Please Review The Data & Give Recommendations

[Fixit50]

This sounds really good to me!  
Just curious though since my flow rate waveforms often look a lot like yours, did you expand your flow rate around areas such as 23:15, 00:55, 04:30?  Did it look like a normal breathing pattern?

[Hojo]

This sounds really good to me!  
Just curious though since my flow rate waveforms often look a lot like yours, did you expand your flow rate around areas such as 23:15, 00:55, 04:30?  Did it look like a normal breathing pattern?

I'm sorry, I don't know enough yet to interpret the flow rate data, other than I believe that I moved around a lot last night. 

There were times as I was falling asleep that I felt I would have liked a bigger push of air, like faster inspiration.  I was feeling a bit claustrophobic which may be why I wanted a faster breath.  Overall I was pleased that I had absolutely NO central episodes and only 3 Hypopnea events, and the biggest thing; I felt good when I woke up.  I was not gasping for air after a bunch of CA events and my blood pressure wasn't up from CA events, hence, it was a good night.

[Fixit50]

Sounds outstanding to me! As i recall you used to have a whole bunch of centrals. I'll bet you're going to feel like a new person!

[Hojo]

I would like to know if it is possible to see from Sleepyhead if the machine is kicking in for a CA event.  I see I've had a few hypopnea events (well controlled) but would kind of like to know what the machine is doing for and when.  If I am able to know such data, I'm assuming that I could fine tune the pressure/PS to a bare minimum and give me too much of a good thing (dependence).

[Sleeprider]

Hojo, if you make a chart with the events, flow rate and mask-pressure, you will easily see the machine response on a breath by breath basis. The pressure increases are most visible in the mask pressure graph. You can also include graphs of resp rate and minute volume to see the effect on your respiration.

[Hojo]

Sleeprider:  You mean like this; it shows just prior to the hypopneic events and while we can see the 'flow rates' etc, I can not appreciate what is my own respiration vs the machine kicking in.

https://imgur.com/a/FsGRu

I'm suppose to be on EPAP of 5 but at least when falling asleep, I prefer 4 (would like to go lower) to make it easier to exhale.  Conversely, I want to make sure that I have enough pressure during inhalation;   What I want to make sure of is if I keep the EPAP pressure low, will I be able to get enough air or will I peak the machine out on my tidal volume unless I have more PS. 

Call me paranoid, I felt like I was sleeping with a pillow stuffed down my throat on CPAP the last few weeks.  At the same time, I don't want my muscles to get lazy so I don't want any more pressure or rate, than I absolutely need.

[Sleeprider]

It would help to see the Flow Rate and Mask Pressure and Pressure on the same chart. Flow rate is your respiration, while mask pressure and pressure are the machine response. These charts only gave us one out of 3 useful charts.

You are getting 8-10 pressure support on each breath here, and it's obviously working. As you zoom out, your will see where pressure support is near your minimum of 3, and other times when it is near the maximum like in the posted example above. You need to look at this with the Flow Rate and Pressure to really appreciate what is going on, and if you are responding to the pressure.

[Hojo]

Sleeprider:  Sorry for the delay, is this what you meant, I moved the RR, Press, Flow Rate, and the Mask Pressure all on the same screen.  For last night I lowered my PS from 3 to 2.8 and I had 1 hypopenic event (I'm now at 3.75 H events for the last 4 nights, along with more sleep time and much better quality sleep).

What I can appreciate from the graph is a very fine tooth shape waveform with the Flow Rate and Mask Pressure, leading UP to the hypopenic event.  Shortly before the recorded event the waveform changes from quick spikes to more of a sine wave form, not perfect sine wave but it looks smoother.  I also see the pressure goes up, so I'm guessing it is at that point that the machine is sensing my central events and kicking in, correct?

I think I mentioned that I don't want to be completely dependent on the machine for all my breathing, the abdominal breathing muscles need to get a work out each night, nor do I want to be starving for air because I don't have enough pressure.  I'm not sure yet if I need a PS of 3 (ordered) or just the back up rate, I guess time will tell.  I'm willing to start dropping my PS, last night I went from 3 to 2.8 and while it isn't enough data points to draw a conclusion, my RR was reasonably similar, while the 95% was just slightly up.  The tidal volume was the same.

I also am curious to see if using ASV is aggressive enough to prevent my OA events that are caused by the FFM...the chin strap draws my chin down and that is when I get OA events, with the collar on I have zero OA events.  

https://imgur.com/a/AyrV1

[Sleeprider]

This is a really good graph on several points.  In this short segment we can see the machine varying pressure support in response to your breathing.  It is actively helping you set the pace and volume of each breath.  The bottom of the mask pressure line is your minimum pressure of 4, while the peaks show your EPAP+PS which appears to be in the range of 5-9 cm (IPAP 9-13 cm).  It's working well, and although the breathing flow rate is irregular, you are breathing!  This may have been a central except for the ASV.  The machine is pacing you here, and keeping your volume and flow more or less steady. 

You can improve the flow rate graph by right-clicking on the left near the title, and formatting the Y-Axis to have a minimum of -80 and maximum of +80 and adding a dashed line at zero.

[Hojo]

Yes, I see what you are pointing out.  Very interesting, and wow, I feel so much better, I'm not getting up at wee hours of the morning. 

I'm not trying to push the device to get me to an AHI of 0, I'm more interested in sleep quality with minimal mechanical exposure.  I may try sleeping without my cervical collar tonight to see if the machine will still prevent OH events.  It would sure be nice to have one less thing to pack when I travel.