Not able to bring my AHI reading down

[OpalRose]

Hi Cliffh,
Great results.  

It looks like your minimum pressure may need to be closer to the median pressure which is around 12cm.  You can run with the current setting a few days to see if AHI lowers any further, or you can start to raise the minimum pressure slowly by .5cm daily until you see a decrease in the Obsructives.  If you start to see a rise in Clear Airway Events, then either back off on the minimum pressure a bit or my preference is to set EPR to 2 or 1.

Next time you post data, you only need to show the following graphs:  Events, Pressure, Leak Rate, Snores, and Flow Limitation.  Include the left sidebar as you did above, but you can leave off the pie chart.  The rest of the graphs aren't needed unless we see a problem.  This way, you whittle it down to one graph.  

Good luck and don't make too many changes at once.

[Ron AKA]

OpalRose has given you some good suggestions. On the SleepyHead charts if there is anything you can do to show more vertical height it would be helpful so you can put more variables on one screen. Might be the limit of your computer if you are going full screen before you capture though. You can click on the grey bars between graphs to drag them larger or smaller. 

The pie chart is tricky to disable. Go to File, Preferences, Appearance, and uncheck the box that says show pie chart.

As for variables to show, I like to put Pressure at the top but under the Event Flags, then mask pressure next, Flow Limitation, Snore, Flow Rate, and Leak Rate. The reason I like to see Flow Limitation and Snore is that they are used by ResMed to bump pressure up, as well as OA events. It lets you see better what is going on. But the most important one for now is Pressure, if you could post a chart that includes Pressure, it would be helpful in picking a minimum and maximum pressure. Some do it with the Statistics text box numbers, but I like to see it on a graph.

[Cliffh]

Ok, I have taken "Squeeze" to the limit, and fitted it on 1 page now.
Hope you are able to decipher what's going on.

[Apnea Infant]

Cliffh

First off, Welcome to the Forum.

Secondly well done on your great results and length of sleep through the night in such a short time.

Thirdly congratulations on getting to sleepyhead display so quickly.

I say the above as most of us, myself included, do not 'get there' so quickly. But then all of us are different. No question here in this forum is a silly question. There is a lot to learn and it is a continual process and the jargon and the charts can be really daunting when we are new to it. I know I was but soon we learn to understand it.

It is clear that your obstructions are in clusters and as noted by Opal Rose and RonAKA these are usually positional with back sleeping and also chin tucking. I use a soft cervical collar to knock my final OSAs off. Try it to see if you can tolerate it.

Your EPR is set at 3, so therefore your EPAP is 16-3 = 13. Rather than increasing your min. I would suggest reducing EPR to 2 and then 1 to see what that does for you. With that your EPAP would be 16-2 = 14.

I started with a titrated level of 16.8 but could not tolerate the high pressure and was advised to turn on EPR. However with sorting leaks out and finally turning off EPR I was able to very slowly reduce down to my current level of 11.2. This was gradual through weeks and months with monitoring the sleepyhead data.

Now with a cervical collar I can return to bouts of back sleeping-unaware during the night- and yet achieved 0 AHI last night. I recommend the collar highly as I know I tuck my chin onto my chest as I drift off to sleep and this is what produces my obstructions, along with my neck physiology.

One last thing, I know you are changing your stats but it would be good to alter your information as you change your pressures etc it as it helps others to quickly assess where you are at.

[Walla Walla]

I think a soft cervical collar is the way to go here. You have clusters of obstructive events which can be caused by tucking the chin down and in, cutting off the airway. No need to change the EPR. I'd try the collar first before increasing the pressure any more. You can pick up a collar at any drug store or online at Amazon.

[OpalRose]

We need to work on the obstructives. As stated previously, this look mostly positional. Are you sleeping on your back? If yes, you will definitely need to use a soft cervical collar to stop chin tucking.

The minimum pressure needs to be increased to help with obstructives.

Look at the stats on the left side bar, and the median pressure should guide you where it needs to be set. But do this slowly and try the collar too.

The machine will raise pressure in response to flow Limitations and snores. You can see this on the charts. This is also an indication that the minimum pressure should be bumped up.

As far as EPR use, in your case there is no clear reason to change it, unless you see an increase in Clear Airway events. If you do change it, set it to 2cm.

Graph layout is squeezed together too much. My recommendation: Eliminate the mask pressure graph.

[Ron AKA]

Ok, I have taken "Squeeze" to the limit, and fitted it on 1 page now.
Hope you are able to decipher what's going on.

Excellent layout, and one of the easiest ones to decipher that I have seen. If you want to stay with the EPR at 3 you need to increase your maximum pressure. Virtually all of your events are occurring when the pressure is maxed out. It looks like you have near zero leaks, so your mask should be able to handle it, if you can. I would just increase the maximum to 20 and see what happens for a few nights. You should get a significant reduction in OA and H events.

I have done a fair amount of investigation on the pros and cons of EPR. In short without EPR your maximum mask pressure will be lower, but your comfort level may to lower too. No EPR can be easier to get a mask seal with, but you don't seem to be having trouble there.

[Cliffh]

Thanks "Apnea Infant" and all the other guys and girls. That was very informative especially about the EPR.
(Still do not know what it stands for though)
I am really impressed with my readings so far. Getting better by the day.
Someone asked me to display settings as and when I make changes so that they can ascertain what the effects are.
I notice that every day these changes are displayed on the left in the Sleepyhead report.
Managed to get a soft collar so will try it out tonight and show the results tomorrow.

Greetings from Sunny South Africa.

[OpalRose]

Cliffh,

EPR  From the Wiki
Exhalation pressure relief is a CPAP feature that lowers the pressure on a CPAP machine when the patient exhales in an effort to make breathing more comfortable. CPAP machines provide continuous positive airway pressure, making it easier for the patient to inhale, but harder to exhale. Exhalation pressure relief generally offers three possible settings: 1, 2 or 3, with each number signifying the degree of pressure reduction. (A setting of 1 provides the least pressure relief; a setting of 3 provides the greatest relief).

There are several brand-specific terms for exhalation pressure relief. ResMed uses the term EPR. Philips-Respironics uses the term A-Flex for its APAP machines, Bi-Flex for its BiPAP machines, and C-Flex for its CPAP machines.

More good reading:
http://www.apneaboard.com/wiki/index.php...SleepyHead

[Ron AKA]

Thanks "Apnea Infant" and all the other guys and girls. That was very informative especially about the EPR.
(Still do not know what it stands for though)
I am really impressed with my readings so far. Getting better by the day.
Someone asked me to display settings as and when I make changes so that they can ascertain what the effects are.
I notice that every day these changes are displayed on the left in the Sleepyhead report.
Managed to get a soft collar so will try it out tonight and show the results tomorrow.

Greetings from Sunny South Africa.

 
OpalRose had given you a good explanation of what it is. Not all manufacturers do it the same. If you want to know more of the detail there is a good article about it. Google the title of it below to find it.

Comparing expiratory relief in different CPAP machines