Getting AHI lower

[Pugsy]

Mask fit test should blow at the higher pressure and not minimal.
The UAs...that's because the leaks are SOOOOOO bad the machine couldn't decide what to call the event it sensed was happening.
You essentially had really bad large leaks the entire time.
Something wasn't sealed or attached or fitted correctly to get large leaks this massive.

Do you by chance have facial hair?

[mgundy]

I do have facial hair. Beard is about 1/2" long. What changed for the last chart was I tried a mask liner. I took it off and ran a few minute test and checked it out in OSCAR.

But are the leaks really that bad? It was showing large leaks at around 27 L/min. See 4:40 - 4:50. When I look at the manual the leak rate at a pressure of 22 is around 50 L/min. Or is OSCAR reporting leak rate differently? When using the same mask with the DreamStation at the same leak rate (~30) DreamStation/OSCAR was not reporting a large leak.

screenshot-20200216-160616.png (880.47 KiB) Viewed 7907 times

[Pugsy]

If you see the UA flag.....the leaks are bad enough to impact the machine sensing, reporting, recording and response.

I don't normally get worried until I see stuff over 35 L/min for a prolonged time. From my own personal experience that is when I would start seeing UA flags. Short lived excursions over 35 L/min probably not a big deal but prolonged means your therapy could be impaired.

You can't compare a Respironics reported leak to a ResMed reported leak because they report the leak totally different.
Respironics is total leak which is the vent rate plus excess leak and the ResMed is excess leak only.

[mgundy]

Gotcha, very helpful!

I turned on the mask leak alert feature so at least I know tonight if I'm wasting my time. If all goes well I'll turn it back off.

[mgundy]

Figured out what was causing the mask leak. It was the chin strap I was using to keep my mouth closed. I have to put that on after I put my mask on. So you see the leaks went away after I figured that out. I lowered my min EPAP to 16.8 for the first night just to get used to it and figure out what was going on with my mask (it's hard to hear the leaks at the higher pressure). I'm a *little* concerned the the pressure on this machine maxed out once during the night. Oh well...

I'm going to try and set the min EPAP to 17.6 tonight and see how it goes.

screenshot-20200217-102812.png (250.38 KiB) Viewed 7884 times

[Jas_williams]

Rather than a chin strap to keep your mouth closed have you considered a soft cervical collar this would prevent you chin being pushed back by the chinstrap causing a possible obstruction also it would help to prevent your chin tucking down to your chest and may reduce the overal pressure needs

[mgundy]

I did order a cervical collar. Should arrive tomorrow or the next day. I'll try that instead of the chin strap when I get it.

Thanks!

[mgundy]

From last night. I couldn't really get settled it seemed like. But eventually I fell asleep. I've noticed an uptick in CA's with this machine. Don't know if that's because the DreamStation detects them differently than the AirCurve. Before I was seeing a few a night, no more than 5 total. The most in one night with the DreamStation was 7.

Any thoughts? Or is this is what I can expect for the future? Cervical collar is arriving today. I'll try that tonight instead of the chinstrap.

screenshot-20200218-080609.png (858.34 KiB) Viewed 7853 times

[Pugsy]

More likely the centrals flagged that seem to be a little more than normal are a few false positive flagged events muddying up the evaluation.

Go here and watch the videos
http://freecpapadvice.com/sleepyhead-free-software

It's the first thing I think of when someone says that they "had trouble getting settled" or didn't sleep so soundly.
Awake/arousal breathing is very irregular when compared to asleep breathing and the machine will often flag those irregularities as some sort of event. I have seen false positives in all categories but especially in the central category.
It's normal to have a few centrals anyway and not a big deal but when we add in those arousal pauses when we toss and turn ...the numbers increase.

Arousal/awake related flagged events we have to ignore and work more on what is causing the poor sleep if we know what was going on.

[mgundy]

Thank you! I did watch them. I guess his comment about higher pressures can cause an increase in CAs struck me. I saw how he explained where a CA is falsely flagged. I saw one of my CAs look like that. I don't think the rest did. I've attached some of them zoomed in if anyone would like to verify if these are legitimate CAs or not.

screenshot-20200218-092142.png (850.31 KiB) Viewed 7850 times

screenshot-20200218-092226.png (849.91 KiB) Viewed 7850 times

screenshot-20200218-092240.png (850.63 KiB) Viewed 7850 times

[mgundy]

screenshot-20200218-092007.png (846.94 KiB) Viewed 7850 times

screenshot-20200218-092132.png (862.9 KiB) Viewed 7850 times

[Pugsy]

Those pretty much all look like false positive flags to me. If I look at the flow rate (breathing) before the flag it doesn't look like asleep breathing to me.

Higher pressures can cause centrals in SOME people but not all people and it's actually not very common.
Most of the people who get centrals from cpap pressures will get them at any pressure and not just higher pressures.

If your centrals were related to pressure we would see a LOT more of them all through the night.

Now remember an occasional real asleep central is normal and not anything to worry about.
We can have sleep onset centrals where we are transitioning to sleep and that's normal. It's normal to wake up after each REM stage and with each wake up we have another transition back to sleep and thus another chance of having another sleep onset central that is entirely normal and not unexpected.

I had a night last week where my AHI was nearly 4.0. Unusually high for me...about half central and the other half OAs and hyponeas.
All the centrals were false positives and about 90% of the OAs and hyponeas were false positives. I just had a crappy night's sleep.
My AHI runs between 1 and 2 and 80% of the events are false positives. I do a lot of tossing and turning due to the back issues and I remember waking up always at least a dozen times. I just don't sleep so great because of pain issues.
On a rare occasion I get an AHI below 0.5....and that means that I slept rather soundly for the most part. A good night for me....maybe only a handful of remembered wake ups.

You might also take some time and evaluate the OAs and hyponeas....you can have false positive flagging with them as well.
What often happens is a real OA causes an arousal and then some false positive arousal related flagging follows close by.

To ease your mind about using the higher pressures and centrals popping up. You aren't having nearly enough centrals for us to worry about that. Even if every central you are seeing as the real deal you aren't having enough of them. You would need at least 5 per hour all night long every night for us to worry.

[mgundy]

I wore the cervical collar last night. Much more comfortable. When I woke up I knew I got a good night's sleep. First night with my AHI below 5! Thank you! Thank you! Thank you!

Any thoughts on going forward a couple of nights? I think I'll just keep it as is to get a good baseline.

screenshot-20200219-072640.png (851.52 KiB) Viewed 7830 times

[Pugsy]

Looking good.

Keep these settings for a week. Some of those centrals are right at known awake times and I am reasonably certain they aren't real.

[zonker]

I wore the cervical collar last night. Much more comfortable. When I woke up I knew I got a good night's sleep. First night with my AHI below 5! Thank you! Thank you! Thank you!

Any thoughts on going forward a couple of nights? I think I'll just keep it as is to get a good baseline.


screenshot-20200219-072640.png

looks like you are down to centrals, which is good. because i'm with pugsy; those might be either fake centrals or something that will go away over time.

stick with it!