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I still can't read anything and I don't get a magnifying glass when I do your little trick.
You still have more graphs than are needed and that makes the needed graphs very small and even harder to read/evaluate.

On the surface from what I can see...looks like you need a little more minimum pressure still. Not sure why you are seeing the times with the larger increases in pressure but the 2 most common suspects are supine sleeping or REM stage sleep. The fact you see more pressure increases in the last half of the night make me think REM stage sleep because that's when we typically have more REM stage sleep.
So it could be REM sleep or maybe a combination of sleeping on your back and REM sleep.

The bulk of your AHI (and the stuff that is present but not part of the AHI) leans towards obstructive in nature apnea events....to better prevent that from happening more minimum pressure is needed. How much more I don't know but at least 1 cm and most likely 2 cm more minimum.
I don't see why your doctor would throw in the towel so quickly...there's still lots of things that can be done to improve the AHI.

Andypap wrote:Here's another screen shot. Just right click, open in another tab, and use the magnifying glass to blow it up...

no... do NOT resize the screencap, upload it at full size. upload it to imgur, pick the 'large thumbnail' and select the 'linked bbcode' link.

it's simpler to use than photobucket it's easier for people that you're asking to look at your stuff to see your stuff.

shrinking the pic and posting that results in fuzzy crap when it's blown up.

Here is last nights chart after putting the relevant graphs at the top, and using IMGUR...

My Doctor wanted to do a sleep study at his sleep lab - he was setting it up and was going to get back to me after the insurance approved it. I never heard from him again, so I assume my insurance wouldn't go for the in-lab study after paying for the home study. So, now I'm changing the settings based on my doctor's prescription, plus actual data from Sleepyhead.

I could bump up the min pressure to 13 or 14, but figured if the auto feature was set, the machine would bump up the pressure where needed? Not sure why it doesn't reduce the AHI in auto mode.

Andypap wrote:I could bump up the min pressure to 13 or 14, but figured if the auto feature was set, the machine would bump up the pressure where needed? Not sure why it doesn't reduce the AHI in auto mode.

Bumping the minimum pressure up should help bring the AHI down.

Yes, in APAP mode the machine will respond to events, but here's the thing: The machine doesn't instantaneously respond to events and when the min pressure is set too low, clusters of events wind up happening before/while the machine is increasing the pressure.

Typically:

1) An APAP will NOT respond to an actual event while it is happening. An APAP is NOT a ventilator and it will not try to force you to inhale when you are not breathing. Rather it waits for the event to end and then it increases the pressure in response to the event.

2) An APAP does not respond to an individual event. Rather it is programmed to increase the pressure when two or more events occur sufficiently close to each other. In the PR System Ones, the two events must occur within about a 2 minute period. The pressure is increased by one cmH2O after the second event and then the machine is programmed to wait for about 3-5 minutes before increasing the pressure again. The idea is that the machine waits to see if the breathing stabilizes at the new pressure level, which follows the guidelines used in a full PSG when a tech is manually titrating a patient.

Because of these two parts of an APAP's Auto algorithm, if the minimum pressure is set several cm too low, it can take a fair number of events before the pressure manages to increase up to where it belongs.

A couple of other comments however:

APAPs do try to proactively increase the pressure before events start. The proactive increases are based on the detection of flow limitations and snoring. On the PR System One machines, flow limitations and snoring show up as "event" tick marks in the event table. In the data that you showed, there appear to be no flow limitations scored, and hence the machine didn't respond to flow limitations. Two different kinds of snoring are scored, and the summary data in the left side bar does indicate that some (minor) VS snores were recorded, but I don't see the tick marks for them.

Usually with System One machines you see "test" pressure increases due to a so-called "search" algorithm where the machine periodically increases the pressure by 2cm over the course of about a 4 minute period to see whether there are subtle improvements in the wave flow pattern. If improvement is seen, the machine continues to increase the pressure by about 0.5cm/minute until no further improvement is seen, and the machine then leaves the pressure setting at the new level for a while before it starts is "reverse search" algorithm to see if it is safe to start reducing the pressure. If no improvement is seen during the first 2cm increase, the machine drops the pressure back down to the original level. It usually starts a new "search" every 10-20 minutes when there are no events being scored. I'm not seeing any evidence of that search algorithm in your data, and that is unusual.

Interesting! Not sure if my machine isn't working correctly, or, maybe it's normal and my pressure needs an increase. That's why my doctor said he wasn't a fan of the AUTO setting I guess. Not instant response, and it goes up and down based on previous events, etc?

I'll try bumping it up to min 13, max 16 - and see if that lowers my AHI tonight/tomorrow morning. I'll also try to stay on my side more.

Like Robysue I was also wondering why we didn't see the usual test pressure probes.

Normally the pressure looks like these examples seen in this thread where I explained the sawtooth pressure probe appearance.
viewtopic/t80875/Respironics-APAP-press ... se-up.html

Your pressure line doesn't follow what I would expect to see except maybe in the case of excessive leaks and you aren't having anywhere near excessive leaks...so I have no idea why your pressure line isn't typical unless the machine is not yet at a pressure level where it only needs to do the pressure probe thing.
Meaning perhaps once we minimum pressure is more optimal and doing a better job then maybe it will then be able to go to the level of readiness where the probes are sufficient......and I am going out on a long skinny limb with that idea.

All I know to offer is to try to fix what is known at this time that needs some fixing...and the minimum pressure is still not yet optimal...it's getting close but not there just yet.

I wonder if my machine is set up correctly? There is a lot of exhaust through my mask vent holes. Is there a way to know?

Andypap wrote:Here is last nights chart after putting the relevant graphs at the top, and using IMGUR...

very nice, thank you, nice and readable, with the most important bits.

Andypap wrote:I wonder if my machine is set up correctly? There is a lot of exhaust through my mask vent holes. Is there a way to know?

there's no setting for what you're talking about.. however, the amount of exaust (vent) is reflected in the upper leak line, look in the back of your manual for the expected leak at your pressure, and compare.

Pugsy wrote:Like Robysue I was also wondering why we didn't see the usual test pressure probes.

that is curious, and I *think* it's because of the rather unsettled flow/respiration rate. there's a lot of variability in there, and the pressure pokes usually only happen when things are nice and calm.

anyway, that's my theory... and I third the "more minimum pressure"

palerider wrote:

Pugsy wrote:Like Robysue I was also wondering why we didn't see the usual test pressure probes.

that is curious, and I *think* it's because of the rather unsettled flow/respiration rate. there's a lot of variability in there, and the pressure pokes usually only happen when things are nice and calm.

This is an interesting theory.

Tonight I'll try looking a bit more closely at my own data to see if I can find any stretches of breathing that either support this idea or contradict it. I'll let you know what turns up.

robysue wrote:

palerider wrote:

Pugsy wrote:Like Robysue I was also wondering why we didn't see the usual test pressure probes.

that is curious, and I *think* it's because of the rather unsettled flow/respiration rate. there's a lot of variability in there, and the pressure pokes usually only happen when things are nice and calm.

This is an interesting theory.

Tonight I'll try looking a bit more closely at my own data to see if I can find any stretches of breathing that either support this idea or contradict it. I'll let you know what turns up.

please do, I don't have anything I can point to handy, but I've seen it enough to make me think that's what's going on.

I look forward to your interpretation.

palerider wrote:
mask liners can make the leaks less bothersome, karen at padacheek.com is a regular here, and a really nice person to deal with.

The strange noises are usually from leaks, that's why PR suggests mask liners. I make my own liners from old t-shirts, found a pattern online. Karen's liners are used by many here, but they are not the only liners around. You can get liners from our forum sponsors as well: https://www.cpap.com.

Here are my latest results - improving thanks to the idea of upping the min pressure!

Andypap wrote:Here are my latest results - improving thanks to the idea of upping the min pressure!

maybe even some more, after after a few days to let it settle.