Please help newbie making 2nd attempt!

Think of it this way- you know those long skinny balloons-- imagine that's your throat.-- You are trying to get enough air pressure to keep the balloon inflated, keeping your throat open. That's what prevents the obstructive events from happening. To do that, you slowly increase the minimum pressure. Sort of inflating your throat like a balloon.

Others can look at your charts and make educated guesses at what pressure you need to raise the minimum to.
It looks like 8 is not enough to do the job. I would raise it to 9 or 10 and see if that is enough.

You don't want the machine to respond to events After they happen. You want the pressure to be sufficient to Prevent events from happening.

You can't do anything about the CAs/centrals except hope they go away (for the most part) once the obstructive stuff is better treated. It wouldn't be impossible for some of those CAs to be related to arousals which are related to the OAs happening. Now remember some CA/Central flags are totally normal and to be expected....like a sleep onset central or sleep stage transition. So don't get worried if you seem to always have a few CAs here and there. They are not a problem unless present in large numbers and we can't get the numbers reduced in typical ways.

Looks like your minimum pressure does a good job for part of the night but maybe not the best job for other parts of the night. The usual culprits for when we see pressure needs change like this is either supine sleeping or REM Stage sleep or maybe a little of both. It's common for our OSA to be worse when on our backs or in REM sleep and it's common to require different pressure needs for sleeping on one's back or for REM stage sleep.

What we have to do is figure out a minimum pressure that does the best job at
1. holding the airway open well enough to do a good job for the bulk of the night
2. be able to get to where it needs to be when the pressure needs change...in a timely manner.
So the minimum pressure has to meet 2 goal and yours is just not quite there yet.
The change to 8 minimum brought about significant improvement but there's still room for some improvement in terms of bringing down those OA numbers or really better yet, breaking up the OA clusters. If it wasn't for so many of those OAs clustering together it might not be all that important to do anything about an OA index of 4ish.

I don't know how much more minimum pressure you will need to break up the clusters....but probably at least 1 cm more and maybe 2 cm more minimum. I prefer to go up slowly in small stages unless it's obvious a big change is needed. In your situation with OA index of 4....a big change may not be needed. You are at the tweaking stage of things. The reason I prefer to go up slowly is that sometimes we are so close with our tweaking that a small change gets the job done and we don't end up needing as much pressure as we first thought. Sometimes we don't but going up slowly allows for a more gradual adjustment and less likely to create issues falling asleep or staying asleep just from the change.

Ignore the CAs for the time being...let's hope with time and better sleep they reduce on their own but if they don't or they get worse we have a different discussion but let's cross that bridge only if you come to it.

Pugsy and Cardsfan, thanks so much for the continued advice. I am encouraged that I seem to be in the ballpark with no huge red flags. I'll keep tweaking and report back!

RichCee wrote:I bumped up the lower end of the pressure by 2cm last night (to a range of 8-16). Slept ok until about 5am and then found it hard to get back to sleep. I don't think that was related to the increased pressure, maybe just a fluke. CA came down from the prior night, hoping that is still just my body adjusting after < 1 week. Obstructive has been > 4 the last two nights - the machine is responding, but I am not sure how to drive that down farther.

Still appreciate any insights as I try to make a more permanent go of this! Hopefully the image below works ok - you can click thru for a larger size. And as palerider requested, I have pulled up the Time at pressure chart to be visible as well.

if you look at the TaP chart, you're spending most of your time with the pressure between 10.5 and 13, anytime it's dropping below that, you're having events. I'd suggest raising the pressure by 1, and lowering the EPR by 1... which will have the effect of raising your base pressure (between inhalations) by 2cm. that should help cut down on the clusters of events you get when your pressure gets too low.

palerider wrote:

RichCee wrote:I bumped up the lower end of the pressure by 2cm last night (to a range of 8-16). Slept ok until about 5am and then found it hard to get back to sleep. I don't think that was related to the increased pressure, maybe just a fluke. CA came down from the prior night, hoping that is still just my body adjusting after < 1 week. Obstructive has been > 4 the last two nights - the machine is responding, but I am not sure how to drive that down farther.

Still appreciate any insights as I try to make a more permanent go of this! Hopefully the image below works ok - you can click thru for a larger size. And as palerider requested, I have pulled up the Time at pressure chart to be visible as well.

if you look at the TaP chart, you're spending most of your time with the pressure between 10.5 and 13, anytime it's dropping below that, you're having events. I'd suggest raising the pressure by 1, and lowering the EPR by 1... which will have the effect of raising your base pressure (between inhalations) by 2cm. that should help cut down on the clusters of events you get when your pressure gets too low.

Thanks for the input, I will definitely give that a shot and let you know how things change!

Again, thanks to all for their advice! Last night, I bumped up the pressure to 9, and reduced the EPR by 1. I also used a CPAP pillow that I bought on Amazon that helped me avoid sleeping on my back. End result was the most restful night I've had yet, with an AHI of 2.46!

Looks like about 50% of the AHI (which is already low) is CA/Central events and we can't do anything about them with any pressure tweaks on your machine.

I think I would now settle in with current settings and give things some time to settle down.

When you evaluate your AHI in terms of pressure needs you need to remember that if you are wanting to fix something with pressure then it needs to be fixable with pressure and the things that are fixable with pressure are
OAs, hyponeas, Flow limitations, snores and RERAs....
Centrals/Clear Airway events we don't treat with more pressure so you have to mentally remove them from the pressure needs evaluation.

At this point there's not enough centrals/CAs to warrant concern.

Time to sit back and just let the machine do its thing because it's doing it really well.
Don't try to totally eradicate every single little flagged event...you will drive yourself crazy trying to kill the last one and some centrals are normal anyway so we can't do anything about them.
Give yourself a week at these settings and see if you continue to feel like you have slept well and feel decent during the day. If this sort of result holds for several nights...there's no urgent need to increase that minimum more if the reports have an AHI of around 1.0 (when the CAs are removed) as long as you are sleeping well and feeling decent during the day.

There is some truth to the "give it time" thing.

RichCee wrote:Again, thanks to all for their advice! Last night, I bumped up the pressure to 9, and reduced the EPR by 1. I also used a CPAP pillow that I bought on Amazon that helped me avoid sleeping on my back. End result was the most restful night I've had yet, with an AHI of 2.46!

I'd go ahead and bump it up to 10 and see if things are even better. you're certainly getting 'in the zone' though.

Yea!! Now that looks better.

Thanks so much for the help pugsy, cardsfan and palerider - much appreciated!

I'd want to move up to 10 in a few days to see what happens.

I did move up to 10 at the low end last night (now 10/16) and slept pretty well. AHI < 5 although could be better - I don't feel compelled to get it below 1.0 or anything, but any ideas for tweaks to lower it a bit? Thanks again or all advice.

Leave the setting at min 10 for a few nights to see what happens. Increasing the pressure base on last night's results will mean you are chasing your tail every day. AHI can and will vary from night to night without changing anything and sometimes it can vary a lot for no apparent reason. So pick a number and stay there for a week and then look at the pattern. Either 9 or 10 minimum (either one seems to work well for the obstructive stuff) and give things some time for a trend or pattern to show up.

About half your AHI is CAs and we can't tweak anything for those. You have to mentally subtract the CAs from that hourly average to get the average for the events that can be fixed with pressure.

Since the med. pressure is 10.8, I'd move the minimum up to 11. Your machine is operating very close to 11 anyway. If that improves the OA some, leave it at 11 for a few nights.

I posted this on Julie D newbie too, thought it might help you too - I have been using Philips cpap for 18 months now. I cried when I first put mask on but I was also desperate for uninterrupted sleep. I felt agoraphobic with mask on and would feel panicked but I knew this was going to be a long term thing so would have to make things to how I wanted it. Britain Is not as informative as USA so the USA forums helped me. First I set up a metal oblong flower pot holder to the wall above my bed, this houses my machine, I put a hook on my very secure curtain pole and hung from it a large loop made from lace, through the loop my tube goes. The tube hangs directly above me to when I turn in my sleep I am not fighting with it! I use a feather pillow which when on my side just let my mask nestle without moving it off my face. I went through 5 masks within a year (thanks to NHS) to find right one for me, but I still found my nose and cheeks were sore. The mask liners are so expensive, I found a template on Internet and made my own from an old white soft cotton t shirt, which are also washable I didn't worry about sewing rough edges! These masks do not effect my seal. So as you can see, even though I still hate the fact that I use a cpap, I have made the best out of a bad situation! I still think cpap accessories are way over priced so I try and adapt and make my own! Without a cpap you are risking a stroke or heart attack, so really it's a no brainer! I wish you well for the future.