Need Help with Better Sleep and Pressure Sets

[palerider]

all I see are fish fin action and otherwise it's just flat pressure line all through the night.

The more fish fins, the better the machine thinks your sleep is.

[ajack]

I have this type of pillow and could use it if that would help.

https://www.amazon.com/Wonwo-Sleepers-C ... way&sr=8-6

Try that pillow and see. Think CPR with your head back to open the airway. A pillow that supports the neck is on the right path. These were at the start of sleep and a 90min sleep cycle, REM normally happens at the end.

[apap_user]

Thanks for all these replies, I am going to go through them in a few minutes after my morning shower. I have attached the data from last night's sleep with settings of 11min - 20 max.
Aside from a period where the mask probably fell off my face between 12am and 1:30 pm, the rest of the night was quite good I think. I think the straps were a bit loose and may have cause the mask to pop off my face during that time, so I will need to tighten that up to be more snug.

Thank you.

[apap_user]

dreamstation machines, don't raise the pressure, if the timing of the events are not what the algorithm is using. You can get events that the machine doesn't respond it. I would follow basic procedure and raise the min pressure 1cm at a time, till the events subside
http://c398534.r34.cf1.rackcdn.com/DOCU ... Canada.pdf

Hello ajack, the titration pdf you linked is a great reference, thank you for providing it. I just read through it for the cpap titration and noticed the recommendation to reduce pressure by 1cm if central apneas persist. I was getting a few CA events a night at a max pressure of 14.0. By recommendation from raisedfist I did increase the setting for max pressure to 20 last night and had no CA events so that's a positive. But correct me if I'm wrong, doesn't that go against the titration guideline to reduce pressure by 1 and observe? I do understand raisedfist's reason for suggesting I raise the max pressure, since I was hitting the 14.0 max or approaching it in several instances.

[apap_user]

all I see are fish fin action and otherwise it's just flat pressure line all through the night.

The more fish fins, the better the machine thinks your sleep is.

Wouldn't that suggest that the pressures as is are okay, or would that just indicate that I'm getting good sleep on certain nights.

[palerider]

all I see are fish fin action and otherwise it's just flat pressure line all through the night.

The more fish fins, the better the machine thinks your sleep is.

Wouldn't that suggest that the pressures as is are okay, or would that just indicate that I'm getting good sleep on certain nights.

If your sleep is disturbed (on a respironics) it'll just sit there and do nothing. If your sleep is smooth and even, it starts shark finning.

So, your sleep could be better. try raising the pressure and seeing if you get more sharkfins.

[apap_user]

Hi Palerider, can you please explain what you mean when you say if the sleep is disturbed it will sit there and do nothing. I understand the part about smooth sleep and sharkfins. Thank you.

[palerider]

Hi Palerider, can you please explain what you mean when you say if the sleep is disturbed it will sit there and do nothing. I understand the part about smooth sleep and sharkfins. Thank you.

If you zoom in on the flow rate, you'll see that when there's a shark fin, your flow rate most likely is very smooth and even, and when there aren't any sharkfins, your flow rate will (at least this is what typically is shown) will be less even and smooth...

Basically, when a little more pressure might help, the machine does nothing... when things are very smooth and even... it gets restless and starts fiddling with the pressure.

[apap_user]

Hi Palerider, can you please explain what you mean when you say if the sleep is disturbed it will sit there and do nothing. I understand the part about smooth sleep and sharkfins. Thank you.

If you zoom in on the flow rate, you'll see that when there's a shark fin, your flow rate most likely is very smooth and even, and when there aren't any sharkfins, your flow rate will (at least this is what typically is shown) will be less even and smooth...

Basically, when a little more pressure might help, the machine does nothing... when things are very smooth and even... it gets restless and starts fiddling with the pressure.

Oh, okay, I got it thank you for explaining.
With that being the case, how would it activate the need for an increase in pressure if the sleep isn't smooth, and yet it does nothing? I was assuming it would anticipate the need for a pressure increase with respect to the resistance of one's airway, and if the airway appears to be obstructed (full/partial) it should increase pressure to open it up, prior to an OA or HA event occuring. I've read somewhere that when it senses two events happening within a short time interval of each other it would increase the pressure in response to that, but that is reactive rather than proactive. And that's still okay in those instances, because more pressure may be required to open up the airway.

Below is data from last night's sleep. The pressure plot appears to be much rougher than I've had in prior experience over the past year of using the machine. Do I need a pressure adjustment? I'm currently at 11min - 20 max.
Please help with your feedback.

Thank you.

[palerider]

With that being the case, how would it activate the need for an increase in pressure if the sleep isn't smooth, and yet it does nothing?
I was assuming it would anticipate the need for a pressure increase with respect to the resistance of one's airway, and if the airway appears to be obstructed (full/partial) it should increase pressure to open it up, prior to an OA or HA event occuring.

Well, that's pretty much how Resmed machines work, but if you look at pressure traces from Resmeds vs Respironics, you'll see that the resmeds are much more active, there's a lot more movement, whereas Respironics have long periods of flatlines... basically, the Respironics are much less responsive to your needs.
https://www.youtube.com/watch?v=lzCCgNLya_g

I've read somewhere that when it senses two events happening within a short time interval of each other it would increase the pressure in response to that, but that is reactive rather than proactive. And that's still okay in those instances, because more pressure may be required to open up the airway.

It *should* increase pressure in response to snores and flow limitations... but it doesn't seem to do so very well, and all machines are reactive as far as apneas.. they increase pressure after the apneas.

Below is data from last night's sleep. The pressure plot appears to be much rougher than I've had in prior experience over the past year of using the machine. Do I need a pressure adjustment? I'm currently at 11min - 20 max.
Please help with your feedback.

I'd leave it for another couple nights and see.. except at the very start of therapy, I don't recommend making changes based on one night, since sleep varies from night to night.

[apap_user]

Thank you, I'll collect a few more data points at this setpoint.
Usually at the start of sleep in some cases it may take me a good 10-15 minutes to fall asleep, so some of the earlier recorded apneas might be the machine's response to my breathing while still awake with the mask on.

[zonker]

Thank you, I'll collect a few more data points at this setpoint.
Usually at the start of sleep in some cases it may take me a good 10-15 minutes to fall asleep, so some of the earlier recorded apneas might be the machine's response to my breathing while still awake with the mask on.

that's a very good observation. it's what's called here Sleep/Wake Junk or SWJ. it seems to happen mostly when we are new to using cpap, though it can still crop up from time to time.

[apap_user]

Last night's report is below. Much better I think. I had to reduce the pressure back to 10.5, just to see if the cluster of OAs I was getting at 11 would go away and it seemed to be better , at least according to the chart.

[palerider]

Last night's report is below. Much better I think. I had to reduce the pressure back to 10.5, just to see if the cluster of OAs I was getting at 11 would go away and it seemed to be better , at least according to the chart.

*sigh* a change of 0.5 is negligible, it's better because you had a better night.

But, if you want to keep twiddling with the pressure every night.. that certainly is your right.

[zonker]

Last night's report is below. Much better I think. I had to reduce the pressure back to 10.5, just to see if the cluster of OAs I was getting at 11 would go away and it seemed to be better , at least according to the chart.

leave it as it is set now for 3 nights. then post the charts for those 3 nights.

what you want to look for here are trends. one night of data doesn't mean much because we don't sleep the same way each night.

give your poor tired brain some time to settle in and become accustomed to the pressure changes. this may take some time to see just what the trend is and where your therapy needs to go.

good luck!