APAP chart analysis

[klauskinski]

Hi, folks,

I've gotten my first glitches with the mask sorted out and the graphs are becoming a bit more consistent. So I am going to attach graphs for three days and I'd kindly ask you to let me know what you t think. 

I started with very open settings min press = 4.4, max press = 20, EPR = 1 (see Graph1). Graph2 picture is a zoom into the timeframe when I had a runaway machine that actually completely woke me up   and a lot of events. I repeated the same setting on the second night just to get another picture (Graph3). 

[ I guess I can only attach 3 pictures so I'll continue in the next post ]

[klauskinski]

On the third night I have decided to raise the min pressure to 8 with EPR = 2 to be more in line with where the machine operated anyway during the night. And the results are attached with zooms into more interesting timeframes.

I'm guessing the neck support is mandatory (still need to get it somewhere). 

What other changes would you suggest? 

Thanks,
Klaus

[Sleeprider]

Klaus, your results look better with the minimum pressure at 8.0, and you clearly need to resolve the positional apnea/chin-tuck with a soft cervical collar. I think once that happens, we will see more clearly what minimum pressure range offers the best therapy with minimal pressure fluctuation, however, I'm pretty sure you will be at 9 or 10, and with a higher EPR. EPR at 2 improved some parts of your results. We see some very good quiet sleep between the positional apnea episodes, and that is what we want to focus on as a model for your future therapy. You can see that pressure stabilized near 9.0 cm.

When you zoom into the graph to look at flow rate, try to keep the zoom level near 2-minutes where the flow wave is visible and easily interpreted. We actually learn more by looking at periods of good therapy and sleep, than the periods of apnea, although both can be useful. The only glitch I see in your respiratory statistics is a short expiration time, and we might want to look at that more closely to see what is happening. You should kick ramp to the curb or increase the pressure and reduce time. I see lots of RERA (spikes in the respiratory flow) during ramp. These are because pressure is too low to stabilize the airway at sleep onset.

[klauskinski]

Hi, SleepRider,

Thanks for your feedback. I attached 2 graphs that represent the same time frame when I slept very calmly. 

You should kick ramp to the curb or increase the pressure and reduce time. I see lots of RERA (spikes in the respiratory flow) during ramp. 

I'm not sure what you mean by the first sentence in the quote above. Are you talking about the initial ramp which is suppose to help me falling asleep? I still have it on auto and I can try to change it tonight. Any suggested values? 
 
Regards,
Klaus

[Sleeprider]

Either turn ramp off completely (most of us just don't need it), or increase the minimum pressure of ramp from 4.0 to what you are able to tolerate comfortably. Using Ramp on Auto is fine, but you can still adjust the pressure.

This chart shows a very regular and normal sleep pattern. It runs about 8 minutes so the scale is a bit too long to really see the flow wave, which is why we try to get about 2-minutes in. I see about 16 BPM with a normal time of inspiration and expiration, with a brief pause at zero flow at the end of expiration.  This probably accounts for the reporting error of a shorter expiration time.  Looks good.  Do this all the time and you will have slept well.

[klauskinski]

Hi, again, folks,

So, I have gotten my neck support and I raised the minimum pressure. I have also incresed the ERP = 3. I can't say I'm sleeping well -- I wake up at night. Attached is the typical pattern: A couple of times a night the machine simply "runs away" to max or substantially higher pressure.  The pressure jumps so rapidly that it wakes me up because my mask is trying to fly off my face   . And later in the night I have periods when I wake up occasionally for no good reason. I would say my sleep is shallow. 

The good thing is that I don't wake up with headaches and other typical apnea symptoms anymore . But sleep is not good. I have attached the whole night graph and the zoom-ins of the run away periods. I you'd need to see other periods, feel free to ping me and I'll upload.

Any suggestions how to improve the situation? Or do I simply need to get used to it? 

Thanks,
Klaus

[Sleeprider]

Klaus, set a maximum pressure of 13 or 14 cm. This will avoid the run-away and is well within your effective therapy range.