My Sleepyhead screenshots - help in interpreting, please?

[Anj6787]

I have had my new BiPAP machine for two weeks now. I have just downloaded the info into Sleepyhead and am posting my last two nights' screenshots.

My AHI was diagnosed as 83. The past two weeks on the machine the AHI has been all over the place, from a high of 34.10 to a low of 8.03.

Frankly, I don't have a clue what I'm looking at. Any help in interpretation and suggestions on pressure adjustments is appreciated!

[Pugsy]

How was it decided to use these settings?
Did you have an in lab attended sleep study using cpap to find the optimal pressure?

It appears that these pressure settings work well some parts of the night and not so great other parts of the night.
Makes us wonder what changed from working well to not working so great. Usually when we see this happen it's going to be either related to maybe being on one's back when things are obviously not optimal or in REM stage sleep.
Either can cause OSA to be worse and need more pressure to hold the airway open.

Essentially you need more pressure to better hold the airway open and prevent the airway collapses ...OAs, hyponeas, snores...all point to the airway collapsing and more pressure is needed.
The Pro model machine doesn't have the ability to flag Flow Limitations in the fixed bilevel mode so we don't know if your FLs would be higher but I am betting that if your machine would flag FLs you would have a lot of them.

You need more pressure. Too bad they didn't give you an machine that could auto adjust as needed because some parts of the night the pressure is fine but with your fixed only pressure machine you will have to use more pressure all night instead of just part of the night.

[Anj6787]

My doctor specified the settings. The pressure on my first brick machine was set at 19, and the dr acknowledged that wasn't working, so I wondered why he kept it the same on this new machine. But then what do I know about this stuff?

What would you recommend changing them to?

I usually fall asleep on my side, but wake up on my back, if that helps explain anything.

[Pugsy]

Well if 19 on a cpap machine didn't work so great then using 14 exhale and 19 inhale is unlikely to be better since there's a substantial drop during exhale.
You probably need more pressure when on your back than when on your side.

Can you go check the setup menu and see exactly what mode options you might have?
I know there is cpap mode available and the fixed bilevel mode you are now using....If you have an auto trial mode available I think it would be useful to try it and let the machine decide what it needs when you are on your back.

Do you know how to get to the clinical setup mode area to see the modes?

If no auto mode trial to try...if 19 isn't doing the job then you have to use more than 19 IPAP.

Maybe try EPAP at 18...IPAP at 22 and see what happens. or if you need the PS difference of 5...18 EPAP and 23 IPAP.

[Anj6787]

I just checked and there is no auto-trial mode. I will try 18 and 23 tonight and see how it goes. Update tomorrow.

Thank you for the input!

[Pugsy]

Yeah, I just found the manual for it and there is no auto trial mode available.

I wish they had given you the DreamStation BiPap Auto...it has that 3rd mode that is auto adjusting available.

Oh well...you wouldn't likely have much room for it to auto adjust anyway.

[palerider]

But then what do I know about this stuff?

I'd say the same could be asked about your doctor.

[Anj6787]

Agreed!!!! The whole experience with this doctor/sleep center/in-house DME setup has been so frustrating.

My mom has a doctor that she loves. He's in another town nearly an hour away, but I'm switching.

[Anj6787]

I wish they had given you the DreamStation BiPap Auto...it has that 3rd mode that is auto adjusting available.

I'd probably have to "fail" with this machine to get the auto.....like I had to "fail" with the brick to get this one.

[Pugsy]

The Auto will only go to max IPAP of 25...and you are likely going to come close to that anyway.
The main advantage would be that some of the night you probably could use the current 14 EPAP and PS of 5 (that difference between inhale and exhale) and IPAP of 19. It's working okay for part of the night...using auto adjusting would let you use the lower part of the night and only go up when needed. That's the theory anyway.

You might also see what you can do to stay off your back...but I know that is often easier said than done.
Those higher pressure needs might also be related to REM stage sleep and we can't do anything about REM. We need REM.
REM doesn't normally happen in such large chunks of time though and that's why I first suspect would be supine sleeping.
I have a lot of experience with REM making OSA worse...my OSA is 5 times worse in REM and documented as such on an in lab sleep study.