3 Nights in…Need Settings Advice

[bnephew]

Thank you all for the posting help and quick responses with suggestions/guidance.  I will make some changes for a couple nights and be back on with the results.  

And with this post I should be able to post links/pics from now on so I will follow-up with a clean list of links to my data...

[bnephew]

Sleep Study page 1:  http://imgur.com/VqwqSzX
Sleep Study page 2: http://imgur.com/J0aPjTw
Sleep Study page 3: http://imgur.com/daz0Mpc
Sleep Study page 4:  http://imgur.com/ujzWnIf
Sleep Study page 5:  http://imgur.com/8A3L1IC
Sleep Study page 6: http://imgur.com/hl7725R

9-18 Sleepyhead:  http://imgur.com/xiNq8Xk
9-19 Sleepyhead:  http://imgur.com/xT7FlGA
9-20 Sleepyhead:  http://imgur.com/Pirq3AA

[SarcasticDave94]

You're welcome and glad I could assist. As you see, you're able to post now. Good day to ya.

[PaulaO2]

I don't see where anyone has told you....

Changes are to be made slowly. As in make one and wait about 7-10 days. We are looking for trends, not individual nights. Unless an issue comes up where it is so very obvious (or uncomfortable) that a change is not working, then it can be altered. But usually you let it run for a while. This allows you and your body to get used to the change, for everything to settle down, and for the data to reflect what is truly happening.

You have only been on this machine for 3 days. Usually I advise to leave it alone for now. But yours is set to wide open and it is probably contributing to your issues. Narrow the range down as suggested above. Then leave it alone.

[PaulaO2]

I am also going to remove the posts about how to do a link or those that fixed the link. I fixed them in the original posts. This way the thread doesn't get bogged down and the OP can get the help he needs with his data. - Moderator

[SarcasticDave94]

Good catch, PaulaO2, and very sound advice as usual. I'm going back to my corner now. Good day y'all.

[trish6hundred]

Hi bnephew,
WELCOME! to the forum.!
Good luck to you on your CPAP journey.

[bnephew]

I totally get the wait and give the changes a chance approach but I feel like the changes I made last night may have been to my detriment.  I tightened up my pressure range as suggested (moved to 8 min and 13 max); however, this resulted in my highest AHI night yet...both obstructive and CA events increased and my overall AHI was about double what it had been. 



Should I go back to wide open or does this chart suggest that something else is needed?

[Sleeprider]

Interesting. You were at 6-20, and 8-13 resulted in more events. The problem with OA events occurred when the machine reached maximum pressure between 11:20 and midnight, so from that we can deduce you may need higher pressure at times, or positional therapy to prevent events when you are on your back (see sleep study). Your pressure remained above 8 most of the night, and your median pressure was 10.3. Looks like a range of 8-16 might get you there, or if you want to keep pressures lower, a soft cervical collar might prevent the need for that higher pressure. The CA event rate is also higher, and I don't see how these settings would have affected that as your median pressure was still 9.5 to 10.4 under the previous settings. That said, CA usually responds in a positive way to lower more steady pressure, which was the original idea behind the 8-13 trial.

One night does not make a pattern, but hitting the maximum pressure did raise OA and H events. Most of the increase was CA, and we don't know the cause of that yet in your case. I suspect that if you added exhale pressure relief (EPR) the CA events might increase further. We know from your sleep study you actually have a complex apnea, and without a titration study, that issue was not investigated in regard to how it responds to CPAP pressure. I think at this point, I would hold at the current pressure and consider adding a soft cervical collar, or increase maximum pressure to 16 to deal with the added OA when you reached the maximum pressure in this trial.

By doing your own titration evaluation, you will eventually find the solution that results in the lowest possible event rate. It is possible that result will not be as low as you'd like, however if you end up going in for a titration study, it will be to evaluate bilevel or ASV.

[bnephew]

So the increased OA when limiting pressure to 8-13 concerned me...I changed the pressure to 10-20 in an effort to control the OA and since it appeared my CA was not negatively affected by the increased pressure.  My first night at 10-20 resulted in almost no OA and the CA wasn't negatively affected.

I turned EPR setting on and set at level 3 (I know this runs counter to the standard thinking that EPR would increase CA) thinking it may mimic bipap settings?  The first night with these settings resulted in my best night so far...overall AHI under 3 (as a side note I had actually had a few beers that night and expected it to be a disaster on my breathing but it was the exact opposite).

The last couple nights with similar settings (although I did bump up to 11-20/EPR3 last night) haven't been as great but I'm trying to give it some time.  Does anything stand out with these charts which would suggest another change may help?

Is it likely that an ASV machine will be needed to correct my CA?

Once again, thanks for all the advice and insight on my treatment...I won't stop until I get this as corrected as possible.

Friday:

Saturday:

Sunday:

Monday: