Newbie's first post-Sleep Onset Central Apneas & Other ?

Thank you Pugsy and Robysue so much for your quick responses. After reading your comments I went back to look at the charts again and see that's what it did- a slight pressure increase after the OA was over. In answer to your question Robysue, my initial setting on my bipap was 7 EPAP/11 IPAP. I was awake for most of the night during my sleep study so I would have to wonder how good the initial settings really were.

Does the APAP take your nightly trends/history into account for starting pressures or does each night stand alone?

riley525 wrote:Does the APAP take your nightly trends/history into account for starting pressures or does each night stand alone?

Only on apaps with Opti Start mode enabled which ends up being a fixed single pressure that it will remember and implement.
It isn't available on bilevel machines that I know of.

Each night stands on its own and the machine makes no adjustments based on past night's results. It doesn't remember anything except the date and time.
This is why we talk about the minimum pressure being critical for preventing the collapse because sometimes it can't get to where it needs to be to hold the airway open fast enough.
In your case the minimum is mainly the minimum EPAP baseline. You might need just a tad bit more minimum EPAP to better prevent those little clusters from popping up so the machine can get to where it needs to be in a more timely fashion.
Now if more pressure creates other issues (aerophagia or whatever) then maybe we just let these little clusters slide if you don't see them often and they aren't huge...and if you are sleeping decent and feeling decent.

The one cluster is a tiny bit ugly but trust me....I have seen worse myself but if this were my report and I was sleeping decently and feeling decently and this didn't happen very often...I would shrug my shoulders and move on.
I suspect a REM related cluster that for some reason just needed more pressure..maybe REM and supine sleeping combo...we don't really know and have no way to know with 100% certainty but it's very possible that it is related to REM due to where it is occurring.

Pugsy wrote:

riley525 wrote:Does the APAP take your nightly trends/history into account for starting pressures or does each night stand alone?

Only on apaps with Opti Start mode enabled which ends up being a fixed single pressure that it will remember and implement.
It isn't available on bilevel machines that I know of.

Each night stands on its own and the machine makes no adjustments based on past night's results. It doesn't remember anything except the date and time.
This is why we talk about the minimum pressure being critical for preventing the collapse because sometimes it can't get to where it needs to be to hold the airway open fast enough.
In your case the minimum is mainly the minimum EPAP baseline. You might need just a tad bit more minimum EPAP to better prevent those little clusters from popping up so the machine can get to where it needs to be in a more timely fashion.
Now if more pressure creates other issues (aerophagia or whatever) then maybe we just let these little clusters slide if you don't see them often and they aren't huge...and if you are sleeping decent and feeling decent.

The one cluster is a tiny bit ugly but trust me....I have seen worse myself but if this were my report and I was sleeping decently and feeling decently and this didn't happen very often...I would shrug my shoulders and move on.
I suspect a REM related cluster that for some reason just needed more pressure..maybe REM and supine sleeping combo...we don't really know and have no way to know with 100% certainty but it's very possible that it is related to REM due to where it is occurring.

They actually lowered my EPAP 1 point when they set up the new machine. Not sure if that was done on purpose or not. How long should you give yourself to get used to a new machine setting before you request a change? Does the fact that it could be REM related impact pressure settings?

Thank you Pugsy!

Pugsy wrote:

riley525 wrote:Does the APAP take your nightly trends/history into account for starting pressures or does each night stand alone?

Only on apaps with Opti Start mode enabled which ends up being a fixed single pressure that it will remember and implement.

Is Opti Start something on the PR DreamStation APAPs or the Resmed AirSense 10 APAPs? I ask because I've never heard of it, but I'm still learning about the AirSense/DreamStation generation of machines.

It isn't available on bilevel machines that I know of.

I certainly didn't see anything in the Clinical settings or the patient settings when I was setting up my new PR DreamStation BiPAP Auto. I'll try to check tonight just to be sure.

Pugsy wrote: The one cluster is a tiny bit ugly but trust me....I have seen worse myself but if this were my report and I was sleeping decently and feeling decently and this didn't happen very often...I would shrug my shoulders and move on.

Are you talking about the cluster that is roughly from 22:00 to 22:30?

The last data that riley525 posted appears to have an afternoon nap as well as overnight data. Since the flow rate curve is zoomed into the level of being able to see the 35 second long OA, we don't have any information of when riley525 went to bed relative to that 22:00-22:30 cluster of events.

I suspect a REM related cluster that for some reason just needed more pressure..maybe REM and supine sleeping combo...we don't really know and have no way to know with 100% certainty but it's very possible that it is related to REM due to where it is occurring.

Yeah, it's possible one or more of the clusters on this night's data is REM related. It's also possible that the 22:20-22:30 and 3:00-3:10 clusters are sleep-wake-junk stuff.

robysue wrote:Is Opti Start something on the PR DreamStation APAPs or the Resmed AirSense 10 APAPs?

Usually the APAP but I think the Pro also has it. I would need to go dig out the manual to see for sure.
It uses the AHI to try to decide whether to reduce the pressure. 30 day averages or something like that.
Only on Respironics models as far as I know. The PR S1 machines (some of them had it) and I think the DreamStation non bilevel have it...if I have time I will go back and reread the manual to refresh my memory.
Not available on the brick model though...so apap and maybe the Pro.

riley525 wrote: Does the fact that it could be REM related impact pressure settings?

It can...not always but it can. I myself have REM dependent OSA...in non REM my OSA is only around 12is but in REM it's over 50 and I have always seen substantial pressure needs in REM when compare to non REM. Like 6 to 8 cm more in REM. I had to nudge up the minimum a little to adequately deal with REM pressure needs.
When I was using apap I did well with 8 cm minimum except during REM and I would often see it go to 16 to 18 and have some pretty ugly clusters multiple times a night. Once I increase the minimum to 10 then the ugly clusters stopped. It just couldn't get the job done with the 8 cm minimum...took too long and I didn't have enough stuff in non REM to keep the pressure up to where it could get to that 16 or 18 quickly enough.

riley525 wrote:How long should you give yourself to get used to a new machine setting before you request a change?

It depends on how things look. If what you showed above was the worst of it I would give it quite some time and wait to see if any patterns or trends develop. If things are really ugly (and yours above isn't) I wouldn't waste a lot of time waiting for things to get better. I don't have much patience...and I wouldn't request a change...I would just do it myself. Now if you aren't comfortable doing this sort of stuff yourself then don't do it...wait and ask.

With the one brief zoomed in screen shot you posted I can't really offer much input except generalizations because I can't see how the pressure trended over the entire night.
From what I see on the events graph though...I see no reason to urgently start increasing the minimum at this time.

Pugsy wrote:

robysue wrote:Is Opti Start something on the PR DreamStation APAPs or the Resmed AirSense 10 APAPs?

Usually the APAP but I think the Pro also has it. I would need to go dig out the manual to see for sure.
It uses the AHI to try to decide whether to reduce the pressure. 30 day averages or something like that.
Only on Respironics models as far as I know. The PR S1 machines (some of them had it) and I think the DreamStation non bilevel have it...if I have time I will go back and reread the manual to refresh my memory.
Not available on the brick model though...so apap and maybe the Pro.

Ah---Opti Start is the new name for the "AutoIQ" mode or whatever it was called on the PR System One Pros with AutoIQ.

Yeah, the PR BiPAP Autos don't have that feature.

And yes...the little "cluster" I was talking about was the one around 22:00 with the little bit of RERAs and snores.
It could just be post arousal stuff with the CAs...we can't see what the pressure was doing at that time frame but unless I saw stuff like this often...I don't know that I would dig very deep into such a small random cluster.

Here's a thread where I have a good example of multiple dense clusters which are most probably REM related. I have seen such clusters often when my minimum pressure just isn't doing a good job. I had them when I first started cpap therapy and was using apap with 8 cm minimum...and now in this thread when I was using a Bilevel Pro. I can make a fixed pressure machine work but it means I have to use more pressure all night and I simply don't want to do that. Less is just more comfortable and if I can get by with less for the bulk of the night then that's what I am going to do.
I am fortunate in that I never really have had much of a problem with aerophagia (had it bad only twice) so I am okay with letting the machine decide where to go and when. If I had been unfortunate enough to have problems with higher pressures then I would have had to re-evaluate things and likely come to some sort of compromise.
viewtopic.php?f=1&t=88508&st=0&sk=t&sd= ... ster+child

Looks like OptiStart is only on the apap and it relies on 90% pressure numbers with short term trial apap mode being used
CPAP-Check...available on both and that may be what uses the AHI. I can't remember exactly for sure and no time to dig deeper in the manuals.
From the DreamStation manual...see image below. The 560 manual I have is so old it doesn't mention Opti Start which I think was added later.

Thanks Pugsy and Robysue!! Lots of good info! Yes, I did sneak in a short nap yesterday, since I am sick with a cold and wanted to try out the new machine. My sleep has been so bad with this cold, I hate to count on these numbers for much right now...I do have the Dreamstation Bi level autopap. We just traded out my bipap machine & she didn't give me my new instruction book so I will have to look it up online. I am ok with changing the pressure...my DME person acts like it is a really big deal...IDK if the doctor would care or not...I would like to increase the EPAP to at least 7 or 8.

Thank you!!!

riley525 wrote:TWe just traded out my bipap machine & she didn't give me my new instruction book so I will have to look it up online. I am ok with changing the pressure...my DME person acts like it is a really big deal...IDK if the doctor would care or not...I would like to increase the EPAP to at least 7 or 8.

You can request a copy of the clinical manual for your Dreamstation by going to http://www.apneaboard.com/adjust-cpap-p ... tup-manual

You may have to register; I'm not sure about that. Instructions on how to request the clinical manual are in Section Three of the page I linked to, so keep scrolling down until you find it.

Thanks, Robysue! I followed your links and increased EPAP from 6 to 7. Other than my usual sleep onset junk it looked pretty good.

My cold is pretty much over so I was able to sleep through most of the night for the 1st time with my new APAP bilevel. Ignoring the attempt at a nap earlier in the day, starting at the 23:11 hour, you can see I had a really bad section ( my guess is REM sleep) I have my machine set at minimum 7 epap and max 18 IPAP. I am curious as to why it never went above 16 when I had this long cluster starting at 1:21 lasting until 2:00? It hit 16 pressure at 1:28.



This closeup above shows the start of the bad section.



This close up above shows the section at 1:45 when I had been at 16 pressure for awhile.

Appreciate your thoughts.

My guess is that bad cluster is indeed REM. Or REM+Supine sleep.

Are you sure that Max IPAP = 18? Because your machine is clearly acting like max IPAP = 16. So I'd double check that setting.

It looks to me like you may need to need to increase the min EPAP a bit. Also what are your min PS and max PS set at? And do you have BiFlex turned on or off, and if it's on, what is it set at? It looks to me like min PS = max PS = 4, but since you didn't include the left side bar's summary data we can't confirm your machine's settings.

At any rate if min PS = max PS = 4, you might also want to increase the max PS setting a bit as well as the min EPAP setting; that increase your starting IPAP and it would also allow the machine can increase the IPAP a bit more without necessarily increasing the EPAP.

In other words, if you are looking for a tweak that might just take care of the nasty REM clusters, you might try:

Min EPAP = 8
Max IPAP = 18
Min PS = 4
Max PS = 5 or 6

And use these settings for at least 3 or 4 days. If you're still getting the nasty REM cycles, you may need to increase the Min EPAP up more than once. But I would say to go slow: Increase the Min EPAP by 1cm at a time and use the new setting for at least 3 or 4 days before deciding to increase the EPAP again. It may be that you will eventually need something like a min EPAP of around 10 to really deal with your REM clusters.

Here is the section with my machine settings.