Need Some Advice Please

Good job. You will be able to lower that AHI once you have a machine that can go above 20 cm when it needs to. I think you can easily see when it wants to go higher but can't.

I do hope they give you an auto bipap/bilevel because that way you only have to use the higher pressures when needed and not all the night.
I have used both...the fixed bilevel and the auto bilevel and while I could make the fixed work...the auto adjusting bilevel meant I could use lower for most of the night and only go higher when needed which in my case was REM sleep where my OSA is worse and needs more pressure.
Given the pattern to your clusters I wouldn't be surprised if you also have worse OSA in REM sleep...it's very common and wouldn't be unusual.

So you have a good argument for auto bilevel but I know they do things differently in Canada...but do give it a try. You won't be sorry...the auto bilevel machines are like 3 machines in 1...they have cpap mode, fixed bilevel mode and auto adjusting mode...pretty much like your apap does but they can just go higher and with the PS (Pressure support which is the difference between inhale and exhale) at the higher pressures it is more comfortable.

Great progress!

3.1 last night.

I am so excited with progress WE are making together.

The Large Amara View is so much more comfortable for me than the Medium.

NoInsurance Medical Supplies on Amazon were 1/3 price being charged in Canada.

Hopefully I will get the auto bi-level machine as recommended by Pugsy next week.

Is less than AHI goal of 1 possible?

AcedDublB wrote: Is less than AHI goal of 1 possible?

It is possible but don't beat yourself up if you don't get it.
Even once you get your bilevel machine and can use the pressures you need there still maybe occasion events slip past the defenses or what I hate worse...awake/semi awake stuff messing with my good numbers.

Back in Canada and picked up my Respironics System One Auto BPAP Heated Humidifier unit today.

Two week loaner to see if it suits.

Three nights ago I recorded my first AHI under 1.0

I have given up on chinstrap and find cervical collar seems to hold jaw semi-closed and is comfortable.

Sleeping right through for at least 8 hours so I hope the new machine will be even better.

I will post results.

The staff person didn't know anything about Sleepyhead and was surprised about me being able to see my daily chart.

Apparently this new unit provides data to your tablet it iPhone.

I told equipment supplier that the great help on cpaptalk.com were the only reason I have made progress that I did over last 6 weeks.

She wasn't impressed that I was changing maximum pressures.

First night on my new Auto BPAP
New Prescription at Bottom
First night's Results in first column
Last 6 months & Last Year to be Disregarded as not my Data.


Details Most Recent Last Week Last 30 Days Last 6 Months Last Year
CPAP Usage
Average Hours per Night 10:30 08:54 08:37 08:05 07:26
Compliance 100% 100% 93% 92% 86%
Therapy Efficiacy
AHI 5.24 7.65 12.35 9.79 9.00
Obstructive Index 2.19 4.60 8.06 6.55 5.67
Hypopnea Index 2.48 2.39 3.91 2.89 2.64
Clear Airway Index 0.57 0.66 0.37 0.35 0.69
Flow Limitation Index 1.05 0.64 0.63 0.37 0.56
RERA Index 1.90 0.32 0.46 1.52 1.26
% of time in Cheyne Stokes Respiration 2.70% 2.34% 1.71% 1.37% 1.13%
Leak Statistics
Average Leak Rate 1.61 3.17 3.74 4.12 4.24
90% Leak Rate 6.00 11.00 10.00 12.00 13.00
% of time above Leak Rate threshold 0.00% 0.53% 4.02% 3.76% 4.43%
Pressure Statistics
Average Pressure 0.00 14.48 16.55 9.22 8.33
Min Pressure 0.00 0.00 0.00 0.00 0.00
Max Pressure 0.00 20.00 20.00 20.00 20.00
90% Pressure 0.00 19.80 20.00 19.50 19.20
Average EPAP 13.25 2.23 0.54 3.10 3.09
Min EPAP 8.00 0.00 0.00 0.00 0.00
Max EPAP 17.00 17.00 17.00 17.00 17.00
Average IPAP 17.94 3.02 0.73 4.80 4.89
90% IPAP 21.00 21.00 21.00 13.90 13.80
Min IPAP 12.00 0.00 0.00 0.00 0.00
Max IPAP 22.00 22.00 22.00 22.00 22.00

Changes to Prescription Settings
First Last Days AHI FL Machine Pressure Relief Mode Pressure Settings
Tue Dec 8 2015 Tue Dec 8 2015 1 5.24 1.05 RemStar BiPAP Auto with Bi-Flex (761CA) Rise Time x3 Auto Bi-Level (Variable PS) Min EPAP 8.0 Max IPAP 25.0 PS 4.0-8.0 (cmH2O)
Tue

I suspect your minimum EPAP (which is at 8 now) needs to be increased to better prevent the airway from collapsing. Probably would need to see some actual pressure graphs to get any sort of idea as to what might be better...at all depends on how much time you spent below 10 cm EPAP.
While I don't think that you will need quite what you needed as for APAP minimum as your EPAP minimum...I do think that you will likely need a little more EPAP all night.

Terrible night.

Went to sleep right away with lots of pressure matching my breathing pattern.

Woke up in 3 hours and very little pressure and unable to get back to sleep.

Turned machine off and then back on and very little pressure.

Turned machine off and had 6 hours of virtually no sleep.

Worst night in a month and my first night on BPAP was only fair.

http://imgur.com/ZhtDCEy

http://imgur.com/ZhtDCEy

Heading to supplier but I know they put in settings prescribed by Doctor.

Pugsy, just as you said,Minimum Pressure too low.

Hopefully I can get resolved today.

Another terrible night with new Auto BiPAP machine.

Can't get to sleep, took it off after laying in bed 3 hours.

Not enough pressure in my mind.

http://imgur.com/SZ5kaaB

Supplier says I need to see Sleep Doctor and I am heading there now.

What a setback after so many weeks of perfect, restful sleep on CPAP.

I was almost forgetting how tired I was before CPAP success now I am back to square one.

After 13 nights with the Loaner BiPAP I picked up my own Respironics DreamStation Auto BiPAP today.

I was unable to enter the data and waiting on help to get into the Clinician mode.

Wow is this unit high tech including Bluetooth connection to the iPad accompanying iPad app.

The last 13 days on the BiPAP have been terrible after a great 2 weeks finishing off with the CPAP.

Awaiting Pugsy's valuable input so we can make this new shiny Cadillac do what I need it to do.

This is a much longer and more difficult marathon than I was expecting but I can certainly see that many of you are in the same boat as me.

When I picked up my new machine today the Manageress related the story of her 45 year old husband's massive heart attack because he refused to use his CPAP. He died in hospital almost immediately. Very eye-opening.

I'm surprised the DME didn't set it for you. If you know your settings, here is how to access the clinician menu. http://www.apneaboard.com/dreamstation- ... structions

Thank you.

The supplier set the Sleep Doctor's settings which were the same as I have used for last 2 weeks with loaner.

I am attempting to input recommended settings provided to me here.

I downloaded that very link you just provided this afternoon.

Several times I held down the 2 buttons and the screen changed very quickly and I briefly saw the clinician screen but within a second it was gone and I couldn't get in despite repeated tries.

For tonight I will use another night of the Physician's prescription.

The last 2 nights I have went to sleep but take at least 30 minutes to do so, despite being very tired, and 3 to 3.5 hours later I wake up and cannot get back to sleep and I toss and turn for 5-6 hours as my brain won't turn off and I am emotionally drained.

Today I wrote my Sleep Doctor a 2.5 page letter explaining why and what I Was doing. Hopefully I won't be an ex-patient!

I sincerely appreciate any advice you can provide although I know P..... Will check in with me as I PM'd her this P.m.

I remove the modem and SD card before I change my settings. I also unplug, then plug back in. Then I hold the two buttons down and the clinician menu appears after a beep.

Have really enjoyed reading your thread. I think you are really close to being where you need to be. Very happy for you~

First night on my own Respironics DreamStation Auto BiPAP after 13 days with loaner System One BiPAP.

Same settings as before but unfortunately even worse results.

I should have done a daily diary every morning over the past months but am starting today.

I could not get to sleep at all.
Inhale pressure seemed high but the sound was the worst as it kept me awake the entire 2 hours and I had to remove it.
May try earplugs tonight but I tried them a month ago and I don't think they are effective because noise is being transmitted directly to my eardrums.
I found I was anticipating the drop in pressure on my exhale and tried to breath through my brain rather than breathing normally.
Amara View mask feels excellent no issues with it.
Despite my long term lack of sleep I was not overly tired last night.
Went to bed at 10:40 and got up at 8:30 but tossed and turned most of night.
DreamStation will not Bluetooth pair with iPad although tablet and unit recognize each other but no connect.
Data very easy to review on screen, very high tech.
Small amount of water I swallowed for first time ever but no issue.
May need a heated hose as air at 20.0 seemed cool as our bedroom is cool.
Supplier said most people have heated hoses.
Noticed my mouth was open near end of use and I may have swallowed air as I was farting several times which is not usual.

Therapy Hours - 2.1, just as I thought as I lay awake.
AHI - 15.2 but that is probably irrelevant given I was awake whole time.
Mask Fit - 100%
Periodic Breathing - 4%
BPAP - 20.0
EPAP - 13.0

Will pull SD card later this morning and load into Sleepyhead and post results url if that will help our experts analyse what is going on but without being able to go to sleep I don't know whether it is all that useful but what do I know.

Over past few months I have removed my bedside clock, I am going to put it back.

Will certainly retry the Clinician setup with the experienced advice in previous post. Thank you for your quick response.

Hopefully I can turn the corner really soon. I am getting increasingly frustrated but I refuse to quit.

Watched a great YouTube video yesterday by an Aussie specialist explaining EPAP, IPAP and PS (Pressure Support.

There is so many resources out there for any question you might have.

I wished I could help others but I am putting my faith in Pugsy that she can guide me through this dilemma.

Hopefully I can enter new numbers in machine today and we can move to new therapy.

The noise is going to be another issue.

I may need medication to help me get to sleep but that is a question for the specialists to answer.

Looking forward to more helpful advice here.

Loaded new SD Card into laptop and Sleepyhead said there was no data to load.

I can only presume Sleepyhead may not yet be updated to accept new DreamStation data but I am guessing at that.