Fine tuning help please

[Slim1950]

In general, the BiPap machine has been a gift to me. 10 years ago, I was prescribed a CPAP machine, and the only way I could get a decent sleep with it was with 10 mg of Imovane every night, and after 1 year their effectiveness wore off, and I just quit the machine altogther. I don't know why, but my apnea condition seemed to change, and for 8 years I managed to get by without the machine. Then the apnea came roaring back. Woke up with headaches every morning, would drag myself to work.

A friend of mine is a dental surgeon, and he made me a dental device, and for about 3 month, it helped, but then, once again, it lost it's effectiveness.

Started the whole sleep study over again, different doctor, I explained at length how I could not sleep with a CPAP originally; the doctor tried to understand, and subsequently prescribed an Apap machine for me. Tried to use it again and again. No use, I could not sleep, because I could not breathe.

I was put in touch with the owner of the sleep lab, who does one on one councuting with difficult clients. He looked down my throat, saw immediately that I had a very narrow air passage and an enlarged uvula. He said, "It's very obvious - you need a bipap machine"

I got that machine, and wonder of wonders, I can breathe! What a godsend.

OK, to the present day. I still average anywhere between .5 to 1.5 AHI per hour during my sleep.
My pressure is between 4-12, with PS settings at 4 epap and ipap at 6.

I have read here in the forums that the number of AHIs I am having is really insignificant. Yet I do still often wake up with a headache because the last AHI I have will cause me to walke up at times.

I don;t think I totally understand what PS does. SHall I slowly increase the range of PS to eliminate the AHI altogether? I will try to attach my SH charts in my next post, and wouldn't mind if one of you more experienced guys can help me to eliminate my events completely.

BTW, I was told by my sleep doctors (3 different ones) that 30% of their clients never adjust to the machine and stay non-compliant. I have found that they simply do not take the time to determine what the actual problem is.

[Slim1950]

http://i.imgur.com/ao1r7pT.png

[Sleeprider]

Hi Slim, welcome to the forum. Your machine appears to be a Philips Respironics System One (PRS1) 60 Series model 760 BiPAP. This is an auto bilevel machine. Pressure Support (PS) is simply the difference in pressure between IPAP-EPAP. In your case you seem to be using a fixed pressure support of 2.0, and we would abbreviate your current prescription as 12/4 PS 2 (IPAPmax/EPAPmin, PS xx).

Your pressure does not seem to reach the IPAPmax very often, and on the graph you posted, pressure was as high as 11/8.5. The saw-tooth pattern on the red IPAP line is the auto algorithm evaluating pressure increases of 1.5 cm. These occur through the night about every 40 minutes. Most of your pressure increases are related to snores, and your AHI consists mainly of hypopnea.

Your machine has a variable pressure support feature in settings; both a PSmin and PSmax. It appears they may be set the same at 2.0 currently. Your therapy is excellent, and there is no need to make a change; however if you want to try to treat some of the hypopnea, it might be useful to increase PSmax to 3.0 (increase by 1.0). There is no obstructive apnea, so increasing EPAP min would only be done for comfort if you don't feel you get enough air delivery at the lowest setting. You didn't mention that to be a problem.

Take a look at the links in my signature. The describe how to better organize the charts. Including summary information from Details in the chart would be more useful than the events summary.