What does this tell me?

[kcellwood]

Ok another night with high a AHI number. I seem to be trending is the wrong direction. Been on CPAP for one week. 100% compliant at 7 hrs per night. I tried the APAP mode last with with my min and max pressures both set to 8 so to get FL flags. Here are the results. I do not know what this is telling me. I could not get a FL graph even though I have checked the box so not sure if one should be generated.

I know I was awake briefly about the time of the CA cluster around 3:30 AM. Felt like I slept well and was surprised to see the AHI number. I felt pretty good when I got up. Much better than pre-CPAP.

On a side note: Wife states she is sleeping much better now. So as most know, that is another important benifit of using CPAP.

[Pugsy]

The PR S1 machine doesn't do FL graphs like the ResMed S9 machine does.
The PR S1 machine flags FLs as individual events shown on the events graph with all the other hyponeas, OAs, RERAs, CAs and snores. So you won't have a FL graph all by itself.

The stuff that gets flagged while we are awake...we have to mentally remove from the evaluation process because awake stuff don't count.

The hyponeas (which are the most numerous)....I think that the 8 cm pressure is simply not quite optimal.
Not sure how much is going to be needed but most likely not a huge amount above 8 cm.
You are most likely going to need to let the machine do what it is designed to do in apap mode ...increase the pressure or use a fixed pressure that is higher.

[kcellwood]

So if I wanted to do some tweaking to see how it affects the results would a min of 8 and max of 10 be a good place to start?

[Pugsy]

yep....that would be a good place to start IMHO.
I am not 100% certain as to the 8 cm minimum being ideal but have to start somewhere and that's as good as any.

[robysue]

As pugsy said: We have to mentally throw out any long periods of time when you were using the machine while awake (or even lightly dozing off and on between chunks of wake).

There seem to be two really bad nasty clusters of events:

1) The cluster of hypopneas that starts at about 22:45 and runs until about 23:30.

2) The cluster of CAs that starts at about 3:30 and runs until about 4:00.

There are smaller clusters of events as well, but these two are the biggies---both in terms of number of events and the length the cluster lasts.

So the question is: Were you excessively restless during either of these time periods?

The hypopnea cluster that starts at 22:45 has the right timing to be a possible REM-related cluster since it starts about 90 minutes after you turn the machine on. So there's also a good chance that that cluster might be REM or perhaps supine REM sleep.

What to do? Seems like your plan to go back to APAP, but with a very narrow range is reasonable. 8-10cm is a reasonable starting place, but you need to leave it there for several days rather than switching the pressure settings every night or so. If you continue to get the kind of clusters that we're seeing here over several nights of data, then it may become necessary to bump the min pressure up a bit. If the centrals persist and you think you are asleep when they're occurring, then a trip back to the doc may be needed.

[igdoc]

Sorry posted a reply on your CFLEX setting topic. Same applies to the AFLEX which can potentially increase the central apneas and hypopneas. Try reducing the setting and see if your AHI comes down. Hope this helps.

[penuel]

IMO, until you clear the issue of the hi central apneas and hypopneas you should avoid the APAP mode. This is per the guidelines of the The American Board of Sleep Medicine (ABSM), that APAP is contraindicated if someone suffers from Central Sleep Apnea syndrome, COPD, etc. get your Doc involved!