[Treatment] New in this forum. Need help to understand the graphs and adjust therapy

[Santi123]

Hello:

My father was diagnosed with osa 16 years ago.
His AHI was 51 at that time. Most of them were obstructive and no centrals.
For different reasons he had to go through a sleep study this year but couldn't because of the coronavirus stuff.
He has been using a Remstar CPAP machine which was set at 7,5 . No idea about the AHI level he has been having till very recently but he continues falling asleep everytime and everywhere...
We asked the doctor and  he recommended to go through this sleep study and to increase the pressure to 9 in the meantime. 
We changed from the CPAP to the Autoset, so we started setting up the pressure from 8 to 12.
First nights there was a lot of mouth/mask leakage and the AHIs readings were around 20, 25...
He slept last night with a chin strap and the AHI was better (about 10) but told me it was very unconfortable. So this night he is going to try to tape his mouth and see what happens.
I assume we will have to make trials with different chin straps, soft cervical collars and so on in order to bring this AHI down.


But I'm most of all concerned about the centrals should we go lower with the maximum pressure just in case?
The central apneas events do look like real centrals, right?
Last night there was little leakage and still a lot of centrals and hipopneas. 
If we reduce the maximum pressure to, say, 10 then the AHI will go higher because he spent most of the night at a pressure of 12
Could you please give me advice on what should we do next?

Many thanks in advance,


Santi

   

[Crimson Nape]

Hi Santi123!  -  
Your chart shows a high flow limit.  A Resmed will interpret this as a need to increase pressure.  The pressure seems to indicate that he might be sleeping on his back and then possibly turning to the side.  I would recommend that he try sleeping on his side and avoid sleeping on his back.  Normally I would recommend that you use the EPR setting to reduce the flow limits but with the CA's listed, I would try adjusting the sleeping position first.

[Santi123]

Hello Crimson:

Thank you for your quick answer. You are absolutely right, I forgot to tell. 
My father can only sleep on his back because a problem with his spine.
So I'm afraid we cannot change his sleeping position.

Thank you.

Santi123

[staceyburke]

One big difference in the 2 charts is the extremely high leakage in the 2nd chart. You can NOT have any therapy until you control the leaks. The top had 1/2 fewer events because of less leaks. Did you change masks? What was different between the 2 charts?

[OpalRose]

Your graphs are dated April and May. Do you have anything recent to post?

[Santi123]

One big difference in the 2 charts is the extremely high leakage in the 2nd chart. You can NOT have any therapy until you control the leaks. The top had 1/2 fewer events because of less leaks. Did you change masks?  What was different between the 2 charts?

Thank you so much for your answer!
Both charts are from consecutive days. The one with less leaks is the one corresponding to the night that my father wore a chinstrap
This was the only difference.

Santi123

[Santi123]

Your graphs are dated April and May.  Do you have anything recent to post?

No, sorry. 
My mistake! 
I wrote the date in the spanish way, so the graphs are in fact from yesterday and the night before yesterday: two consecutive nights
The only difference is that he used a chinstrap in the night dated September the 5th

Santi123

[OpalRose]

Oh, thanks for clarifying.

It will probably be trial and error. You could bring the maximum pressure down to 11cm. You are bumping your max of 12cm now, but that is due to the flow Limitations driving the pressure up. We generally use EPR to help with Flow Limitations, but using EPR can also cause more Clear Airway.

If you do decide to try EPR, set it to 1. If you see an increase in CA, turn it back to off.

As far as leaking, he will have to find what works best. Hopefully, the taping will work better.

[staceyburke]

Many times chine straps don't work very well, but it seemed to be much better with than without.  You might want to look at the links at the bottom in my signature - for a collar.  They seem to work well.

[Santi123]

Thank you very much for your comments and advices!
Good to know that EPR would help if he had no centrals.

We will make a little bit of trial and error in the coming days and see what happens.
And I think it's also a good tip to try with a cervical collar.
I have been reading in the main forum different threads and it's worth a try.
I will follow the directions of those links when choosing a collar.

Thank you so much!!!

Santi123