likely only part of that night. reading any titration report, you'll see that "oh, your good pressure was 12cm, you slept for 45 minutes at that pressure!"

it's a simple fact that sleep varies from night to night, you'll have better and worse days with the same exact settings. yet the "gold standard" is a small number of minutes tested on one night.... a brief photograph taken during the marathon run that is your sleep.

it's not surprising that sleep studies are somethings quite wrong, what's surprising is that they're ever right!

[TASmart]

Because there are many things that I do not nor have not discussed with the Dr. And I do learn a lot here. Why are you here?

[palerider]

Because there are many things that I do not nor have not discussed with the Dr. And I do learn a lot here. Why are you here?

because the " board certified sleep doctor"s fail so many people.

you say 'you learn a lot' but then when someone tells you what you're saying is wrong, you discount what you're saying you're here to learn...

[Okie bipap]

When it comes to fine tuning my therapy, I would rather take the advice of someone that has actually used a machine for several years than a medical professional that may know what the book says about treating sleep apnea but has never actually slept with either a cpap or bipap machine. Luckily, the first RT I worked with had sleep apnea as did her husband. She offered a lot of good information that is not in the books.

[TASmart]

Because there are many things that I do not nor have not discussed with the Dr. And I do learn a lot here. Why are you here?

because the " board certified sleep doctor"s fail so many people.

you say 'you learn a lot' but then when someone tells you what you're saying is wrong, you discount what you're saying you're here to learn...

Interesting. You are making a claim that you are more qualified than a board certified sleep physician. Interesting. As far as someone telling me I am wrong, what would you do? On one hand I have a Physician who is board certified in sleep medicine, and on the other had the statement made by someone who at least know to me has no verification of their credentials. On first pass who do you believe?

Then again, Maybe the brain trust here could explain why the OP's data shows increased breathing disruptions at higher pressures? After all, it's not about what I think or don't, not about anything except what the OP's issues are. I, based on demonstrated expert's advice, and limited experience of my own, suggested a possibility. You on the other hand, have mostly just snarked at me for being wrong, without offering either a solution nor shred of evidence to solve the OP issues. That's really helpful, maybe even as much as one of those failing board certified sleep Dr's you disparage.

Note to Pugsly - in no way is tis directed to you. After reading many many many threads here, I recognize your knowledge and helpfulness. Please not I did not say you were wrong in your assessment of my advice, only explained the basis for my thoughts.

[Guest]

THANKS for the reply s I'll crank it up tonight and post a few day data