[Diagnosis] Diagnostic help for Son in law

[b.e.wilson]

My son in law just restarted on an APAP. The AHI isn't bad (2-4) but there are events as he sleeps I don't understand. See images below. Is there a better setting which might help? He's reticent to increase the pressure too much, because at 8 cmH2O his lungs feel "stretched" and hurt in the morning.
Thanks in advance!

   
   

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Sorry, duplicated the image. Here's the one I meant to post:

   

[jaswilliams]

Your son in law is using a very narrow range of pressures, I would suggest a max pressure of 20 no need to have that limited to 6.6 the machine won’t go higher than it needs to more pressure is needed unless there is a specific reason the pressure is set so low.

6cm of pressure is very low even if it does not feel like it at the moment. It’s only like blowing bubbles in a glass of water

[Gideon]

About 1/3 of his Apneas are central.  Based on that he is fine with those settings.  My assumption is that higher pressures may increase his central apnea.

The S9 is an older machine.  What are the total hours on the machine? You bought a new machine right?
Are you self pay or insurance?

Can you post a full copy of the sleep studies.  I would like to see if he had central Apneas then too.

Fred

[Sleeprider]

And yet another opinion...I'm going to fall between the two above. Your son is using a narrow pressure range of 5.5.to 6.6 with an unknown EPR. EPR is clearly on full time and at least 2 cm because the minimum pressure never rises above 4-cm as shown on the Mask pressure line. AHI is acceptable, and primarily obstructive. While there is minor central being reported, we can't really judge if it would increase at higher pressures. My recommendation is to change the pressure range to 6.0 to 10.0 with EPR at 2. This should allow us to see if the OA events can be cleared without increasing CA. I think with this minor increase in pressure range, he can probably achieve an improvement in the results and comfort. The higher minimum pressure should help stabilize the pressure rather than bouncing up and down which can be disruptive. It is important also to hear some feedback on his comfort at these slightly higher pressures.

[b.e.wilson]

Thanks, everyone, for looking at this. One strange thing: the pressure/air-flow profiles for CA and OA events look identical, as are the many unflagged events. They all look the same, or nearly the same. That's what the zoomed-in graph shows. There is a very small periodic fluctuation in breathing after a hypopnea, but not enough for me to call it periodic breathing. I have EPR set at 3 right now. I'll have him lower that to 2, and I'll bring the min and max up a notch each. I don't want to increase the max to 8 just yet until he gets more used to it. He's probably reading this.

He had a sleep study three years ago, but didn't follow up on the diagnosis. He got the machine used (1400 hrs) from his dad and it was so dirty he didn't really want to use it himself. I helped him clean it up and get back on it every night.