Question about autoset pressure range

robysue wrote:
Things get really bad a little after 2:00AM and they stay bad all the way to when you turned the machine off around 3:30. Any ideas what the heck happened between 2:00 and 3:30??

You turned the machine back on without using the ramp around 3:30, but my guess is that you either fell back asleep pretty quickly or your wake breathing was more regular than it was at the very beginning of the night. The pressure increase between 4:00 and 4:40 is most likely caused by flow limitations or snoring or both since there are no events scored during this time frame.

Always using the ramp would prevent what happened to you at the beginning of this night.

My guess is REM sleep between 2:00 and 3:30 I was dreaming when I woke up. I have the auto ramp turned on now. I should mention my AHI during my sleep study was 12 I believe but 35 during REM. During my titration I was at my optimum pressure for only 14 minutes.

Uncle_Bob wrote:

Tformhals wrote:

Uncle_Bob wrote:Lots of good advice here. But one question from me, what does your sleepyhead report look like when you are on straight CPAP at 8cm

First night with a data capable machine last night. So I don't know that yet I only know what my AHI has been. Which has been up and down as low as 1.8 and as high as 7 on average nights. It was higher when I had a cold between 16 and 22.

You might consider backing the bus up and starting at CPAP 8cm with your data capable machine as a starting point and then go from there, while concentrating on getting your leaks under control. In my opinion there should not be any reason to use ramp or EPR at just 8cm. Just my opinion

Not against doing this. Not sure why my leaks spiked other than me possibly moving around and jostling my mask.

Personally, I would increase the minimum to 7 (maybe eventually and the maximum to 14. Your machine maxed out at 12 from 2:00 to 3:30 and couldn't stop the events. Leaks did increase, but were not a major problem.

Tformhals wrote:

robysue wrote:
Things get really bad a little after 2:00AM and they stay bad all the way to when you turned the machine off around 3:30. Any ideas what the heck happened between 2:00 and 3:30??

You turned the machine back on without using the ramp around 3:30, but my guess is that you either fell back asleep pretty quickly or your wake breathing was more regular than it was at the very beginning of the night. The pressure increase between 4:00 and 4:40 is most likely caused by flow limitations or snoring or both since there are no events scored during this time frame.

Always using the ramp would prevent what happened to you at the beginning of this night.

My guess is REM sleep between 2:00 and 3:30 I was dreaming when I woke up.

I don't think REM episodes usually last that long, particularly that early in the night. Certainly the end of it is likely to be REM since you remember waking up dreaming.

I should mention my AHI during my sleep study was 12 I believe but 35 during REM. During my titration I was at my optimum pressure for only 14 minutes.

Given that your diagnostic REM AHI is so much higher than non-REM and the nastiness of that very long cluster of events, I agree with LSAT: A min pressure of 6 is too low. I'd bump it up to 7 or 8, which was your titrated pressure as I recall.

I have the auto ramp turned on now.

That should prevent the kind of discomfort that you had at the beginning of the night. What do you have the beginning ramp pressure set at? It should not be set too low: I'd say set it no more than 1-2cm below your min pressure setting. So if you increase that min pressure to 7 or 8, the beginning ramp pressure should be set to around 6cm.

You know if your OSA is worse in REM which is very common (mine is 5 times worse..12 in non REM and 53 in REM) if you didn't happen to get much REM they may not have been able to get a good pressure idea for REM. That happened to me...I only got 6 minutes of REM at my titration. It's no wonder they didn't my RX optimally set.

Tformhals wrote: Not against doing this. Not sure why my leaks spiked other than me possibly moving around and jostling my mask.

Possibly. You could also be jaw dropping and losing the seal of your full face mask. Have you tried opening your mouth whilst you are awake to see if you have a good seal, both on your back and side sleeping positions?

Got it set for 8-14 tonight. I will try opening my mouth and seeing if the mask leaks. I also went to sleep on my side and woke up on my back. My first sleep study they wanted me on my back all night. My titration she said I could lay on my side and i did, not knowing that OSA is usualy worse on your back.

Tformhals wrote:Got it set for 8-14 tonight. I will try opening my mouth and seeing if the mask leaks. I also went to sleep on my side and woke up on my back. My first sleep study they wanted me on my back all night. My titration she said I could lay on my side and i did, not knowing that OSA is usualy worse on your back.

If you want to try and force yourself not to sleep on your back then you can try wearing a tee shirt with a pocket back to front with a tennis ball in the pocket or taping it to the back of the shirt. But from my experience and the advice I've received here its best not to try too many things too soon. Good luck.

So better night last night sleep quality wise woke up once which is fairly normal. At first I wondered why I was missing an hour of data but then remembered the time change. Looking at some of the clear airway events and zooming in some of them the flow rate looks the same as when there are no events. There are two at the beginning of the night that you can see the flow rate looks different. Not really sure there is anything I can do about the clear airway events not really sure if I need to.

Also having some mask issues with my Amara View. Its a love hate thing right now. If I have it to loose my nose slips inside the hole and the little flap can actually block my nose. If I have it to tight it hurts my teeth. When it is just right it is perfect.

Tformhals

The data looks quite good. Even the leaks are better. Yes, there's some stuff that looks like mouth leaks between 23:50 and 0:35, but it's well below the 24 L/min official Large Leak territory. So if you didn't wake up with a dry mouth these leaks are not really worth worrying about, particularly in light of:

Tformhals wrote:So better night last night sleep quality wise woke up once which is fairly normal.

You also write:

Looking at some of the clear airway events and zooming in some of them the flow rate looks the same as when there are no events. There are two at the beginning of the night that you can see the flow rate looks different. Not really sure there is anything I can do about the clear airway events not really sure if I need to.

The early ones are more than likely sleep transitional and "don't count."

The later ones? They might be real, but there's not enough of them to worry about in the grand scheme of things AND you can't eliminate them with more pressure. It could be the case that as you get more acclimated to CPAP, this kind of CA will go away on it's own. So I'd say "prudent watchfulness" is the best strategy: Don't get hung up on any one day's data, but if there's a decided trend that starts to head the wrong way, at a certain point you reevaluate what comes next.

I agree with everything RobySue has said and don't want to bruise my fingers typing all that.
The bulk of the (already low AHI) is central and while I doubt that all of them are the real deal...even if they were there aren't enough of them to worry about and we can't do anything about them anyway.

If they remain a little higher than you would like to see...and you want to try something to see if you can reduce them...maybe reduce EPR or turn it off. I doubt it will make a difference but there's a very small subset of people that EPR will trigger real centrals (not the awake SWJ centrals) and turning EPR off or down seems to help.
I don't think that EPR is going to be a factor in your centrals...usually when EPR is the trigger we see a LOT more of the centrals than is showing on your reports.

Personally...deal with the mask issues as best you can...give yourself 2 to 4 weeks to get adjusted to the new therapy...watch the centrals but don't dwell on them and after a month or so if the centrals still persist more than you want to see...then consider experimenting with EPR.
A few centrals are normal and to be expected...like the sleep onset centrals.
It's also normal to have SWJ centrals...hopefully as you get more used to the new settings and get the mask issues reduced you will sleep better and sleeping better means less SWJ anything.

I appreciate all of the feedback. Thank you for taking time to help others getting adjusted to therapy. I think I am ready for a new mask cushion I didn't have as much trouble when the mask was new but my face was a little chubbier too.

So kind of a crappy night last night woke several times mostly because my wife was having trouble sleeping and was moving around a lot. data from last night.

The events after 5:00 are probably not true because I was mostly awake from that point on should have just got up. Major mask issues last night though the wife woke me up at least twice because it was hissing and I had to readjust the straps. I get new cushions on Friday going to see if I can possible get a new cushion and a different mask to try not sure how the insurance works. Going to leave EPR where it is for now and keep all settings where they are for at least a week if not longer. I am hoping it is pretty well dialed in.