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What's the AHI breakdown into event categories?
Is the leak line within acceptable range?
What cpap mode pressure are you using now to get that 14 AHI? 4 cm or 6 cm?

Pugsy wrote:What's the AHI breakdown into event categories?
Is the leak line within acceptable range?
What cpap mode pressure are you using now to get that 14 AHI? 4 cm or 6 cm?

The pressure was at 6 and his leaks are good.
Hypopnea 114 events
Obstructive Apnea 1 event
Pressure Pulse 62 events
Resp.Effort Related Arousal 1 event
Unknown OB 110 events
Vibratory Snore #2 84 events

Snores and hyponeas...pressure as you suspected is not quite optimal at 6 cm.
How about a tight apap range? Start out with ramp at maybe 30 minutes at 6 (if he isn't bitching too much about it) and set minimum to 6 and maximum to 8. He will probably hit maximum but it shouldn't be such a change that it will wake him up.
If he can sleep better with it and cut down some of those events...maybe not wake up in the night...and lets see what happens with the events.
Hopefully he can sleep through the increase because it will sneak in while he is asleep and never notice it.
Worry about what is left after you see what letting the machine go to actually does. Might get lucky.

Pugsy wrote:Snores and hyponeas...pressure as you suspected is not quite optimal at 6 cm.
How about a tight apap range? Start out with ramp at maybe 30 minutes at 6 (if he isn't bitching too much about it) and set minimum to 6 and maximum to 8. He will probably hit maximum but it shouldn't be such a change that it will wake him up.
If he can sleep better with it and cut down some of those events...maybe not wake up in the night...and lets see what happens with the events.
Hopefully he can sleep through the increase because it will sneak in while he is asleep and never notice it.
Worry about what is left after you see what letting the machine go to actually does. Might get lucky.

I would love to do that but the crusty old fart would refuse to use his machine again. I set it to 5 and will gradually sneak it up a little at a time. I know this doesn't make sense to anyone else but I know the only way this can possibly work is in baby steps. He would notice the slight increase in pressure. He has even accused me of increasing his pressure when I didn't. I think the next step should be getting him comfortable back on 6 and more data checks. I will need a lot of help from Doctor Pugsy. I am just thrilled he is wearing the mask and trying again.

To be continued.

Slip him a micky ... lol j/k

If he is using 6 cm...in APAP mode it will stay at 6 until he is asleep and the events trigger the little pressure increases.
It won't change until he is asleep anyway and I bet he won't even notice it if you don't tell him.

Whatever pressure he is using now...just leave it there but in APAP mode and cap the max at 8cm.
It won't go there unless it needs to and for sure it won't go anywhere till he goes to sleep.

Pugsy wrote:If he is using 6 cm...in APAP mode it will stay at 6 until he is asleep and the events trigger the little pressure increases.
It won't change until he is asleep anyway and I bet he won't even notice it if you don't tell him.

Whatever pressure he is using now...just leave it there but in APAP mode and cap the max at 8cm.
It won't go there unless it needs to and for sure it won't go anywhere till he goes to sleep.

Shouldn't I wait until he is keeping the mask on all night again? I am not trying to disrespect you excellent advice. I know that you are always spot on with your recommendations. I just want to keep him trying to wear his mask again. This has been a long hard battle. At least we have the mask problem already solved. Now we just need to work on the therapy without him throwing in the towel again. He doesn't have a clue how bad his sleep really is. Have you ever seen a dog dreaming running and barking in his sleep? Well this is what my husband looks like. He never takes naps. If I spent a night like he does I wouldn't be able to get out of bed the next day. When he is wearing the mask he is calm as a baby.

If he is having 14 events per hour..and routinely waking up after 4 hours...maybe the events are waking him up.
He may not ever make it through the night at this rate..

Are the events clustered in groups?

How about compromise ... APAP 6 min and 7 max??? He won't ever know if you don't mention it.

Hey..this is better than what I thought you were going to do to him not so long ago.

To bad you can't make a video of him sleeping one night and then show it to him.

Pugsy wrote:If he is having 14 events per hour..and routinely waking up after 4 hours...maybe the events are waking him up.
He may not ever make it through the night at this rate..

Are the events clustered in groups?

How about compromise ... APAP 6 min and 7 max??? He won't ever know if you don't mention it.

Hey..this is better than what I thought you were going to do to him not so long ago.

I will post his data tomorrow. He is already asleep. It is 8:56 here and he has been in bed about an hour. He should be healthy wealthy and wise. He is trying to get on my good side by using his machine again. At least that is something I can easily support him on. Other thing he does not so much.

nanwilson wrote:Some of these guys (not all of you boys) are babies when it comes to this kind of stuff...." Nan

Not all of us... of course not...

Sheriff

I am so sad he didn't keep his mask on very long last night.
Channel Min Med 95% Max
PressurePressure (cmH20)
W-Avg: 0.00 5.00 0.00 0.00 0.00
Minute Vent.Minute Ventilation (L/min)
W-Avg: 4.66 0.38 4.25 7.81 18.64
Resp. RateRespiratory Rate (breaths/min)
W-Avg: 15.27 11.95 15.20 16.80 17.34
LeaksLeak Rate (L/min)
W-Avg: 0.86 0.00 1.00 2.00 3.35
Total LeaksTotal Leak Rate (L/min)
W-Avg: 26.97 26.00 27.00 28.00 29.23
SnoreSnore (unknown)
W-Avg: 1.46 0.00 0.00 7.75 8.00
Insp TimeInspiratory Time (seconds)
W-Avg: 1.84 1.00 1.80 2.32 3.32
Exp TimeExpiratory Time (seconds)
W-Avg: 2.07 0.12 2.06 2.46 2.66
Tidal VolumeTidal Volume (ml)
W-Avg: 301.65 30.00 260.00 520.00 1230.40

How long was "not very long" and what was AHI during that period?

Pugsy wrote:How long was "not very long" and what was AHI during that period?

5.04 about an hour. I didn't turn on the light and I thought he was wearing his mask.

This whiny old fart couldn't keep the mask on until I found the right pressure, that took about 4 months and a change to APAP. After many different pressure changes I made one more change and went from 4-5 hrs per night with the mask on to 9.5 the first night. My average is almost 7 now.