Can't seem to dial my settings in

[C0mbe]

I am having a real issue getting myself dialed in, and hoping someone can point me towards some better settings.   I seem to generally experience 40-60% O/HA during a night, and the remainder is CAs.  Most nights are actually quite excellent, but there are enough bad nights that I feel like its still effecting my therapy.   Going on my third month of use, I am not really seeing any reduction in CAs.  They aren't too bad, but I generally see CAs every night.    

This seems to be further complicated by whatever altitude I am at.  As I have said in a previous post I basically move quite frequently between sea level, 6000 ft (home) and >9000 ft.  

• At sea level I am basically <1 every night on my Aircurve 10 vAuto.  I see maybe one central a night, and a few O/HA.  
  
• At home I am primarily under 5, but can jump over 5 for a few nights.  Centrals are noticeably worse, and on days when I am over 5, they usually make up 0.5-3.0 AHI.  
  
• When I am >9000 ft, anything goes.  My pressures are higher, and I can see anywhere from 0.2 AHI to 12 AHI with a lot of centrals.  
  

Hoping someone has some suggestions.  My thinking is, I set the machine to address my needs at home, but it almost feels like I need different settings at different altitudes.  

Some notes about my sleep:  

• Leaks are mainly under control, I've had a few bad leaks recently due to my p10 headgear stretching.  The leaks don't seem to correspond with CAs or O/HA.  
  
• I am a side-sleeper.  I very rarely sleep on my back.  
  
• Events tend to come much later in the night in clusters.  The first few hours are almost always <1 AHI  
  
• I sleep for longer stretches on my Auto BiPap then I did the APAP (I routinely sleep the full night without waking).  
  
• I have been trying to lower the max-IPAP to control centrals, but that doesn't seem to work.
  
• I have tried to lower the pressure control, but I have found a direct correlation between PS and length of uninterrupted sleep.  
  
• I tend to make changes at 1 week intervals because I can have a string of great days, and one or two bad ones.  
  

Here is an example of a reasonably good night, but my AHI is above 5.  The previous nights before 1.4 AHI, and 4.98 respectively.  

Any thoughts, or suggestions would be greatly appreciated!  

[/url][url=http://imgur.com/Uar2pz7]

[Clay L]

Many (most ?) machines automatically adjust for altitude. When we used to spend the winter in AZ at about 250 feet and then the summer in CO at 5000 feet, I had more CAs in CO and my sleep doc told me that CO is the CA king state because of high altitudes.

When my wife was diagnosed with sleep apnea she had CAs that did not respond to higher pressures. He prescribed a BIPAP machine and oxygen at night. I think the reason for oxygen is that if her blood oxygen level is high enough it acts as buffer when a CA causes a drop.
You might ask your sleep doc about BIPAP.
For a good explanation of BIPAP vrs CPAP see [url= http://www.alaskasleep.com/blog/what-is-...y-pressure] http://www.alaskasleep.com/blog/what-is-...y-pressure[/url]

[C0mbe]

Many (most ?) machines automatically adjust for altitude. When we used to spend the winter in AZ at about 250 feet and then the summer in CO at 5000 feet, I had more CAs in CO and my sleep doc told me that CO is the CA king state because of high altitudes.

When my wife was diagnosed with sleep apnea she had CAs that did not respond to higher pressures. He prescribed a BIPAP machine and oxygen at night. I think the reason for oxygen is that if her blood oxygen level is high enough it acts as buffer when a CA causes a drop.
You might ask your sleep doc about BIPAP.
For a good explanation of BIPAP vrs CPAP see [url= http://www.alaskasleep.com/blog/what-is-...y-pressure] http://www.alaskasleep.com/blog/what-is-...y-pressure[/url]

Thanks for the response!  I'm starting to see why CO is a problem.  I actually already have an auto bipap, and it's incredibly comfortable.  I just can't seem to find a happy place where I can keep my AHI below 5, and don't have to constantly micromanage for altitude.

[C0mbe]

So as not to create multiple threads, I am going to continue with this one.  I seem to be having a real issue with my AHI.  I haven't had to much of a problem, but lately I am 50/50 whether I can keep it under 5.  I tried to increase my base EPAP to try and combat obstructive events, and I know I have some leaks to reign in, but I'm lost as to what to do to try and fix this.  Any thoughts would be helpful.  Here are my last 3 nights, I was pretty happy with the 25th:  

[Sleeprider]

C0mbe, first thing I want you to do is turn off the damn calendar. Just click the triangle in the date line. And the second is to turn off the pie chart in file/preferences/appearance/and unclick the check box.

With that out of the way, your night of 2/25 looks great. Your EPAP pressure averaged 8.6 (7.6 min) and the 90% was under 9 cm. This suggests a reasonably well tuned bilevel titration that produced very few events. Great start, and just a couple leaks late.

On the 26th you had a couple clusters of OA that the machine called mixed with centrals...I don't believe it because the flow rate line shows recovery breaths typical of OA, similar results on the 27th and now your leaks are getting pretty large.

I could be wrong, but your event clusters look like positional apnea, and most likely involve your head position tucking down toward your chest. It could also be back-sleeping, which is normally fine, but I'm going with head/chin position. You need a different pillow or soft cervical collar to correct this, and this will also put slight pressure on the back of your jaw and should help with leaks. You're not alone, ask Melman.

[C0mbe]

Thanks SR.  Damn calendar turned off!

Hadn't thought of positional Apnea.  I move around a lot when I am sleeping, which I assume is the cause of the the leaks.  I am looking forward to an adjustable P20 to help with that.  

I seem to recall Melman had success with a buckwheat pillow... I'm not sure I can handle a collar quite yet, but I am more than willing to start with the pillow.

Out of curiosity, where are you seeing the recovery breaths?  Ah, you said flow rate. I would love to be able to understand the difference for future reference.

[Sleeprider]

Look at the amplitude of the flow rate graph where OA occurs...see the spikes?

[C0mbe]

Look at the amplitude of the flow rate graph where OA occurs...see the spikes?

I do.  I think I get it - the larger spikes correspond with a gasp or deep breath.  This differs from an actual CA where there is diminished respiratory effort.  

Ok I can work with this.  Thanks again.  Was kind of getting lost with good nights here and there, mixed with bad ones.

[Gideon]

I am having a real issue getting myself dialed in, and hoping someone can point me towards some better settings.   I seem to generally experience 40-60% O/HA during a night, and the remainder is CAs.  Most nights are actually quite excellent, but there are enough bad nights that I feel like its still effecting my therapy.   Going on my third month of use, I am not really seeing any reduction in CAs.  They aren't too bad, but I generally see CAs every night.    

This seems to be further complicated by whatever altitude I am at.  As I have said in a previous post I basically move quite frequently between sea level, 6000 ft (home) and >9000 ft.  

• At sea level I am basically <1 every night on my Aircurve 10 vAuto.  I see maybe one central a night, and a few O/HA.  
  
• At home I am primarily under 5, but can jump over 5 for a few nights.  Centrals are noticeably worse, and on days when I am over 5, they usually make up 0.5-3.0 AHI.  
  
• When I am >9000 ft, anything goes.  My pressures are higher, and I can see anywhere from 0.2 AHI to 12 AHI with a lot of centrals.  
  

Hoping someone has some suggestions.  My thinking is, I set the machine to address my needs at home, but it almost feels like I need different settings at different altitudes.  

I'm going to suggest a different approach going with you assumption that altitude is causing issues.

Can you optimize for 3 different zones, 1st Sea Level which it sounds like you are already optimized, 2nd 6000 ft because it is home, and 3rd, finally 9000+ ft which is your worst.

Given that data see what seems reasonable for a single setting if that is possible.  I know you stated later that you didn't want to micro-manage for altitude.   This should provide info to decide on next steps and worst case you will know what is optimal for you at each altitude.

Thoughts???

[C0mbe]

I am having a real issue getting myself dialed in, and hoping someone can point me towards some better settings.   I seem to generally experience 40-60% O/HA during a night, and the remainder is CAs.  Most nights are actually quite excellent, but there are enough bad nights that I feel like its still effecting my therapy.   Going on my third month of use, I am not really seeing any reduction in CAs.  They aren't too bad, but I generally see CAs every night.    

This seems to be further complicated by whatever altitude I am at.  As I have said in a previous post I basically move quite frequently between sea level, 6000 ft (home) and >9000 ft.  

• At sea level I am basically <1 every night on my Aircurve 10 vAuto.  I see maybe one central a night, and a few O/HA.  
  
• At home I am primarily under 5, but can jump over 5 for a few nights.  Centrals are noticeably worse, and on days when I am over 5, they usually make up 0.5-3.0 AHI.  
  
• When I am >9000 ft, anything goes.  My pressures are higher, and I can see anywhere from 0.2 AHI to 12 AHI with a lot of centrals.  
  

Hoping someone has some suggestions.  My thinking is, I set the machine to address my needs at home, but it almost feels like I need different settings at different altitudes.  

I'm going to suggest a different approach going with you assumption that altitude is causing issues.

Can you optimize for 3 different zones, 1st Sea Level which it sounds like you are already optimized, 2nd 6000 ft because it is home, and 3rd, finally 9000+ ft which is your worst.

Given that data see what seems reasonable for a single setting if that is possible.  I know you stated later that you didn't want to micro-manage for altitude.   This should provide info to decide on next steps and worst case you will know what is optimal for you at each altitude.

Thoughts???

I can try.  The higher I go, the more my nights resemble the three nights I posted earlier today.  The ones posted today were from 6000 ft (home).  Ill be up at 10k next week.  If they aren't real centrals, I can just go with a higher base EPAP for higher altitudes which should take care of the OSA.