[Diagnosis] Chart evaluations please

[harrywr2]

"I zoomed the area of the most events. Does anything look interesting?"

5 events in 5 minutes in an otherwise pretty quiet night...probably a 'chin tuck' as Dormea explained above.

[Gideon]

The guys got this right.  
See how 'smooth' your breathing is to the left of the event, anto the right of it see how the chart has a greater magnitude, and a little rougher.  That is in recovery from this instance of what is IMHO a chin tuck.  

With one instance I'm not in favor of having you use a cervical collar.  If you see more clusters, then definitely.  It's great to see the improvements, congratulations.  
Your numbers are far better than most.  Without some specific complaint to resolve I see nothing to improve.  Without question that may change, but for now you are good.

[Dormeo]

The guys got this right.  

And gals!  

[lacro]

So - I should leave the pressure at the current 7/20. Also, Should I have anything to mention at my Dr's appt. this Thurs.?

[Gideon]

What to mention to your doctor are the negative aspects of your therapy, if any.  Otherwise this is to make sure you are compliant and well treated ( AHI of < 5)

[Sleeprider]

In your physician follow-up, there are two limited objectives.
1. the doctor will discuss your use in hours per day and verify compliance (usually defined as more than 4 hours per day, 70% of the time or 21 days out of 30).
2. That your treatment with CPAP is medically necessary and effective in resolving your sleep disordered breathing.

Both of those will be accomplished pretty easily, so the rest is just up to you. You can ask him to refine your prescription from 4-20 to something that reflects your effective changes, or allows you to make changes as needed. If you want, you can ask for a copy of your prescription for your records. Your therapy appears to be going great and I think rather than focusing on negative aspects of your therapy, a more balanced pros and cons as you presented in this thread is appropriate. I see very little here that merits complaining about the therapy, and expect to see your doctor note, "therapy is effective and well tolerated". I think this is the time to build a relationship with your doctor that shows you want to be involved and in control of your therapy with his input as needed. If he is okay with that, then he is one of the good ones.

BTW, well done on the self-titration and especially getting EPR on full-time. That change has allowed you to resolve the flow limitations and hypopnea much better. I suspect you will eventually find a higher minimum pressure around 9.0 works best, based on your tendency for median pressure at 9 to 10 cm.

[lacro]

Help me understand my newest chart. The first third of the pressure graph is mostly straight line. What does this indicate? Also, I tend to have 2-3 nightly sessions as I wake for bathroom break(s), blow my nose, or scratch my nose, etc. Is Oscar showing all these sessions together on the chart? Only the first and last session are highlighted at the bottom of left graph.

[Gideon]

You have 3 breaks in your charts, right after you started, just before 1am, and the real obvious one just before 330am. The straight lines mean beyond awesome, nothing better. Your pressure is being driven by flow limits. Cant tell why, possibly a result of changing sleeping position, or a change in sleep state.

[lacro]

Fred, thanks for the quick reply. I am trying to understand everything I can about my therapy. I have another question about when to remove the mask and shut the machine down in the morning. I tend to wake sometime between 5-6AM everyday, and I don't often go back to sleep. I don't actually get up till 7-8AM. So my question is should I continue using the machine/mask while I am awake before getting up or is the therapy benefit only while asleep?

[Dormeo]

More about the straight pressure line: the machine will "want" to go to to the lowest setting that is compatible with the events, snores, and FLs it is detecting. So when it is steady at your minimum, that means nothing is going on to drive it up. As Sleeprider explains, your FLs seem to be responsible for much of your pressure variation, where it occurs.