Almost 20 Years and I need help - CA with a BiPAP and I'm still tired

[Kernelhappy]

You're suggestions have improved me from a 8 to 1.9 AHI index so I'm going to say yes, I will try a PS of 5.  But I have three questions

1. Should I do it tonight, or maybe wait a day and see how last night's setting works tonight?
   
2. My Max PS is currently 5.0, should I raise that as well, otherwise it'll be PS Min 5, max 5
   
3. Also, can you point me to some reading material that explains how the PS setting works?
   

Thank you again for your help.

[Gideon]

PS is from basic BiLevel
BiLevel is 2 defined pressures, one for Exhale Pressure, EPAP, and a typically higher one for inhale, IPAP.
PS or Pressure Support is defined as the pressure difference between Exhale and Inhale.
In a BiLevel EPAP is the base pressure (unlike CPAP where the IPAP is the base) and is used to treat Obstructive Apnea.
The PS or pressure support is used to treat hypopnea, flow limits, RERAs, Snores, and UARS

In "manual"/spontaneous/"s" modes the two pressures, EPAP and IPAP, are set and not the PS
In "auto" mode the min EPAP, max IPAP, and PS are set. The EPAP "ranges" to minimize events and the IPAP follows the actual EPAP pressure where IPAP = EPAP + PS

[Gideon]

If you want to wait a night or two not a problem.

On min PS = max PS =5, i'd rather see a constant PS that is working for you first then go to the variable for comfort.

[Sleeprider]

Just a reminder here, we have the option to move at 0.5 cm increments on PS with the Philips. I think that with results getting close to ideal, and increase in PS may be a good idea, but I favor smaller increments, i.e. 4.5.

[Kernelhappy]

Thank you for the explanation on the PS.

I managed to stay awake long enough to read your response and increase the PS Min to 5.  AHI last night went up to 5.0 from the previous 1.88 but overall the quality of sleep felt the same as yesterday (say maybe a 6 on a scale of 1-10 compared to a 7 the night before).  It's not like I actually know but I feel like the PS change is not likely to have that big a negative change and some other factors came into play last night.  

How much better can I really expect my AHI to get to beyond the 1.88?  Am I at the point where maybe I need to average results over 3-4 days to really see what to do next? I mean I'm not having memories of waking in the middle of the night like I did without treatment, so I'm definitely getting a better sleep, but I'm still not feeling well rested.  It's at the point where I at least feel a benefit of using the machine but I just long for at least an occasional morning where I wak up and feel like I got a good nights sleep.  As I'm typing this I'm sitting here yawning away.

Thanks as always to everyone, this is real progress that I know I would be having without the advice/support.

[Kernelhappy]

Update:

Lat night I split the difference and set the PS Min to 4.5 just to see if I noticed a difference, I think I imagined it seems a little more gently about switching IPAP/EPAP (the ps min/max 5 I noticed the first night MIGHT have been a little more abrupt), but I really think I'm imagining that.

My AHI was 6.05 with more CAs, but overall my sleep quality was better than the previous night.  I think the charts really show what would be described really mixed apneas, and I noticed that my centrals came in groups.   

I broke down the timeline as best I could see from the chart without actually knowing wth I'm looking at.  I was hoping to correlate either my sleep cycle to events or some other pattern. Best I can come up with is that my alarm clock goes off at 5:00 am and I have a pattern of 3 CA's similar to the groupings earlier in the night.  Is it possible my CA's are linked/triggered by an external arousal?



Date T0:00 + Note
22:50  0       Start
22:54  4        OA then smooth flows begins
23:20  30      Cluster of 3 CAs and one OA , third is labeled OA, looks the same as other two from flow
23:25  35      OA, flows between are more rhythmic with a ~1 minute cycle between heavier flows,  but without events
23:46  56      Flows even out, two small blips at 00:28 and 00:42, no events registered
00:50  120     CA, even flows resume
00:55  125     OA even flow resumes
01:04  134     Series of RERA followed by OA, even flow resumes
01:25  155     10 minute period of mixed begins
01:34  164     Even flow resumes but higher volume for next 17 minutes
01:50  180     Cluster of 4 CA's over 2 minutes, followed by one OA 3 minutes thereafter, even gentle flows resume
02:32  222     OA and CA, even gentle flows  resume
02:43  233     Mixed apneas, even flow resumes, higher amplitude
05:02  372     Morning Alarm goes off 5:00 AM, cluster of 3 CA's, overall flow was even from 2:43 to: 5:02 safe for a couple minor CA/Oas that did not significantly change flow pattern