Analysis Help - Back 2 Back Nights

[dews]

Hi Everyone, 

I've been trying to dial in my therapy but since I'm a new user it's been a varied experience. On December 15th I had one of my better outcomes in terms of AHI numbers and CA events but still had some OA events but I was overall happy with the night. To push down those OA numbers, I've read that people want to up the pressure closer to the median pressure reading, so I tried to up it by .6cmH20. That didn't go so well with much high CA events and a bit higher OA events. I'm wondering if anyone has some thoughts on what I should be doing, whether higher pressures, lower pressures, EPR adjustment, to help. FYI - I usually feel pretty good after each sleep. No wild difference in fatigue, yawning, napping, etc... When I started therapy it was to target OA and using OSCAR I found those were coming down but I had a lot of CA events, not knowing if those were treatment emergent I may have to request and in-lab sleep study to discern between OSA and CSA and which one needs to be targeted more. I was only given at at home sleep study. 

I've posted the back to back nights for you to peruse.

December 15th:

Machine - Airsense 11 AutoPap
Mask - P30i Nasal Pillows
Pressure - 9.6-16cmH2o
EPR - 3 (Full time)

December 16th:

Machine - Airsense 11 AutoPap
Mask - P30i Nasal Pillows
Pressure - 10.2-16cmH2o
EPR - 3 (Full time)

Thanks for taking a look and your thoughts! 

PS - I've added a snippet of my sleep study for more background.

[staceyburke]

Both nights you had positional apnea. You can see positional apnea where either H or Oa events are clustered together.  Getting rid of as many as you can will lower your AHI.  Positional apnea can NOT be controlled by pressure changes.  You have to find out what position you are getting into and cutting off your own airway.  Have you changed your sleep position?  Sleeping on your back?  Using more (or new) pillows?  These things can cause positional apnea by chin dropping to your sternum and cutting your airway.  Think of it of a kinked hose – nothing can get through – you have to unkink the hose…

IF you can’t make a simple change like changing to a flatter pillow helps then you will need a collar.  I have a link to collars in my signature at the bottom of the page.  It shows people who are not wearing a collar and the SAME person wearing a collar.  There is a huge difference between the two.

Of course the 2nd night you had a number of centrals.  SOME of those could have been positional also.  On a cpap machine to tell if it is a central its sends a small series of puffs of air and if nothing comes back it is a central, if the air is returned it is obstructive.  In a sleep lab they have you hooked up to a number of sensors and with that they can tell if you are trying to breath. 
So some of the centrals the cpap machine is saying is central may not be.

Anyway as many of the positional apnea you can stop the better.

[Sleeprider]

I'm seeing random OA events clustered together with good therapy and low flow limits between events. This is the signature of positional apnea. Settings may be fine, but pressure tends to be around 12/9 (inhale/exhale), so you may need to bump minimum pressure from 10 to 12. https://www.apneaboard.com/wiki/index.ph...onal_Apnea

[dews]

Thank you to you both staceyburke and Sleeprider!

I’ll have a good read of the Positional Apnea wiki article. And in regards of pillows, I have tried two different pillows so thank you for pointing that out, staceyburke. I appreciate you taking the time to look over my charts and giving me advice and links to read over. Thanks again.