Can anyone help me understand these graphs?

Attached are two screenshots; one of a "normal" flow from between two Large Leak Blocks, the second is a series of events. What do these indicate? I have been on CPAP (APAP?) for 34 days and I am not finding much success. I still wake two or three times per night as far as I know. As to the graphs, only the first portion is valid. At 3:15 I took the nasal mask off (PR Wisp) (its new) and slept without it for a couple of hours, woke, put it on at a pressure of 6 if I remember correctly, but I was congested and 6 wasn't enough --I felt suffocated, so I turned the machine off so it would start again with a pressure of 6.5 with Optistart, whatever that is. But I wasn't falling asleep and I felt like I had to breath really deeply to get any air and it seemed like the machine was responding like "Oh, he's getting plenty of air, let's just wait and see" so I noticed that if I opened my mouth I could breath, so I pulled off the mask, turned it upside down and placed it over my mouth. I started breathing really easily through my mouth with the 6cm pressure, and found that I could exhale through my nose, but not inhale. I fell asleep doing that, but I feel pretty crummy this morning.

Thanks for any help!

read the first post in the annoucements, it explains a lot about sleepyhead.

you probably need a higher starting pressure too.

Can you provide an image without being zoomed in on something so we can see the entire flow rate and pressure graph along with leak graph?
Turn off the AHI graph (preferences/graphs tab ...remove check mark) as it is isn't needed. Don't need the snore graph either because we have snores showing in the events graph.

Using the ramp? The statistics are showing 5 cm minimum but that could be from the ramp use.
Looks like the minimum pressure isn't enough but you also have some big leaks going on.
You need to be able to breathe in and out through your nose and keep your mouth shut.

Thanks Pugsy!

(With my sleepy brain, It has taken me days to figure out how to use this forum)

Here is last nights data. From previous reading I decided to set the PR1 to CPAP at 88cm and the results are very enlightening. Notice the amplitude of the data after the bathroom trip are half the former section. I woke with nose completely stopped up with leak air blowing in my eyes and I'm thinking from that amplitude that the nose wasn't working too well the whole 55 minutes. I feel horrible this morning. I'm going to try to prop up my mattress with a plywood sheet today. Maybe elevation will help. My doctor suggested "The Virgin Diet" to try to eliminate the congestion. I am very excited to hear your comments. Thanks, -here's the graph. Oh, I was using my new Wisp Nasal Mask. The first part was with the XL nosepiece, which was leaking so I changed to the Large size (Which I had trimmed off a bit of the outer seal below my nose in order to make it fit. As some others have mentioned the Wisp needs more sizes) after the break.

The nasal congestion when does it happen in terms of when you put the mask on? Right away? Later in the night?
Or do you also have it during the day?

Look on the bottom of the blower unit and tell us the model number that you see....may have DS or REF in front or behind it.

Does your long hose have a black end where it attaches to the humdifier.

Your report from last night. Much improved with the increase in pressure. Did you have a little trouble falling asleep at the beginning of the night? That cluster of CAs could be awake breathing getting flagged by mistake and that cluster is elevating your AHI.

"raising your AHI" -- I don't care about AHI right now. What this graph says to me is that I have a problem with nasal congestion. To answer your question; I almost always feel at least a little congestion, and I went to bed with that little bit, but I didn't take Nasacort because my nasal passages have been a bit sore the last few nights. So at the first wake my nose was a bit wet, but still open. By the second, it was very congested and the XL mask was leaking. So I tried the L modified mask, but it evenually started leaking too. And I think that's what woke me up. At that second wake-up my nose was completely stopped up and the mask was flapping in the wind. And you are right -- the apneas at the beginning are because I'm half awake. But with a constant pressure (for the 2nd night) the graph is apnea free for two long periods. My breaths are even. Then comes a series of OA, H, and CA, my breathing is very irregular and has much more amplitude and I wake up. This happens at the end of both long sessions (long being relative). So I guess my question is: Is the irregular breathing causing the apneas, or are the apneas causing the irregular breathing?? The irregularity begins before the apneas are indicated. I'm thinking it is all one thing. When the graph starts going up and down with horizontal lines between the body is having trouble breathing and it wakes you up. So I'm starting to think that it is congestion that is the culprit.

I'm going to see a Ear nose & throat guy as soon as I can. I don't think the Respironics can really help me. It centainly hasn't so far. Am I wrong? I'm just looking for help. Thanks for yours.
Please don't take my rantings wrong. I really do appreciate the help I've found here, but i'm a Missourian and this is the show-me state.

Congestion could be a factor but the irregularity of the breathing and subsequent apnea events could also simply be the airway collapsing because the pressure is not sufficient to hold the airway open.
People get the same looking reports and don't have any congestion issues at all.

The 2 most common causes of periods of time where apnea events tend to cluster and/or would need more pressure are supine sleeping and REM stage sleep. To put it simply...it's common to need more pressure when we sleep on our backs because the airway can collapse more or REM stage sleep or maybe even a little of both.

Nasal congestion doesn't normally get flagged as some sort of apnea event.

Humidity settings can also affect congestion. Some people need more added moisture and some people need less and you just have to figure out which way you happen to be.

Suenyo wrote:It centainly hasn't so far. Am I wrong?

Helping what? The sleep apnea? Or the nasal congestion?
It's obviously helping the sleep apnea side of things...just look at the reduction in apnea events that did occur.

That's really all the cpap machine is suppose to fix....obstructive sleep apnea events. If there are other problems unrelated to sleep apnea then it can't fix what isn't related to sleep apnea.

Well, you are right about the events. Changing to fixed pressure made a big difference. So you think I should up it a bit? Go to 9 or maybe 10 and see what happens. Why does the Respironics running on APaP leave me with so many more apneas? Isn't it designed to do just the opposite? The people at the respiratory center certainly seem to want me to set it and forget it, but it has been torture at the lower pressures (4-5) and it takes forever to get up to 8 or so and it is always going up and down and I have more events. Speaking of which, can you explain the time setting on ramp? If set to 20 as it was when I brought the machine home does it take 20 minutes between each step or is it supposed to be able to find your right pressure in 20 minutes? I have it set on 5 now and it seems to work much better for me but maybe i should just turn ramp off if I can stand the blast of, say, 9 right from the start. It did eventually learn to start at 6.5 optistart. I'll check tonight to see where it starts.

Thanks again Pugsy.

Suenyo wrote: Why does the Respironics running on APaP leave me with so many more apneas? Isn't it designed to do just the opposite?

Suenyo wrote:he people at the respiratory center certainly seem to want me to set it and forget it, but it has been torture at the lower pressures (4-5) and it takes forever to get up to 8 or so and it is always going up and down and I have more events. Speaking of which, can you explain the time setting on ramp? If set to 20 as it was when I brought the machine home does it take 20 minutes between each step or is it supposed to be able to find your right pressure in 20 minutes?

Ramp of 20 means that it takes 20 minutes to get to whatever pressure setting is on the machine...starts at 4 cm and takes 20 minutes to get to either the minimum (if in apap mode) or the fixed pressure. So if the minimum pressure or fixed cpap pressure was 8 cm...takes 20 minutes to go from 4 cm to 8 cm. Unfortunately that low 4 or 5 cm starting pressure when using the ramp can often make people feel like they are suffocating. We won't suffocate but it can sure be uncomfortable enough to keep us awake. The solution is to either not use the ramp at all or maybe start the ramp a little higher at a more comfortable pressure like maybe 6.

People (sad to say that includes a lot of DMEs) wrongly assume that APAP mode set 5 to 20 will immediately go to the needed pressure determined by the machine but in truth the machine doesn't do anything that quickly. Works great if a person maybe only need 8 cm pressure to get the job done but not so great if someone needs a little higher pressure because it takes too long for the pressure to get to the needed pressure and a truckload of events can and will happen while the machine is increasing.
The trick with using APAP mode is to use a minimum pressure that gets the basic job done and having a range available for extra stubborn events that might need more pressure and having the minimum close enough to that maybe higher higher pressure that the machine can get there in a timely fashion.

Not to mention that wildly varying pressures can disturb some people's sleep. Not to mention that wildly varying pressures can make for fitting the mask for optimal seal a nightmare. Like at what pressure do I fit the mask....5 cm or 14 cm? Big difference in what is needed.

Now not everyone finds wide pressure changes disturbing...I sleep just fine through some wild changes...always have but when I was using APAP mode I had to have my minimum pressure set to 10 cm to start out the night with (never used ramp as I found it too stifling) and sometimes would see pressures of 18 cm for relatively short periods of time. It worked for me but my overall average pressure was around 11 to 12 cm when using 10 minimum. If I used 8 cm minimum my AHI was around 8 and more importantly I felt it in terms of sleep quality, nocturia and morning headaches. AHI of 8 isn't horrible but it was enough that my sleep quality was in the toilet. It was only when I got the AHI down to a little below 3 that the typical sleep apnea symptoms went away.

Optistart takes a period of time for the machine to figure out where to put your pressure. I wouldn't advise using Optistart.

Using ramp is optional...and/or you can increase the starting pressure to something a little more comfortable if you wish to use ramp.

Suenyo wrote:Well, you are right about the events. Changing to fixed pressure made a big difference. So you think I should up it a bit? Go to 9 or maybe 10 and see what happens.

I don't know what to suggest because I haven't seen enough reports to get an idea as to what is going on.
Other than the first reports you posted where the minimum was too low I don't know what is happening at the higher pressures or higher fixed pressure.

I don't suggest making any changes based on a single night's worth of data unless a change results in horrible results.
We don't sleep the same each night so we can't get a good idea for overall trends with just a single night.

If you don't want to use a range of pressures and prefer a single pressure I still suggest using APAP mode but instead of a range of pressures I suggest setting the minimum to equal the maximum. This will make it work like cpap mode but in apap mode.
With the Resprionics machines cpap mode turns off Flow Limitation flagging. Flow Limitation flags are only available in apap mode. So the absence of FLs in cpap mode doesn't meant they didn't happen...it just means the machine didn't report it if they did. Flow limitations are minor reductions in the air flow meaning the airway maybe tried to collapse a little but didn't make criteria for a hyponea or OA. We want to know if FLs are happening and we can't know if they are happening or not in cpap mode.

Oh thanks Pugsy!

That helps a lot. I am going back on APAP but I'll up the low pressure to 8. We'll see what happens.