Clusters of Hypopneas at beginning of sessions

[Sleeprider]

Makes more sense. I would use Ti of 1.8 for what I'm seeing here. That will support your normal respiratory inspiration of 2.4 and might help.

[milesarcher]

Thanks.  I'll try it tonight and post tomorrow.

[milesarcher]

Changed the Ti to 1.8 and results are attached.  I am seeing more RERA than I am used to, is that an issue?  Or should I give it a few more nights to get a good feel for what's happening.

Thanks again.

[Sleeprider]

I don't think that level of RERA is a problem. I note that most, if not all of your hypopnea is during ramp. I think if you can shorten the time, increase the starting pressure, or turn off ramp all together, you will see some pretty surprising results. This chart looks excellent if we disregard the events during ramp.

The change in Ti has significantly increased your tidal volume from 500 to 800 mL. I'm not certain if your doctor wants to target Vt but if this is too large of a volume increase, it is very easy to back off Ti to 1.4 or 1.5 to fine-tune this aspect. The change to 1.8 did eliminate hypopnea during therapy. Other things to note, your respiration rate is high at 38 bpm. This respiration rate does not match the reported inspiratory time of 1.84 + expiratory time of 3.04, which is 4.88 seconds, or 12.3 BPM. So something is in error on the statistics and we need to look closer.

Your inspiratory/expiratory time has normalized with a shorter inspiratory time and longer expiratory time. So something has improved your respiration to a more normal cycle. With the shorter Ti it was exactly the opposite. To interpret any of this, we would need a close-up view of the respiratory flow chart. That would be a zoomed in view to a 2-minute segment. It would be interesting to see the before and after shots for the Ti change. Just looking at the flow rate chart, you have much more consistent looking respiration with the increased Ti. The "hairbrush" appearance is gone, and all inhale and exhale flow now looks much more "solid", meaning breath to breath flow rate is not changing as much. I think all of this points to improvement.

[milesarcher]

I think that I have the charts correct.  Ti10 is before and Ti18 is the after.

I tried to turn off the ramp feature, but the machine just started with a high pressure and tapered down.  Was not comfortable and still had the clusters of hypopneas.  I then turned the ramp start up as far as it would go to 7.0. I will try to shorten the ramp time to see if that helps.

[Sleeprider]

I think just shortening ramp time should do the trick. The close-up shows that respiration has not changed much, but inspiration, lasts longer if anything. The section shown for the new setting immediately precedes a RERA and that is related to the downward sloping inspiration flow (flow limitation) we see, however I don't see an arousal which should indicate RERA. Results here are better, so I think keeping the Ti higher than 1.0 is key, and you can try settings like 1.5 to see if it's more comfortable. I like the absence of hypopnea other than ramp. I'd have to say the sample size is too small to make more conclusions, so you might try keeping things at these settings a couple days before making changes.

[1holegrouper]

I also agree with the sleep/wake junk. I know that the MyAir app algorithm made for a night's sleep seems to adjust for it too. It came to my attention when I would take the occasional nap which always surfaces a higher AHI than compared to a full night's sleep.

[milesarcher]

An update to the changes made on my settings.

Original -> New settings are:
Mode. ST -> (ST)
IPAP. 14.0 -> (14.0)
EPAP. 7.0 -> (7.0)
BPM. 12 -> (12)
Ti. 1.0 -> (1.7)
Ramp 4.0cmH2O for 20 min -> ( 7.0cmH2O for 5 minutes)

Things seem pretty good; a nice improvement from where we started.  Last couple of nights AHIs were .84 and 1.18 per SleepyHead and 1.1 and 1.2 per DreamMapper.  Large leaks were high last night and so I need to work on the mask adjustments (AirFit F10 with a comfort cover). I think also that I dream more now and move around just before awakening.

Thanks again to all.  The ApneaBoard is a great resource with knowledgable members willing to help us new to the Pap journey.

[Crimson Nape]

Looking good milesarcher!
The hypopneas are usually an indication of too low of a pressure. Because they are occurring while you are in the ramp mode, I would suggest that you bump up the starting pressure to around 7cm. . . If you can tolerate it.

[milesarcher]

   It has been a month since my last post.  Things seem to be going well.  I am grateful for all the help, advice, knowledge and opinions that the Board has provided.  I consistently get 6-7 hours of good sleep with an AHI around 1.0.  I started this journey with an AFib diagnosis that led to the sleep study.

Things that work for me that I am grateful that members have shared.

• Sleepyhead
  
• Dr Dakota anti snore collar. (I find more comfortable and cooler than a full collar.)
  
• Xylimelts  (Dry mouth pretty much gone.)
  
• Dr Bronner's Unscented baby soap. 
  
• Melatonin
  
• Mask covers
  
• Magnesium 
  

Again thanks to all.