I just completed my first week of using a machine. What does this data tell you?

[Max Maker]

I am 31 and have been feeling tired for the last 5 years. My first sleep lap in 2017 didn´t find anything. Last year I just bought a Bilevel Philips machine to try it out out of the suspicion I might have central Apnea, but ended up not using it. This year I got another sleep lab and they diagnosed OSA with 38AHI.

So I dug out my machine again from under my bed where it was sitting for 12 months and started using it. I set it to 5-12cm. No idea if that is right or not. Hopefully you can give me some advice here. There are a few settings that I don´t know about. I checked my SpO2 with a finger sensor and my fitness tracker and it seemed to never go below 94%. 

Overal I can get used to this. Last night I didn´t even notice the pressure or noise anymore and thought for a moment it was turned off. 

So what can you tell me about those screenshots? Thank you!

[Dormeo]

It sounds as though you're adapting well to PAP, which is good news.  Your charts show that central apneas predominate, and you also are seeing a fair number of hypopneas.  

Could you zoom in on some of your centrals to see whether they look like the attached?  You're looking to see whether your typical central events follow breathing that is less regular and has increased flow rates, like the sample.  But maybe they don't exhibit that pattern at all.  Either way, it'd be useful to know what the typical pattern is.

Please post a zoomed in view like the sample when you have a chance.

[SarcasticDave94]

I'm a bit concerned with that Central aspect myself. A bit higher than I'd prefer to see and they show rather too consistently.

2 things to maybe consider, maybe do straight 3 PS instead of 3-4 PS and another maybe is increase the EPAP to 6 and see if the events overall are controlled a bit better. Respironics needs a bit tighter start pressure, as in it needs to be closer to your needs. These Respironics are slower to respond to events and to remedy this, pressures tend to be required to be a bit higher than a ResMed unit.

[Sleeprider]

If you have central apnea, a BiPAP without a backup rate is not going to help resolve that. It sounds like your are self-diagnosed, although your sleep study indicates OSA with a AHI of 38. I'd be interested in seeing the actual results, especially the breakdown of central and obstructive apnea. Meanwhile you are using PS 3.0-4.0, and I think we should keep your same settings but cut back pressure support to 2.0-2.0. Let's see if we can reduce the CAI with less pressure support and go from there.

[SarcasticDave94]

Good point Mr. Guru, this could be self-diagnosed. CA cases mostly ends badly on non-backup rate BPAPs for certain. I'm slipping a bit...

[Max Maker]

https://postimg.cc/gallery/g3ZYgtq

Thank you for your advice, I uploaded the data from last night. One overview and two zoomed in CA events. 

I will change the pressure support to 2.0-2.0 tonight. 

I was in a proper sleep lab, and this is the result: 

"Two-cycle sleep profile with reduced REM and greatly reduced slowWave sleep. Microstructure clearly disturbed in phases by arousals. In terms of respiration, especially in the supine position, flow and saturation curves are unsteady in the form of hypopneas and obstructive apneas with subsequent 02- satiety dips up to 94% and heart rate accelerations.
AHI: 20.40 / h, supine position-AHl: 32.97 / h, REM AHI: 38.33 / h, minSa02: 94% “

They invited me for another two nights in June where they try out some machines, although I don´t know which ones. 

[Sleeprider]

Looking forward to seeing if reduced PS helps this situation. In cases like yours, a titration test can be helpful provided they are prepared to evaluate and treat CA events.

[Dormeo]

The zooms show arousal-type breathing before the CAs. So probably the deeper breathing is washing out enough CO2 to reduce your drive to breathe. Lowering the pressure support as Sleeprider has recommended might resolve the CAs. The question would remain why you're experiencing so many arousals; the answer might be just that you are still new to this and will sleep more soundly as you get used to it.

[Max Maker]

I followed your advice and set PS to 2/2. I tried it out for 2 nights and the CAs really went down by about 1/3. 

However, Hypopnea increased by about the same amount. Any advice on how to improve this further?

Thank you so much to Dormeo, Sleeprider and SarcasticDave94! 

  
[url=https://postimg.cc/dkwT3TQT][/url]

[Dormeo]

That's progress! It would be helpful to see the whole night as well as those two zooms, if you have a chance. (And for me at least, it would make for easier viewing if you could attach screen shots instead of using postimage.)

My own sense is that you should stick with your present settings for a while longer, to see how it goes as you continue to adjust. Hypopneas went up only a tick, but as you note, centrals went down nicely.