Just getting into this . . .

[ntntnt58]

I have a similar situation to yours, where my VT/MV and RR are always falling too low, but my problem is entirely psychological. After reading about you throwing stuff across the room in your sleep I would strongly suggest you try sleeping with a nice dose of anti anxiety meds (pills or herbs  ), even if you don't feel like you have anxiety. If everything improves, then you know it's psychological.

[ajack]

I don't think just a psychological issue, is causing the problem you are having, too. Any medication for it, could possible cause an issue.

[TSVanwinkle]

Have attached a screenshot of the non breathing incident from several nights ago.  As mentioned in the previous note, I unfortunately did not have the Oximeter at the time this occured.

[ajack]

How are the periods of low breath rate, minute vent and tidal volume going? They can't be too bad, or you would have posted those.

There would have been a desaturation. The 3 here are obstructive, 2 OA and a H, that was clearing. You can see the rapid breath at the end, when you would of aroused. The 20cm couldn't clear them. The rise in min epap. I would accept the little group, as 'stuff happens' When the AHI is 0.35. I would think it was positional, because of the length. Not just moving around in bed and holding your breath as you turn etc. I don't think I would work on fixing positional stuff either.

Now that you are settling in to this, it might be time to open the max ps18 of the machine, up to it's full range of 25cm. the extra 3cm isn't going to do much, but it just may be the difference here and there.

[TSVanwinkle]

re max ps;  Just to be sure I understood your last post correctly:  My current PS settings are 1.0 - 15.0    You are suggesting changing the upper number from 15 to 25 or 18?

[ajack]

I think with min epap 6 the max PS is 18, that will give the machine a range up to 25 or 24. From memory it didn't add up to 25 but 24 in the settings. I would just dial up the MAX PS as far as it will go.
This is supported by a tech, put this into youtube and start at 12 minutes
Bilevel and ASV Titrations: Pressure Changes for Technologists and Patients.

[TSVanwinkle]

Sunday Night:

I set PS max to 18.  The highest level it will go is to 19.  I hadn't seen your reply before hitting the sack so I went with 18.   There seems to be quite a difference between Sat and Sun sessions.  I have posted a number of charts for both nights and now that I have managed to conquer the Oxymeter, I brought it into the charts just below the minute Vent and TV strips.  Looks like I had a higher number of events all around on Sunday as compared to Sat, especially the amount of o2 flags.  I would be of a mind to try it once again tonight at the higher PS max level and if things are just as "noisy"  I think I will need to back PS max down again.  I can't account for the difference, otherwise.  I had no mask leaks and stayed pretty much on my right side all night.  There was one period where the Oximeter finger probe decided to wander off to  somewhere else in the bed.  I eventually discovered that when I got up to make a w/c stop.    The oxymeter -- is a whole different subject to discuss. Let me know your thoughts.

Thanks, Mate

[ajack]

If you want accurate, I would download the ResScan software. The pressure chart shows 23 and the table shows 21. I use oscar for simple to look at, I use ResScan for stats. You can also change how ResScan charts are displayed, in th settings

The increase may have helped the H at sun 1:56, It can't do anything for the cycle down in resp rate and minute vent. These happen way below the max pressure. The good news is that you are staying above 92% in the bad bits and average higher. This could be why the lab didn't take it further.

[TSVanwinkle]

Thanks to this forum and in particular Ajack's valuable input, I have made steady improvement with my Resmed Air Curve 10 ASV.  If AHI was the only score that counts, than last night would be a home run, with a zero AHI number.  Two adjustments, one on the machine where I raised PS Max to 19, the highest it can go, as per Ajack's recommendation and one positional, where I raised the head end of my bed by appx 3"  roughly 2 degrees.  I think that combination helped lower the number of flow limitations I have been experiencing. The only thing waking me last night, as it does fairly often is  aching shoulders from side sleeping.  The graph clearly shows my two"shoulder relief rollover" events: 1:30a and again at 3:25a.   The rest is more peaceful than a few weeks back. [attachment=12344] I had hoped the five inch side sleeping topper would be enough to help with the shoulders.  Any advice on that would be greatly appreciated.

-VanWinkle

[ajack]

It might have been the shift in posture? It wasn't the increase in PS. The max you used was PS 9-10. The PS will be there, if you have a rough event or night.

Alternating pressure reduction mattress or topper, might be worth considering. My dad's was so good, I got one. Be one of those customers and go and lay on one for a few hours in a showroom.
https://www.newleafhomemedical.com/alter...attresses/