Please Review The Data & Give Recommendations

[Sleeprider]

Yes. Max at 8. It will either provide great relief and confirm CA or you willl have more OA. Let's find out.

[Hojo]

I just read this:  Note: Any time the CPAP machine is turned OFF and then back ON, the AHI graph is reset to 0 because a new session has started. My question is, does stopping the machine (not fully turning it off) to reset the pressure, also affect the overall AHI score?

[Sleeprider]

Stopping the machine resets all pressures to the starting, lowest pressure including ramp if enabled. It does not affect the overall AHI score, but resets the session. In Sleepyhead you can review sessions individually or as a noon to noon period. As long as all sessions are selected, you get the statistics for the current day/night.

[Hojo]

Here are the results from last night;

https://imgur.com/a/JHMl1

[Sleeprider]

Well I think we have come full circle and narrowed things down a bit.  You started off with settings of 5-20 and EPR at 2 and had lots of CA with AHI at 12.66 and max pressure never went above 10 cm.  At fixed 10/8 (EPR 2) AHI was 8.2 with about half OA/CA, but good tidal volume at 480 mL and respiration rate at 13.

At fixed 12/10 (EPR 2), you had 7.66 and were uncomfortable with exhale, and events were mostly hypopnea with some OA, and your resp rate shot up to 39 BPM and minute increased to 10.25 (tidal volume was cutoff in chart)  

At fixed 8/6 you slightly increased events to 8.29 with an increase of OA vs H. Leaks are not a problem, but you have a lot more FL and snores as well as low volume during periods of obstruction.  Your minute rate was 8.12, tidal volume at 300 is not ideal, and what is up with that respiration rate of 24.8 BPM...  

I'm a little frustrated that we are not making positive progress. Your results are all over the place, and are contradictory to expectations.  For example, I usually expect to see fewer central events at lower pressures and fewer obstructive at higher pressures.  I can't explain what is going on with your respiration rate that appears to become erratic at higher pressures.  I suspect this is an error but would need close-ups of the flow rate to see what is happening, and why did this happen at 12 and 8, but not at 10?  

I think going back to auto pressure at 8-14 with EPR at a comfortable level may be the best I can suggest right now.  You need to have more time at settings to see what the impact of that setting is, rather than reacting to one night as we seem to be doing now.  If things don't settle down to a comfortable and effective level, you may need a professional titration study where alternatives can be looked at.  As I recall, you had two sleep studies, and in the first study, you were found not to qualify for CPAP, and in the second, CPAP was recommended at a pressure of 10.  The inconsistency is continuing. Very puzzling.

[Hojo]

Sleeprider:  What is puzzling to me is how much you can remember, geez, I have a hard time remembering yesterday!  I think one night or one sleep study doesn't result in a trend.  I'm sure that most people have good nights (low AHI scores) and some have bad nights.  For me, I can't help but think that my AHI (even before CPAP) waxed and waned and the more I'm on CPAP, the more my results will reflect that.

I think we both believe that the higher pressure is not tolerated for me, and that too high of pressure can cause more CA's, but why did I suddenly have a drop in the number of CA events, it might just be one of those things for me.

[Hojo]

So last night I changed my settings to 5-15 and increased the EPR to 3, hoping to have some ease in exhaling.  Once again I continued to wake up not being able to exhale with the higher pressure.  While the AHI was below 5, my sleep was HORRIBLE and I finally gave up on the CPAP at 03:00.

In order to determine the exact time and pressure that I woke up, I reset the machine, which I had to anyway in order to exhale and start breathing again.  I'm thinking my respiratory rate is directly related to the inability to exhale, and that I need more EPR and/or BIPAP. 

https://imgur.com/a/Wir8I

[Sleeprider]

You may want to confirm that resp rate of 50. If it is true, please consider going back to my previous advise to seek medical help.

[Hojo]

As for as medical help, I'm in great shape, I do a lot of training on my bike, I'm not overweight, I did my second Bataan Memorial Death March this past March (full marathon) with a 35 pound back pack;

http://bataanmarch.com

I will be also doing a Duathlon in November (but letting my adult children do the run), last month my ECHO was outstanding, my resting heart rate is 47.  So all the docs agree that my health is great and that I just need to work out the kinks with the sleep apnea.

[Sleeprider]

Hojo, I believe you, but for some reason, you are experiencing a side-effect of CPAP therapy that isn't common. You are probably better off without it pending a determination of what will work better. It appears that something like ASV or a bilevel device with more pressure support and low EPAP will work for you, but 50 breaths per minute is bad! It's like an allergy to penicillin, it has nothing to do with how healthy you are, you need a different treatment.

Very impressive with the Bataan death march stuff. I'm more of a Hashtown Harrier...a drinker with a walking/running problem.