Help me tune my BiLevel- new graph

several days on the new machine now, comfort level pretty good, but the waveforms look ugly



Only one OA all the rest are CA's and what looks to me like PB for a significant % of the time. Before I switched from APAP I could look at the plot and tell what kind of a night I had-PB around 20% was good, 30%'s decent, 80% not good at all.

Settings
IPAP max 15
min EPAP 5.8
PS 4.4
TiMax 2
TiMin 0.3
trigger/cycle med

CA's 48
Hypopnea 3
OA's 4
UF1 6
UF2 17

UF's set to SH default, 8 seconds

No idea what to change or to what setting

Redo the image and lose all those graphs below leak (which seems to be absent right now).
Those graphs on the right side...these 4 only and large enough to evaluate. Right now the Events graph which is real important is so tiny it's almost useless.
Events
FLow rate
Pressure
Leak

new graph above

https://www.dropbox.com/s/0p2nx0r9o9pl1 ... 5.zip?dl=0
SD card files from just the new machine

here is my sleep study results

SLEEP SCORING DATA:
Lights Out / On (clock times): 21:31:20 / 07:00:51
Total Recording Time (TRT) (min): 570.5
Total Sleep Time (TST) (min): 178.0
Sleep Efficiency: 31.3%
Sleep Latency (min): 5.5
Stage REM Latency (min): 507.0
Wake after sleep onset (WASO) (min): 386.0

Stage N1 Sleep (min, % of TST): 44.5 (25.0%)
Stage N2 Sleep (min, % of TST): 50.0 (28.1%)
Stage N3 Sleep (min, % of TST): 61.0 (34.3%)
Stage R Sleep (min, % of TST): 22.5 (12.6%)
Supine Sleep (min): 43.5
Arousals (index, #): 85.3 (253)

RESPIRATORY ANALYSIS: (index = #/hr)
Apnea/Hypopnea Index (AHI): 40.1
NREM AHI: 45.9
REM AHI: 0.0
Non-Supine AHI: 26.3
Supine AHI: 82.8

Respiratory Disturbance Index (RDI): 40.4
NREM RDI: 46.3
REM RDI: 0.0

Apneas (index, #): 9.1 (27)
Obstructive Apneas (index, #): 1.0 (3)
Mixed Apneas (index, #): 0.0 (0)
Central Apneas (index, #): 8.1 (24)
Hypopneas (index, #): 31.0 (92)
RERAs (index, #): 0.3 (1)

Mean Awake SpO2: 95%
Mean Sleep SpO2: 93%
Minimum Sleep SpO2: 87%
Sleep Time with SpO2 < 88% (min, % of TST): 0.2 (0.1%)

any insight?

Turn off the UF flagging stuff. That's not a Sleepyhead default setting. It's cluttering up things and really unless something is 10 seconds in duration the medical community won't get all worried about it.

While you think that the breathing looks PBish...I can't tell with the existing flow rate image. You are still zoomed way too far out. Need to essentially be at the breath by breath level.
Go to the events graph where there is a fairly dense cluster of CA (centrals) and click on a single event with centrals on either side of it...then your flow rate will be zoomed in at the level we need for better evaluation as to whether or not it looks PBish. The machine doesn't think it looks CSRis or it would have flagged it as such and unless it is CSRish we don't worry as much.

Also...for half the night the report looks really good...which makes me wonder what changed between the first half of the night and the second half. Makes me wonder if a lot of what you see in terms of Centrals are asleep breathing or awake/semi awake breathing and if it's the latter it may very well be insignificant.
I would be more concerned if what we see the second half was seen all night long.

PB itself isn't necessarily bad. We do get concerned with a lot of CSR Cheyne Stokes Respiraton but your machine didn't flag it as such and there must be a reason why it didn't.

At this point....if it really bugs you...notify your doctor.
If the centrals are indeed real and all this stuff is really CSR...doc needs to be aware of it.
If maybe these centrals are simply a response to the new pressure therapy (sometimes bilevel itself just triggers centrals) it's possible that they will reduce with time.
I just really wonder why the change from such a really good first half of the night to a not so pretty second half of the night....because something changed but I just don't know what.

When you have time post the really zoomed in on centrals that I mentioned above. Let's see just how really PBish it might be. Impossible to tell at this level that you show above.

This is a shot from last night, pretty bad sleep as things go
Last night was my first bad night with BiPAP, out of bed 5 times
CA 62
Hypo 3
OA 11

this is the zoomed in capture from 9-6-15


This is an example of what looks to me like PB from APAP machine

You still didn't quite zoom in close enough. I can tell because I am seeing too much time on the graphs.
This is what CSR looks like and the level of zooming in.

It's the real up close zoom in that sometimes tells us if we are maybe seeing arousal breaths...and that's a big maybe. I am not good at that level under the microscope...we need Morbius and he hasn't been around lately. I think all the recent crap threads has affected his willingness to help out and he's the only one that I know of with the expertise to be able to evaluate the minute tiny changes in flow that might help us figure out if this PBish stuff is real PB or just SWJ PB.

But you are correct it sure at least looks PBish even if the machine doesn't think it is CSRish.
I would be contacting the doctor about these results.

It bothers me that parts of the night are really good and parts aren't...so something has changed...could it be sleep position? I don't know but if you see this pattern every night and you know with absolute certainty that you were soundly asleep during the second half of the night when the ugly happens...the doctor needs to be made awake of it.

I don't know of any tweaking to fix it because I don't know what is causing it and I sure don't want to maybe make it worse.
Now if you didn't have a doctor that you were already in a close and recent relationship that would be one thing but you have a doctor who seems to listen to you (or you wouldn't have this bilevel machine) so I am hesitant to offering any Dialawingin playing with the settings. I don't think it is appropriate for me to just blindly guess and that's all it would be because I don't know why things are changing the second half of the night. That bugs the crap out of me because it isn't logical to have such a difference ...so something changed but I don't know what it is that changed.
To be able to fix a problem we first have to understand or have some remote idea what the problem is.
You are on fixed pressures...so can't blame variations in pressure.
I don't see blaming current pressures because the first half of the night they work fine.

Now I do know of one guy who gets the PBish (even some real CSR) stuff in the second half of the night but it's directly a result of medication that he is taking and the fact that it is starting wear off later in the night....very special circumstances that took quite a bit of detective work on his and his doctor's part to get it all sorted out.
Since there is a known cause...they choose to ignore it but they did evaluate it thoroughly before coming to that conclusion.