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Here is the data from his last three nights of sleep. Three days ago we were still feeling good with the results, but the last two days look pretty shoddy:

August 27th:


August 28th:


August 29th:

He's obviously not sleeping well and is taking the mask off in his sleep most likely.
Lets see if a little tweaking will stabilize things and at the same time perhaps deal with the flow limitations a bit better and are likely a driving force for the pressures.

Several changes but not huge changes.

Minimum to 7 cm....max to 10 cm
EPR to 3...fulltime

Can't type my usual explanation but I suspect Miss E can explain for me.

We need the 7cm to get full benefit of EPR at 3.

why flow limitation happens constantly, almost the whole night. This is not typical OSA to me.

Oh....any nasal congestion issues going on during the night?

To channel Pugsy as best I can: We're putting the uptick in CAs to one side, because they probably represent arousals, and if the arousals can be reduced, the CAs will follow suit.

To reduce arousals, we want the night to be as comfortable as possible. EPR makes breathing much more comfortable for many people. It drops the pressure when exhalation starts, then increases it when inhalation starts. By changing the setting from EPR of 1 to EPR of 3, the comfort may increase. A potential side benefit might be a reduction in flow limitations, which themselves can interfere with a good night's sleep for some people, since the FLs may make people work harder to complete their inhalations.

The minimum pressure of 7 means that even at the minimum, the full EPR of 3 is available. (A pressure of 4 is as low as the machine can go.) Pugsy is also suggesting raising the maximum a little to offset the increase of EPR so obstructive events don't crop up with the lower exhale pressure.

Thank you for the additional information. Yes, my father does experience some nasal congestion, even prior to starting cpap. He says it's usually one side that has some congestion, during the day as well sometimes. Prior to bed he sniffs some vicks vaporub but I can only assume some congestion continues throughout the night. Does that change your interpretation of his results, or your recommendation? Again, he is using the dreamwear mask with nasal cushion. I wondered if he may need a full face mask but I have no idea.

Just to double-check --- tweaking pressures and settings won't cause us any issues in meeting his medicare compliance, right? We are happy to adjust it tonight per your recommendation, I just want to make sure we aren't breaking any "rules" that will kick us later. Honestly, I feel more confident with the advice from this forum than our doctors and we are very thankful for all of the assistance thus far.

Also - we're at 9/11 days compliant and can't be done fast enough. Am I correct in my understanding that we just need 30 days compliance within 30-90 days, then we no longer have medicare compliance requirements that can take the machine away from us? If so, then we only need one follow up with the sleep doctor to show compliance and then we just pay the monthly rental for the remainder of the 13 months? Is that right?

Medicare only cares that the machine is used. Medicare doesn't monitor settings or even results for that matter.

For Medicare compliance....
you have 90 days to manage to get 30 consecutive nights where 70% of the nights the machine was used at least 4 hours within a noon to noon reporting period. The 4 hours does NOT have to be consecutive.
So 21 out of 30 days using at least 4 hours.
If it gets iffy...watch tv and use the machine...still counts as using it.

Nasal congestion can sometimes show up as increased activity on the FL graph.
Doesn't change these setting changes but we will keep it in mind if the FL graph doesn't change.

Ok, we adjusted the machine as advised (min 7, max 10, EPR 3 at Full Time)... we had another large gap last night and his AHI was higher than I've seen before. Last night's data is below.

My father's notes:
He remembers the mask being off once. some nasal congestion on one side. he thinks he felt ok in the morning, but he distinctly remembers the air that he was breathing feeling colder than he would have liked.



While the data looks worse to me, it does look like he had two periods of more continuous sleep for about an hour each that may provide some clues. Let me know if you need me to zoom in on any portions that may be of help. Also, while he prefers the dreamwear nasal cushion mask, we do have the N20 airfit nasal mask that we can try again if a leak issue is suspected (it hurt the bridge of his nose after a few nights, but he can wear it one night if it might narrow down suspected issues).

Can you zoom in on 02:00:00 ? A 3 minute segment and a 6 minute segment?
I think the centrals are likely false positives but want to confirm.

Absolutely:

3 minutes @ 2am:


6 minutes @ 2am:


And if it helps, here is a larger view with some time right before and after as well:

okay.
Lets try reducing EPR to 1 and keep the minimum at 7 tonight.

Did he get a heated hose or non heated hose?

Thanks. I'll switch the EPR back to 1, but leave the machine at the min 7 / max 10 that we switched it to last night.

He has the heated hose, and climate control too, I believe. I know the machine has two settings for temp and humidity.

If he continues to complain about cold air increase the hose air temperature a bit.

@pugsy

What about the humidity level??

JLROhio wrote: ↑

Tue Aug 31, 2021 12:43 pm

@pugsy

What about the humidity level??

When someone complains about hose air being cold and they are using a heated hose then my first thought is "warm up the air". I don't like messing with humidity unless no choice. KISS principle when at all possible. We are already messing with more changes than I would prefer here.
Changing humidity settings to alter hose air temp (one way or the other) isn't the optimal way when we have a heated hose available. IMHO