Help with Pressure Settings for New APAP User

Progress is being made, I think. Both in his sleep and in my understanding of what I'm looking at. I've watched the videos Pugsley recommended at http://freecpapadvice.com/sleepyhead-free-software. I've read lots of threads on this forum and apneaboard. I'm going to post several screenshots and my beginning attempts to make some sense of what I'm seeing. Please tell me if I'm off base with something.

This is last night from 8:20 pm to 6:09 am. From 8:20 until midnight, he was awake most of the time, mostly lying flat on his back staring at the ceiling. So I'm thinking the data from that time frame is not particularly meaningful. After throwing out everything before midnight, things look somewhat better. There are several long stretches of sleep with no or very few events, and the AHI is down to only (!) 16.39. There's a big cluster of Clear Airway events for 7 minutes just as he goes to sleep, from 00:17 to 00:24. Here's where I get confused. It does not look to me as if he has settled into a regular breathing pattern, and if I'm understanding what I saw on the videos, this may mean that they are not in fact central apneas and can be safely ignored. (I can't manage to attach more than three files per post, so I'll continue this in the next post.)

el344 wrote: ↑

Sun Sep 19, 2021 4:42 pm

There's a big cluster of Clear Airway events for 7 minutes just as he goes to sleep, from 00:17 to 00:24. Here's where I get confused. It does not look to me as if he has settled into a regular breathing pattern, and if I'm understanding what I saw on the videos, this may mean that they are not in fact central apneas and can be safely ignored.

Redo that segment but this time about 6 or 7 minute segment.
left side start at about 00:12 and end at 00:19.
I don't think he was sound asleep. Need to see more of the flow rate to have a better idea.
They could be transitional centrals though. It's normal to have transitional centrals but normally not in such dense clusters.

(continued from above)
Then there's another giant cluster from 3:05 until 3:39. Again, the breathing becomes very irrregular. So are these actual apneas or artifacts of restlessness? And finally, we have a cluster starting at 5:39 and continuing until he gets up at 6:08. Again, the breathing is very irregular. These clusters seem to correlate with some leak activity. I don't know whether the leaks caused the restlessness or the restlessness caused the leaks. I suspect the latter.

He's still not ready to reduce the EPR, but I'm hopeful we'll be able to do that in a day or two. I've explained why it's important, but he says he is still having a hard time exhaling.

Sorry for the very long posts, but your explanations have been so helpful.

the 05:39ish stuff flagged...arousal related for sure.

I have a sneaking suspicion that a sizable chunk of all event category flagged events are arousal/awake related.
Remember the machine doesn't/can't know sleep status at all.
The machine only measures air flow and responds accordingly.
We can have false positives in all the event categories.....it is NOT limited to just centrals.
I know this for a fact because I have seen them in my own reports and so blatantly awake flagged events that a blind person could see it.

If it were my husband I would make an extra effort to figure out why he is having trouble falling asleep and staying asleep.
Leaks can very well be a factor....they can cause arousals and then people have trouble going back to sleep.

I doubt that EPR is much of a culprit because the times where he is obviously asleep.....no real centrals to worry about and he's using EPR at those times. I would put reducing EPR on the back burner for now. I would also put increasing the max pressure on the back burner for now anyway.

Can you get me a screen shot of a small cluster of OAs? About a 5 minute segment. I am thinking good chance those are arousal related as well. Just need some proof.

el344 wrote: ↑

Sun Sep 19, 2021 4:42 pm

. It does not look to me as if he has settled into a regular breathing pattern, and if I'm understanding what I saw on the videos, this may mean that they are not in fact central apneas and can be safely ignored.

They are central apneas (just not trying to breath) but I don't believe that they're central sleep apneas. ie, yes, I think he was awake.

el344 wrote: ↑

Sun Sep 19, 2021 4:42 pm

This is last night from 8:20 pm to 6:09 am. From 8:20 until midnight, he was awake most of the time, mostly lying flat on his back staring at the ceiling.

A suggestion is that he should go to bed much later. If he had gone to bed at midnight, his sleep quality from midnight to 6:00 a.m. might have been better.

Six hours of high-quality sleep would be so much better for him than what he experienced the years before starting CPAP. Once his CPAP therapy is optimized and he is adjusted to it, he might be able to sleep for 7 or 8 hours.

Pugsy wrote: ↑

Sun Sep 19, 2021 4:56 pm

Redo that segment but this time about 6 or 7 minute segment.
left side start at about 00:12 and end at 00:19.

He seems to have been awake until 00:14. This is 00:15 - 00:19. And this is the very beginning. Is there a way other than editing the screenshot to pull out just one chart? Is that useful?

One can just crop the image I suppose but it isn't really needed. I use the Windows snipping tool to do all my screen shots
so I can crop and get the screen shot in one step.

I agree those CAs/centrals are all awake related. I suspect that the bulk of the centrals and OA flags are awake related.
If he's not asleep they don't count in terms of OSA treatment evaluation for pressure needs other than they alert us to prolonged not sleeping. A real good chance that the bulk of those dense clusters are a symptom of poor sleep and not necessarily the cause of the poor sleep. Have to look elsewhere for the cause of the poor sleep and fix it on that end.
Easier said than done for sure. Gotta try to figure out the cause of the arousals before we can try to fix it and determining the cause is often difficult.

He had a great night last night! Unfortunately, I didn't put the SD card in so all I have this morning is the MyAir data: He really felt good this morning and says he is finally used to the machine. So we're not going to change a thing at the moment.

Pugsy wrote: ↑

Sun Sep 19, 2021 5:32 pm

If it were my husband I would make an extra effort to figure out why he is having trouble falling asleep and staying asleep.

He said he couldn't get comfortable having something on his face, but last night he finally was able to ignore it.

ChicagoGranny wrote: ↑

Mon Sep 20, 2021 6:36 am

A suggestion is that he should go to bed much later. If he had gone to bed at midnight, his sleep quality from midnight to 6:00 a.m. might have been better.

This IS much later He used to go to bed at 6:00 pm and take two naps a day. The dog, who is fairly obsessed with a schedule, is used to going to bed with him at 6:00 and can't figure out why he has to stay up until 9:00 now. He trots back to the bed, lies there for a bit, then comes back out and sits and stares at him, then sighs, and lies down next to his chair. Then he repeats the whole process. The dog also snores like a buzzsaw, but I don't think he'd adapt well to a CPAP machine.

We'd have never gotten here without all your help. This board is phenomenal.

el344 wrote: ↑

Mon Sep 20, 2021 9:13 am

The dog also snores like a buzzsaw, but I don't think he'd adapt well to a CPAP machine.

Veterinary CPAP from Italy
https://harol.it/en/2020/10/24/cpap-hel ... eterinary/

I see a trip to Italy in my future!

el344 wrote: ↑

Mon Sep 20, 2021 9:13 am

The dog also snores like a buzzsaw

Is the dog a brachycephalic dog breed (Like the English bulldog, French bulldog, Pug, Pekingese, or Boston terrier)?

He's a Tibetan Spaniel. The breed is not classified as brachycephalic, but his nose is shorter than most Tibbies. Plus he's 10 years old.

He's my avatar.

He's a cutie.

Or maybe an ankle biter?

A quick update -- not much has changed. He's still having stretches of a couple of hours of good sleep with almost no apneas broken by stretches where he's struggling with the mask and waking up and recording lots of clear airway events and obstructive apneas that seem to be mostly arousal events. He does say most mornings that he thinks he slept well.

Again, thanks for all the help. I think he'll continue to make progress slowly.

ChicagoGranny wrote: ↑

Mon Sep 20, 2021 12:10 pm

He's a cutie.

Or maybe an ankle biter?

Benson appreciates the compliment and rejects the suggestion that he is an ankle biter. He can get to at least the mid-calf