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Hello again HollyL,

Good that they upgraded you to an AutoSet.

At first sight, it looks as if those clumps of apneas co-incide with REM sleep. If you notice, they come at roughly the same amount of time after sleep onset, and thus in a sleep cycle. Pugsy, the forum moderator, is THE expert on that topic, and I'm hoping she'll be along shortly, and that she'll agree.

I note that your minimum is at 4 cm, the ex-factory setting. I posted several paragraphs on pressures in response to Timewarrior2001 only the other day. Perhaps you can read what I added to the thread he started, 'Newbie hello from England'. Saves me typing it twice.

The staff at your sleep-medicine department are being very responsive – remarkably so, IMO. So I think it's a good idea to keep working with them. Meaning, I'm in two minds about what to say about you raising your minimum pressure.

It is the obvious-and-well-supported-by-users'-experience change to make. And there are plenty here who will say 'do it'.

But it seems to me that you making any changes at this stage might anticipate the treatment plan your clinician's may have in mind for you. They may be waiting to get more data in order to support the case for issuing you with a bi-level.

The protocol they are working under is that, in order for that to happen, they have to try you on an auto-adjusting first – in order to get good numbers, but not ideal numbers. They have to show clinical need.

When they have talked with you, has there been any hint of that? Is it, for example, that you are being seen by the chief physiologist or head of department personally? Does the specialist nurse go off to check with someone, and then come back to you?

Seems to me that you should use the AutoSet at the pressures it is set at for at least a week. That will provide some data if data is what the SMD want. At the same time, you can get further used to the mask and the process. And then you can review your sitch again.

Rick, as always you are such a help - thank you!
I am really lucky to have a very supportive team at the hospital, they are truly fantastic. You're right, I do generally get seen by a lady who then disappears off to talk to senior colleagues!
I think you're spot on as well about the majority of events occurring during the ramp, last night's data shows a similar trend. My worry is the events happening whilst not in a ramp period... I think I will do as you suggest, trial it at their settings for a week and see how it goes. Hopefully my chest infection will have cleared up more by then and I won't be waking up so often in the night.

Here's last night's data, it scares me how high that pressure value goes, if it hits 20... what happens then?

REM stage sleep normally starts about 90 minutes after sleep onset and as the night progresses it comes on sooner and lasts longer with the greatest amount of REM happening in those wee hours of the morning.
Google "sleep stages" and look at the normal hypnograms and look at the normal progression of REM through the night.

It's common for OSA to worsen or need more pressure either from REM stage sleep events (my own OSA is 5 times worse in REM and I might need 6 to 8 cm more pressure during REM).......it can also worsen from supine sleeping and have the same higher pressure needs.
So...it's either supine sleeping or REM or maybe a combination of both where you are seeing the dense clustering of events.

Your ResMed machine doesn't record anything during ramp. Ramp is where you have a set pressure and it takes so long for the machine to increase up to that set minimum pressure. If you are using the ramp right now it's doing nothing but prolonging the increasing that the machine needs to do so it can fight the apnea events. Your minimum pressure setting is 4...and the machine starts at 4 anyway...so there's no where for it to go during the ramp.

Look how nothing is flagged for the first 30 minutes or so after you start the machine....I am betting your ramp time is around 30 minutes and then it increases dramatically to try to keep the airway open. You need a much higher minimum pressure than the starting 4 cm...it's simply taking too long to get in the upper teens where it wants to go to hold your airway open.

Turn ramp off for one thing....your minimum is 4 cm anyway so it is doing nothing but stopping the flagging of some events.
You are going to need substantially higher pressure minimums for your machine do be able to do an optimal job and at that time you might have more of a need for utilizing the ramp feature.

Ramp is a set time frame...
not to be confused with the general ups and downs that the auto adjusting pressure go roaming about.

Pugsy wrote: ↑

Sat Feb 29, 2020 7:49 am

Turn ramp off for one thing....your minimum is 4 cm anyway so it is doing nothing but stopping the flagging of some events.
You are going to need substantially higher pressure minimums for your machine do be able to do an optimal job and at that time you might have more of a need for utilizing the ramp feature.

Oh Pugsy thank you!!!! Of course its so obvious when you read it like that.. I hadnt realised nothing was recorded during ramp but it makes sense.

I'll turn that off tonight and whack up the min pressure.

Thank you!!!!

It's weird how some machine manufacturers do things.
ResMed doesn't flag a darn thing while the ramp is engaged but it does Flow Limitation flagging in fixed mode.
Respironics flags events while in ramp and will even suspend ramp and go to regular minimum pressure more quickly in auto mode but it doesn't flag FLs in fixed mode.
Little quirky things regarding the different brands.

I suspect that you are going to need quite a bit higher minimum so you might want to go up in stages so you can adjust to the higher minimums....plus maybe with a better minimum the machine won't need to go quite so high.
If you find you need the ramp in terms of comfort with the higher minimum then by all means use it. That's what it is there for.
Just be aware that the lack of events during ramp only means nothing was flagged....doesn't mean nothing happened.
Now you could be using auto ramp instead of regular ramp and in that case the machine might sense you were asleep and then suspend ramp to deal with the apnea events that might be happening similar to what the Respironics machine does in auto mode.

Are you having much nasal congestion? The FL graph is ugly but sometimes nasal congestion causes the ugliness and not airway obstructions. Increased FLs that are from nasal congestion issues won't normally resolve with more pressure....instead you have to fix the nasal congestion by normal nasal congestion fixing methods....saline rinses, meds, etc.

Pugsy wrote: ↑

Sat Feb 29, 2020 9:13 am

Are you having much nasal congestion? The FL graph is ugly but sometimes nasal congestion causes the ugliness and not airway obstructions. Increased FLs that are from nasal congestion issues won't normally resolve with more pressure....instead you have to fix the nasal congestion by normal nasal congestion fixing methods....saline rinses, meds, etc.

Yep - an absolute tonne. I've had a really bad cold and chest infection, it's the reason for some of the gaps in the night as I'm waking up needing to cough and blow my nose. I'll keep an eye on that chart once its cleared up.
I'm keeping Kleenex in business

Okay...ugly FL graph very possibly can be blamed on the upper respiratory illness (the cold) and we can't really say much about the FL graph until the cold has run its course. The machine doesn't know where the flow reduction is coming from though...so it's going to try to increase the pressure in an effort to open up the airway but it doesn't help much with nasal mucosa swelling type of congestion from when we are ill. So we make a mental note to take a closer look at the FL graph once the cold symptoms are gone.

I don't know if you are using a humidifier or not but I have found that increasing the humidity really helps with the nose issues.
If a hot steamy shower helps the nose clear up a little then you might try increasing the humidity setting. At least maybe make you a little more comfortable.

I also don't put a whole lot of faith in the AHI when we are ill. Too much chance for SWJ sleep/wake/junk false positives because we just sleep like crap because of the illness.

Pugsy wrote: ↑

Sat Feb 29, 2020 2:56 pm

Okay...ugly FL graph very possibly can be blamed on the upper respiratory illness (the cold) and we can't really say much about the FL graph until the cold has run its course.

I also don't put a whole lot of faith in the AHI when we are ill. Too much chance for SWJ sleep/wake/junk false positives because we just sleep like crap because of the illness.

Thanks Pugsy - I went straight from a minimum pressure of 4 to 8 on Saturday night (silly) and WOW did I regret that Sunday morning...! My AHI was 6.91, so a drop from the 9.28 but I did have a very disturbed night of sniffling/coughing so I wasn't overly concerned. Last night I dropped the minimum pressure down to 6 and I felt A LOT better for it this morning. Still a little bit of side effect but NOTHING like Sunday morning and no pain, I think I will increase in smaller jumps and let myself get used to it!
AHI of 6.2 this morning and a much calmer looking FL chart. I'm going to take your advice and ride this cold out before tweaking too much again.

HollyL wrote: ↑

Mon Mar 02, 2020 6:42 am

Pugsy wrote: ↑

Sat Feb 29, 2020 2:56 pm

Okay...ugly FL graph very possibly can be blamed on the upper respiratory illness (the cold) and we can't really say much about the FL graph until the cold has run its course.

I also don't put a whole lot of faith in the AHI when we are ill. Too much chance for SWJ sleep/wake/junk false positives because we just sleep like crap because of the illness.

Thanks Pugsy - I went straight from a minimum pressure of 4 to 8 on Saturday night (silly) and WOW did I regret that Sunday morning...! My AHI was 6.91, so a drop from the 9.28 but I did have a very disturbed night of sniffling/coughing so I wasn't overly concerned. Last night I dropped the minimum pressure down to 6 and I felt A LOT better for it this morning. Still a little bit of side effect but NOTHING like Sunday morning and no pain, I think I will increase in smaller jumps and let myself get used to it!
AHI of 6.2 this morning and a much calmer looking FL chart. I'm going to take your advice and ride this cold out before tweaking too much again.

yup! i had to ease my minimum pressure up over MONTHS of time in order acclimatize. sometimes, i had to drop back for up to a week before i could try again.

not a fun time at all!

zonker wrote: ↑

Mon Mar 02, 2020 6:03 pm

yup! i had to ease my minimum pressure up over MONTHS of time in order acclimatize. sometimes, i had to drop back for up to a week before i could try again.

not a fun time at all!

I can imagine!!! I am so glad it happened on a day I was at home and not at work

To everyone that helped me out on this thread - a huge, huge thank you!!

Since my last post my AHI hasn't been above 1.19 and I'm feeling like a different person.

I'm a CPAP convert

HollyL wrote: ↑

Mon Mar 09, 2020 5:43 am

To everyone that helped me out on this thread - a huge, huge thank you!!

Since my last post my AHI hasn't been above 1.19 and I'm feeling like a different person.

I'm a CPAP convert

Jolly good.