Please Review The Data & Give Recommendations

[Hojo]

I seem to go in cycles of good and bad nights, is this common when trying to find the appropriate settings? 

I woke up this morning feeling like I had another good night but the data says otherwise, what do ya'll think needs to be done?

https://imgur.com/a/gRB0b

[OpalRose]

Have you talked to your doctor? Looks like Central Sleep Apnea.

Also, the way the events are clustered, this could be a positional issue. Try sleeping with a cervical collar. I also recommend turning EPR off and see if that makes a difference.

Either way, time to talk to the doctor about possibly needing an ASV machine.

[Gideon]

This is Central Apnea. On this machine you should be fixed pressure or a very narrow band and no EPR. The concept to be to do the best we can until you are able to get a better (ASV?) machine.

I'd suggest 10cmH2O as before then see and adjust from there.

[Hojo]

OpalRose & Bonjour:  Thank you, my thoughts exactly; Central Apnea.  I have an upcoming appointment with my doctor and I have a feeling I will have to direct him towards ASV, which I am ready to do.  Until I see him, I too feel that with the occasional OA I experience I should have more pressure (the low end set at 5 isn't responding soon enough), but what will turning off the EPR do for me, I'm not clear in what it does.

Oh, and as far as positional; YES, I looked at the data when I woke up I was shocked to see how bad the results were, I felt that I had slept well and would have a low AHI. When my wife got up she told me that she heard (and felt) a large leak, which happened to have been exactly when the recorded CA's took place. Since I didn't have a large leak at that time, I told her that it was the exhaust air blowing on her and that I had apparently rolled over onto my left side (I sleep on the right side of the bed). I am in excellent health, cardiac ejection fraction 65%, ride my bike almost every day, not obese. That being said, when I roll over onto my left side I know I get arrhythmias, which is why I probably why I had Central when I rolled onto my left side, but I know I get Central while on my back or my right side (no arrhythmias).

Thank you.

[OpalRose]

Turning off EPR has helped many with CA events. Using EPR may cause CO2 washout, thus causing more Clear airways. It's worth trying to see if it makes a difference for you. It may or may not.

[Walla Walla]

I agree with bonjour about the fixed pressure and no EPR. You might even be able to with a pressure of 9cm or even 8cm.

[Hojo]

I didn't want to make 2 changes so I turned off the EPR last night.  I woke up around 3ish feeling like I couldn't breath and thought for sure my AHI would be high (yesterday it was high but I felt great so go figure).  I was stunned to see the AHI was 2.75 and the CA was pretty darn good.  The one thing that I did notice was my tidal volume was the lowest it had ever been.  Did turning off the EPR do this?

https://imgur.com/a/b0z8F

[OpalRose]

Give it a few days to see if that trend sticks.

In the meantime, you have some leaks to work out. Mabye mouth breathing?

[Hojo]

Give it a few days to see if that trend sticks.  

In the meantime, you have some leaks to work out.  Mabye mouth breathing?

I'm thinking I need to put the EPR at 1 (I started at 2 and then 0 last night) to see if I can get use to it.   I think the added pressure trying to exhale is probably what caused my discomfort when I woke up, and perhaps the air leaks with me trying to exhale even harder? against my nasal pillows???

Interesting observation on the air leaks; I did wake up some what on my face, not entirely, so that may have been part of the issue.  I'm having to learn how to sleep on my side but even with the air leaks, the pressure never went up super high so maybe the leaks weren't as bad as I'd think, just that it was leaking.

Oh, and another interesting observation is the fact that my tidal volume took a nose dive. I'm wondering if it was because I need to get use to exhaling against the higher pressure.

[Hojo]

I had my 30 day visit with the doc yesterday and he was very interested in not ony what I had to say, but what I showed him; Sleepyhead.  I was concerned he might be put off by showing him the data but he was very pleased to see such good info, much more info than what is sent over from the DME based on what they 'see'.

I showed him the data on the CA and my concerns for the possible need for an ASV, and that I understand we need to try other alternatives before making the jump to ASV.  He confirmed that he would need to make changes to my therapy first, which he has done once already, and this would be a second change, evaluate, then move forward with ASV if still indicated.

So, when I first started CPAP I was at a pressure of 10, then switched to 5 and 20 to see if that would minimize CA's.  Last night I was put on a constant pressure of 12 and I below are my results.  First, I'm a firm believer that one data point isn't enough (in this case, one night), you generally don't have a trend until you have at least 3 data points moving in the same direction.

That being said, I noticed some interesting points, the number of CA's went down significantly, but again, it was just one night.  Conversely, the number of OA's went up a lot, as well as the number of hyponea episodes (SIGNIFICANTLY).  This leads to another two questions; 1)  what is the difference between a CA event and an hyponeic event.  I know that with hyponea there is air moving, just not that much, but can the machine really be sure it isn't a central episode.  2)  If you have a lot of hyponea episodes, would that also indicate the need for an ASV machine?

I just had a thought, I wonder if I had more OA's because I slept on my back all night instead of forcing myself to sleep on my side, i prefer my back but have been forcing myself to sleep on my side except last night my hip was too sore to stay on it.

https://imgur.com/a/RcLkn