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I usually get up twice a night to go to the bathroom or because of dry mouth.

And i do turn off machine when I do that.

No, the pressure isn't waking me up. I am very comfortable with the machine.

Jaz1943 wrote:I usually get up twice a night to go to the bathroom or because of dry mouth.
...
And i do turn off machine when I do that.
...
No, the pressure isn't waking me up. I am very comfortable with the machine.

Okay. This is where I would start, but hopefully some of the other more experienced veterans will weigh in. The pressure you need to effectively control obstructive apneas appears to be somewhere in the low teens. You can see this yourself in your reports. Whenever you start the machine you have rapid strings of VS, H, & OA events and the machine reacts by climbing straight into the teens every time. That is a strong indicator that pressures below that level are not effective for you. Your minimum pressure is currently set around 5. If we know you have obstructive apenas below 10, we know the machine starts at 5, and we know the machine only raises the pressure after events start occurring, the inevitable result is that you are going to have events for a while any time you restart the machine. If that only happens at the beginning of every night then the effects are minimized, but for you this is happening three or four times a night. If the pressure doesn't bother you, I think your numbers would likely improve if your minimum pressure was raised to something closer to your effective pressure. VS and H are also highly correlated to pressure, so a higher minimum should also improve those numbers some as well. If that were my nightly report I'd raise the minimum to around 10, monitor the results closely for a while, and reevaluate from there, but this is your treatment and your health and that is a decision you and/or your doctor need to make.

Sounds like a plan to me. I'll keep in touch.

Are you refering to Epap Minimum or PS Minumum?

Jaz1943 wrote:Are you refering to Epap Minimum or PS Minumum?

--> EPAP minimum. EPAP is the lower pressure the machine switches to when you exhale. If that is too low it allows the airway to collapse during the exhale and an Obstructive Apnea happens. An auto machine will increase the EPAP in response until they are brought under control.

PS minimum if the smallest pressure difference the machine will allow between your inhale pressure and exhale pressure. The machine will raise the PS (pressure support) difference if OAs are adequately reduced by the EPAP but Hypopneas aren't. That setting is probably best left alone unless your EPAP minimum is already dialed in well, you are experiencing difficulty exhaling, or your PS is always high enough that it triggers large numbers of CA events.

Got it

Changed Epap Min to 10, took a nap and AHI was 12. Going back to 5 for tonight

Going through rep. Tech. Settings tonight after reading titration protocols and physician's protocol and patient case studies I discovered that Biflex Mode was set to off. I have set epap min to 7 with Biflex Mode on. I will post results.

Today's report attached. Set Epap min to 4.5(increase from 4.0) and turned Biflex on last night. Nap time yesterday was with Epap min set to 10 and Biflex off. I think this skewed readings but H is lower than ever now. Will set Epap min to 5 today unless there are other recommendatikons.

[url]https://www.dropbox.com/s/dlgaissvud422 ... jpg?m=[url]

Note: Perhaps Epap min of 10 will work now with Biflex turned on?

All the Best and thanks for all the support. I now think I'm getting somewhere.

https://www.dropbox.com/s/dlgaissvud422 ... -14.jpg?m=

Corrected link access

How are you doing your images? They are a bit difficult for me to see.

The image looks sharp to me Brenda. You do have to enlarge it though. Let me repost a brighter image.

Jaz1943 wrote:Today's report attached. Set Epap min to 4.5(increase from 4.0) and turned Biflex on last night. Nap time yesterday was with Epap min set to 10 and Biflex off. I think this skewed readings but H is lower than ever now. Will set Epap min to 5 today unless there are other recommendatikons.

[url]https://www.dropbox.com/s/dlgaissvud422 ... jpg?m=[url]

Note: Perhaps Epap min of 10 will work now with Biflex turned on?

All the Best and thanks for all the support. I now think I'm getting somewhere.

Taking EPAP up slowly as you verify it isn't doing anything negative is a fine approach. In terms of information you might want to consider, take a look at the new daily report you posted. On the left we have the nap with EPAP min at 10. On the right we have the night with it set at 4.5. The events directly effected by EPAP are OA, while VS, FL, & H are more affected by IPAP. IPAP = EPAP + PS, so the EPAP is part of the equation for dealing with them, but OA is the primary indicator of whether EPAP is set properly. Once EPAP has OA under control, you can go after taming the H events with PS Min.

Look at the OA line in Sleep Therapy Flags for the section with the nap at 10 and compare it to the rest of the night at 4.5. Take a look at the improvement in the VS line as well. OA and VS were far better during the nap than the rest of the night. That is the goal of increasing EPAP Min. When that kind of mostly clear OA line is normal, then you can increase PS Min slowly until the H line begins to improve as well.