Help interprete sleep study results

Pugsy wrote:Leaks are going to be a challenge with any mask at those pressures.
I assume you have discussed liners and different masks, etc?
Facial hair by chance?
Any chance at all he could get by with a nasal mask of some sort or is his nose so congested there's no way?

He tried P10 and really liked them as it helped keep the nose open and didn't leak but he had problems with mouth leaking.
No facial hair. His FFM leaking isn't bad but it does hit him in the eyes.

So this is data using fixed pressure of 13 as prescribed. This is the longest he was able to keep the mask on. Most nights were only 1-1.5 hrs.

After a few weeks of open failure, I had him change to APAP.

Then changed the minimum to 15.

Then changed lower limit to 16

Because of the large variability still seen at 16, I raised the pressure to 17

How bad were the mouth leaks with the P10?
Did they wake him often?

What are his issues at the present time?
Leaks that wake him often? These reports aren't showing bad leaks in terms of large leaks.
Waking often for unknown reason?

Pugsy wrote:How bad were the mouth leaks with the P10?
Did they wake him often?

What are his issues at the present time?
Leaks that wake him often? These reports aren't showing bad leaks in terms of large leaks.
Waking often for unknown reason?

You ask such simple questions but unfortunately I don't have great answers.
He is not very methodical. His sleep hygiene is still bad so he will skip the mask a few nights a week. Even at the latest settings where he is getting good results, he missed the other night.

I have access to his data as he shares a copy of his SD card in a shared folder. But exactly what was happening every night is hard know. I don't know for sure what nights he was trying pillows but I don't think I posted those nights as they were short periods. I think mouth leaking was waking him up so he stopped therapy for the night.

Currently his issue is still compliance and small leaking from the FFM into his eyes. I think the medium cushion will help that.

At some point I hope to have him go back and try pillows again with chin straps.

OK I am done trying to organize and present all the relevant data.

So since we home study sleep data, split night laboratory sleep data, and a fair amount of sleepyhead data, I am trying to square the circle.

Regarding data analysis, at all the pressures there were no significant amount of flow limitations. My understanding is that they are important in the auto algorithm - that is why I kept raising the minimum pressure.

It is also interesting to see the large number of Clear Away events in the some of the charts yet his home study showed very low CA and the split study showed some.

I don't think I would worry much about the CAs at this time. With his history with leaks and wake ups and taking the mask off I am betting a good chunk of any flagged CAs are SWJ. If they were related to pressure and real as in the breathing imbalance I think you would see a lot more of them instead of nights with a nice low/decent enough AHI. Also remember that even an occasional central that is "real" isn't that big of a deal...like sleep onset centrals and if he is having many wake ups from the leaks during the night (or whatever) then that increases the chance of more sleep onsets which then increases the chance for sleep onset centrals.

Sounds like he is still having "finding the right mask or right size mask" issue and you have to succeed there to really be able to effectively deal with the other other issues. Mask liner...different mask...yada, yada, yada. You know the routine.
His reports with min of 17 look decent enough on paper but if he is still having wake up issues or whatever reason then it's going to be difficult to really dial in the settings until he is really sleeping more decently.

Are you comfortable with zooming in on flow rate to try to figure out asleep vs arousal breathing and flagging? Sometimes its fairly easy to spot but sometimes it isn't. Even now I will have times were I sit here scratching my head wondering what is going on.

Pugsy wrote:I don't think I would worry much about the CAs at this time. With his history with leaks and wake ups and taking the mask off I am betting a good chunk of any flagged CAs are SWJ. If they were related to pressure and real as in the breathing imbalance I think you would see a lot more of them instead of nights with a nice low/decent enough AHI. Also remember that even an occasional central that is "real" isn't that big of a deal...like sleep onset centrals and if he is having many wake ups from the leaks during the night (or whatever) then that increases the chance of more sleep onsets which then increases the chance for sleep onset centrals.

Sounds like he is still having "finding the right mask or right size mask" issue and you have to succeed there to really be able to effectively deal with the other other issues. Mask liner...different mask...yada, yada, yada. You know the routine.
His reports with min of 17 look decent enough on paper but if he is still having wake up issues or whatever reason then it's going to be difficult to really dial in the settings until he is really sleeping more decently.

Are you comfortable with zooming in on flow rate to try to figure out asleep vs arousal breathing and flagging? Sometimes its fairly easy to spot but sometimes it isn't. Even now I will have times were I sit here scratching my head wondering what is going on.

Agree. I think as long as you are struggling with the mask, the events (count and type) can be really misleading. I have done a lot of zooming in. At the lower pressure it convinced my that the OA and H were real so I upped the pressure. If there are some events you would like me to zoom and post, please let me know.
Most of the CA looked like arousals to me so I dismissed them.
Is it unusual to see OA and H without any FL?

TedVPAP wrote:Is it unusual to see OA and H without any FL?

Maybe a bit unusual but not impossible.
I have heard (and seen a few examples) of it happening with people who don't seem to be having much in the way of snores or FLs to drive the pressure up but the airway collapses rather quickly and the OAs/hyponeas will happen without the normal precursors. It is probably why auto mode doesn't work out so great for some people unless that do like what you have done...set the minimum higher than what the machine wants to be using and then it won't move around much because it wasn't wanting to move around much in the first place. They end up using pretty much a very minimally varying auto range quite similar to a fixed pressure.