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[SherriT]

Update. Last night I raised the epap to 19. My 90% IPAP went up to 21.5. My AHI was still 7.9. 36 clear, 12 obstructive and 20 hypopneas. Slept 8.5 hours but had a couple of awakenings.

[Pugsy]

Roughly half centrals/clear airways and half obstructive.
More pressure is unlikely to help the centrals.
For right now if it were me I would live things alone and give it 3 or 4 more nights and hopefully in the next few days will get the software data available so we can have thoughts based on facts and not so much guessing. I still want to see when they got flagged...maybe you had periods where nothing much happened.

AHI 7.9 over 8.5 hours
ClearAirway/central index would be 4.2
OA plus hyponea index would be 3.7

[SherriT]

Hi Pugsy. My husband will tonight try and figure out how to retrieve and post my data. As an update though- last night I slept 8.5 hours and had an AHi of 5.7. Central 12, obstructive 26 and hypopneas 11. My 90% IPAP went up to 23.5!

[Pugsy]

Much better direction...good job. Let's see what the data looks like.
Did you sleep a little better with less wake ups last night?

[SherriT]

I slept pretty well. Took about an hour to fall asleep. I feel pretty good today.

[Pugsy]

It will be extremely interesting to see if much got flagged during that first hour when you weren't asleep.

[SherriT]

Hi Pugsy,

I got the data. There are three screen shots in this reply and the remaining two in the other, thanks!

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[SherriT]

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[Pugsy]

I am going to target Sun Mar 24 since that one I know when you say you were awake and you say you slept decently once you went to sleep and the pressure graphs support what you say. The reports with EPAP too low...just confirm it was too low.

I have one question for you....do you think you might have been on your back at any time during the night especially maybe 03:30 to 04:30 last night??
Last night was really a decent enough night (especially compared to the others with lower EPAP) except for that one rather ugly hour between 3:30 and 4:30.

What is your ramp time set for? Okay, that's 2 questions.

[SherriT]

I never sleep on my back so I doubt it. My ramp time is 40 minutes I think. It starts at 8.

[Pugsy]

Okay....the one hour is a little bit long for REM stage sleep which might also explain what happened around 3:30 to 4:30...it's either REM or being on your back.

Let's see what happens tonight and maybe tomorrow night....assuming you sleep halfway decently.

Maybe consider another increase in minimum EPAP but this time just a 0.5 cm increase.

[SherriT]

Sounds good. Should I be concerned about the number of centrals? I will put up more data in 2 nights. You’ve been so helpful. Thank you.

[Pugsy]

We can't do anything about the centrals at this point with this machine anyway...so while I keep one eye on them I don't worry a whole lot about them right now.
Some of them may be related to the OAs/hyponeas causing an arousal and if we reduce the chances for arousals then maybe the centrals will also reduce.

Right now my thoughts are target what we can fix with your machine those OAs and hyponeas and once those get reduced AND you are sleeping decently...then we look at the centrals and see if they are present in numbers that are a concern.
Last night....not nearly enough to worry about them even if every single one was the real deal.

When you have nights where you don't sleep well and you do a lot of tossing and turning there is an increased chance that you will have false positives flagged in all event categories and that really muddies up the evaluation process. The flagged event has to happen while asleep for it to matter....awake/semi awake flagged events simply don't matter and all they really tell us is you had crappy sleep from not sleeping soundly.

When you post a report always include how well you think you slept because it's very important to be able to factor in the chance of having very many false positives.
Typically when doing bilevel pressures it's EPAP for OAs and IPAP for hyponeas...not set in stone and more than one way to achieve a goal. There is some truth to the "give it time" thing also. Your body/brain simply has to get a chance to adjust and accept any new settings you come up with. I don't like to make changes based on just 1 or 2 nights unless there is an urgent need. With the new EPAP at minimum of 19....you are getting closer so we go up slower and take a little more time.

[SherriT]

Very bad night. I had insomnia and barely slept. I moved the Epap to 19.5 but for some reason the pressure was really bothering me and my ears felt pressured. I put it back to 19. Even though I barely slept my AHI was 10.4 with 28 clear, 35 OA and 28 Hypopneas.

[Pugsy]

I have no doubt that most likely the bulk of that AHI wasn't from real events but from tossing and turning and sighing and all that comes with insomnia.
When you have time have watch the videos here
http://freecpapadvice.com/sleepyhead-free-software