Seemingly little correlation between EPAP (or PS) and AHI or flow rate. [UARS]

[Geer1]

Overall that night looks good and the backup rate does just enough to keep you breathing. The hypopneas are because we have handcuffed PSmax so machine has limited ability to resolve central apneas. Higher PSmax would probably get rid of these hypopneas but overall I don't think it would be worth it.

You will always have some number of timed breaths because that is the machine fighting your centrals.

You can see how on this night your average PS was lower (3.3) but you do have higher PS for extended times when restriction is present. That is all working as I had hoped it would. Stick with it for a week or two then we can look at data and get a better idea of whether you feel on average these settings are an improvement.

[ldinks]

I agree the night looks good! 

I won't say too much on last night, individual days aren't necessarily important. I didn't sleep enough hours, but felt similar to after the first night, relatively good. Which is nice! To note: 

- PS was at 4 almost constantly. 
- Flow rate looks decent most of the night. Some extremely consistent areas.
- 220 timed events, 51 more than last time. 

Still happy to continue as usual. I wonder why PS was almost always at 4 though compared to yesterday. Seems like there's something that bothers me some nights, not others. 

I can't attach last night due to hitting a 15mb limit. Is there anything I can do, eg delete irrelevant old uploads or something?

[Geer1]

I think when your PS flatlines it is due to restriction not centrals. For example looking at your most recent data posted the period from 6:30 to 7 flatlined, had no timed breaths and no PS fluctuation like one would expect from centrals. With centrals the pressure should be going up and down and you should have timed breaths present for example the section from 5:15 to 6. For further information your best breathing is times like 2:15 to 2:30 where flow rate looks good, there are no timed breaths and PS stays low, this is because your spontaneous breathing is meeting the requirements machine is targeting.

Not sure about the upload limit as I have never had that problem. I thought the forum automatically deletes old uploads as you upload new ones unless that has changed.

[SarcasticDave94]

If you're hitting an attachment limit, you have to go to your UserCP and find your attachments area. You'll need to manually delete least needed ones. Maybe your oldest ones.

[ldinks]

Thanks Dave! Think I've sorted it now.

Geer1 - Most days had the med PS of 4.0 or 3.88, indicating that obstruction. Most days appear really similar, data-wise. I've felt worse, and colleagues have said I seem more tired than usual. Should I raise PSmax?

I'll attach last night and a zoomed image from last night. The zoom shows flow rate at PS 2.5, which looks slightly off to me. I feel like it might make more sense to try a higher PSmin as well, if the flow rate does indeed look a bit off. 

Also to note: I slept without a pillow for one night, just to see how I felt. The data looks worse, and I felt like I do on my worst days with the machine (and like how I felt before getting the machine). I couldn't get out of the bed after 8 hours of sleep and awoke after 12 hours instead. In a strange way, it was quite motivating to try to figure this all out.

My machine seems to make me feel so much worse if I sleep on my side. My partner recently told me that sometimes they move me from my side onto my back again - so I'm naturally going onto my side. I'm not sure if the side sleeping might be playing a role in that obstruction causing a constant PS of 4. Is there a way to ensure I stay on my back?

[SarcasticDave94]

I've used about 4 extra long body pillows stacked 2x2 to create a pillow wall so that I begin side sleeping left side, then roll back onto the pillows to keep me at a 45° or so tilt.

[Geer1]

I don't see anything that makes me think there is something wrong with your breathing at these settings. Your minute ventilation is the same at these settings as when you were using higher PS. The only difference is that when you used higher PS you had nights where PS got stuck high and your body depressed respiration rate (because your body was regulating minute ventilation to what it requires) to maintain minute vent and that respiratory depression then created a lot more timed breaths. In short your old settings forced the machine to try and breath for you more often because you were trying to give your body more air than it needs/wants.

The only thing I would maybe consider is PSmax of 4.5 which might help the odd hypopnea remaining but I doubt it will make much of a difference. If raising PSmin I would not go over 3.

The only possible breathing issue at this point are RERA's and your data doesn't show any obvious examples, OSCAR has shown us all it can and the only thing that can confirm or deny if breathing is treated is EEG data from a titration study with current settings. Imo residual symptoms at this point are likely due to some other issue.

[quiescence at last]

Hopefully this last month has you getting progressively better.

I did notice once you said that most of the time your PS was 3.5 on a night where your range was 2.5 to 4.0.  I think you might have been using the Med. PS to give you that indication.  If so, just note that Med is median, showing the center-most PS during the whole night, and that 50% of the readings were (3.5 and under), leaving room to have many individual readings of anywhere from 2.5 to 3.5.

I have enjoyed seeing the progression and data taking, and hope it was a rewarding adventure.

QAL

[S. Manz]

It's been seven months since I got the machine and I'm starting to feel a bit hopeless with it. I'd really appreciate any suggestions on what to try or do, and I'm happy to post OSCAR data or anything like that. Thanks!

Since July when your OP was posted, I hope you have found a bit more peace with your DS ASV (my favourite machine which for now I am shelving in favor of a Resmed ASV). 
I have not gone through more than 400 responses here so take my response for what it's worth.
I am currently running an experiment (on myself) to establish whether or not there's a correlation between IPAP pressure and AHI and so far I am convinced that there is indeed a positive correlation. 
The general medical consensus (from what I can gather online) is that higher IPAP does in fact cause OAS patients to develop Central Apnea.
Lookup Treatment-emergent central sleep apnea for further detail. 
Here is a scientific white paper on the subject: '
[/url]
[url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7725531/]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7725531/

All the best with your trials and

[ldinks]

Hi everybody!

I'm sorry for the late update. 

Assistance reached a natural end here and I was stuck so I kept the settings and didn't check the data for six weeks. Adapt to CA/timed, give my brain time to heal, avoid any subconscious worry, etc. No change in symptoms. November 5th I got nose strips for better airflow. I immediately felt a bit better, and have not missed an alarm since! On the 9th I did feel like CA/timed was high, and lowered PSmin to 2.5 though.

Then last night I felt sleepy all day like when CA/timed was high, and figured I should check the data finally. Which still has hundreds of timed events. But I noticed this is the first time in weeks, so I thought about the past three weeks and hadn't noticed until now that:

- Nov 5th improvements have been consistent

- I've had the energy/focus/desire to begin getting into a couple of hobbies I've not touched in a long time

- I've been a bit more "with it" socially

- I've worked longer hours

- Some difficult memories are easier to remember in more detail, and lost memories have randomly popped up. My short term memory is a little better.

- I fell asleep without my mask once, and I felt it, but I actually didn't get hit as rough as I'm used to. As if I've done a bit of healing and a single night didn't undo it all. 

- Very recently I've started itching to get back into exercise and diet interests I've not had in forever.

Although sleepiness/mood/etc hasn't gotten better since the 5th yet, as far as I can tell, it's still been a nice improvement and I feel like the above points are really fantastic and I believe they're signs that I'm healing and that I should give it more time.

It's nice to actually have a hobby again, and be more social, and not stressed about not staying long enough at work, that's for sure. I'm happier.

I thought you all deserved an update. I really can't thank you all enough for the support, patience, and kindness. I'm also interested in giving back if there's anything software-y I can contribute to.

As for data, I had three 0 AHI days in the past two weeks. Although I get obstructive events occasionally now, I don't want to make timed breaths more common considering I haven't adapted after two months. If anyone would like to see anything specific let me know!

Final note, I got side effects from my second COVID vaccine that have persisted over the last two weeks, and may be causing some of the above, but I really doubt it. I'm still going to try a resmed eventually, seek professional help when I can (given last night), and want to try a nasal-only mask now I tape my mouth. I'll keep coming back here and I'll update this thread if anything changes though! 

I did notice once you said that most of the time your PS was 3.5 on a night where your range was 2.5 to 4.0.  I think you might have been using the Med. PS to give you that indication.  If so, just note that Med is median, showing the center-most PS during the whole night, and that 50% of the readings were (3.5 and under), leaving room to have many individual readings of anywhere from 2.5 to 3.5.

I have enjoyed seeing the progression and data taking, and hope it was a rewarding adventure.

I appreciate that explanation, you were right about how I was incorrect before. That makes a lot more sense. Thank you! It's nice to see someone finding enjoyment out of this process alongside me, and it's definitely had it's ups and downs. Although overall, definitely worth it!

Since July when your OP was posted, I hope you have found a bit more peace with your DS ASV (my favourite machine which for now I am shelving in favor of a Resmed ASV). 
I have not gone through more than 400 responses here so take my response for what it's worth.
I am currently running an experiment (on myself) to establish whether or not there's a correlation between IPAP pressure and AHI and so far I am convinced that there is indeed a positive correlation. 
The general medical consensus (from what I can gather online) is that higher IPAP does in fact cause OAS patients to develop Central Apnea.
Lookup Treatment-emergent central sleep apnea for further detail. 
Here is a scientific white paper on the subject: '
[/url]
[url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7725531/]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7725531/

All the best with your trials and

Thanks for the link! I do believe my centrals to be almost entirely caused by the pressure required to treat other events. How do you find the resmed? I hope your experimenting brings you some positive results!