Hit Stuck Point - Need Help

[Sleeprider]

I think you're doing fine, and agree you just need to give it time. As I said, I don't see much difference in the efficacy of the pressures you have used to this point, so use what feels best to you, including flex. I would give things a week to settle down at whatever you choose.

I don't recall if we ever discussed that your inspiration time/expiration time is the reverse of what is normal. We see a lot of people on the forum that have this pattern, and they generally have a more difficult time controlling AHI to low levels, especially hypopnea. There is a certain degree of inaccuracy in how the machines measure this metric, and we don't understand it well. Normal is for expiration to be longer than inspiration. A recent thread may have started to shed some light on this http://www.apneaboard.com/forums/Thread-...ve?page=13 . Ed had a significantly worse problem, but near the end of the thread, I feel may have been a breakthrough for the folks that have persistent AHI related to the I:E ratio. The take-away for you, is that faster transitions between IPAP and EPAP are favorable, and that means a low AFlex or CFlex setting. Hypopnea is a 30% reduction in respiratory volume over the previously registered respiration. http://www.apneaboard.com/wiki/index.php?title=Hypopnea You might want to look more closely at specific events, and see if you see a pattern more closely resembling clear or obstructive apnea. Close ups on the flow rate during events is what to look at.

AFlex affect both IPAP and EPAP transitions, while CFlex affect only EPAP. You can get Cflex by changing mode to CPAP rather than Auto. CPAP pressure is something you may want to try at some point. Overall, it's important to keep perspective you have good, but not great results. They tend to improve. Don't drive yourself crazy over 3 AHI. It's okay.

[RWhipkey]

Thanks Sleeprider

Just the advice and encouragement I needed.

BTW, we have not discussed inspiration time/expiration time.  Thanks for that input.  I'll certainly look at the links.

For now I'll do the following:

1.  Since my 90% Pressure after I solved leaks on 1/24 has averaged 8.35,  I'll keep the Minimum at 7.5.
2.  Since the highest maximum pressure since then was 10.8, I'll raise max to 12.0.
3.  I'll set A-Flex to lowest setting - 1.  (Last option is to turn it off).
4.  Based on this thread http://www.apneaboard.com/forums/Thread-...-Questions and the fact that I had lower AHI's with Optistart enabled, I'll reenable it.
5.  I'll report back in 10 days unless something important comes up.

Here's to patience.

[Sleeprider]

Good luck! If you're a skier, lets meet at 7-Springs or for a beer after skiing one day.

[RWhipkey]

Sleeprider

I would love to meet you.  My daughter and son-in-law live in North Huntington with 4 grandchilden.  I also have 2 sons in Pittsburgh.  I believe I mentioned this in my first thread.  My wife and I are out there all the time.  I'm not a skier though, but can meet you anywhere.  Thanks for your help and encouragement.  Although I'm new to all of this and not well versed, I feel so much better that I have an informed "plan" now.

[RWhipkey]

I agreed to use one setting for awhile to let things "settle down".  Attached are the results of the last eight days on my Dreamstation with a minimum pressure of 7 and a maximum of 11. I used an A-Flex setting of 1 as well.  Optistart was enabled, but the machine never started at anything but a 7 pressure, so I really don't understand what it does.

The positives:
1.  I continue to get used to the machine and have used it for longer periods each night. (with the exception of 2/2 (bad cold) and 2/12 (harsh cough).
2.  Leaks remain totally under control with a chinstrap.
3.  AHI is under 5.0 (average 2.73)
4.  Some nights, IPAP is shorter (albeit marginally) than EPAP (see last night).

The negatives:
1.  Only one or 2 mornings did I feel rested.
2.  AHI is not decreasing.
4.  Sleep is almost always fragmented into 2 or more sessions and the sessions can produce radically different AHI results.

At this point, whille I'd like to see more progress sooner, perhaps waiting is all that will help.

Basically, I feel I have 3 courses of action:
1.  Leave settings as they are and continue them for another set period.
2.  Increase minimum pressure to 8, with maximum at 11 and give it a set period of time.  ( I could also turn off A-Flex if it would help).
3.  Go to a fixed pressure, say 8.0.  This is the least attractive option to me as the machine does move me somewhat beyond that at times and that seems to be the point of APAP.

I have attached 2 nights and their sessions for review.  I would probably miss things other than the basics.   Please give me suggestion on what you think I should do.

Last night (2/12) with pretty good results (I had to shut down the machine for the rest of the night due to a bad cough):


 



And the longest night, 2/6:




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