sleep study attached, looking for advice

[Sleeprider]

I think that is fine. We need to settle on something to get a baseline against which we can compare other variables, That is as good as anything. As you can probably tell by now, I don't have a strong opinion which way your therapy needs to go, but we will probably learn something as you experiment.

[jgrizz80]

So here is last nights data.  I set it to Min 15, max 18, to see if the machine would want to go any higher than my prescribed pressure.  the data from about 11:50 to 12:40 is all pretty much garbage as i was awake with a coughing spell yet again as can be seen in the spike in mask pressure.  The hypopneas around 3:40 in the morning i zoomed in on as well as i'm curious your thoughts on them.  It still seems like a bunch of spread out centrals though not including the cluster of them after getting back in bed.  For some reason i seemed to have a bunch of leaks last night as well.

[jaswilliams]

The hypopnea may not be real as they are in the middle of large leaks.

[jgrizz80]

So i have left the machine alone now for 3 nights straight at 15cm and here are the results.  Apparently i can't get the mask to seal to save my life.  How inaccurate do you think the data is with all of these leaks, and where do i head next with this?

[jgrizz80]

So i've had the Vauto machine for about 2 months now, and played around with a ton of different combinations of settings, and this seems to be the best night i have been able to achieve is an AHI of 0.74 using it in VPAP auto mode, with a pressure support of 4.0 over 15-25 cm.  The key to it was using trigger and cycle settings both set to very high.  Without those set on very high, i still have a decent amount of centrals with it set on the standard medium setting.  I'm concerned that all i am doing though is masking the issue and not really getting effective therapy.  The flow rates throughout the night seem very choppy to me.  

entire night
[attachment=7544]

choppy wave form
[attachment=7545]

this was medium trigger and cycle settings with 5.0PS over 14-25
[attachment=7546]

I've tried a bunch of other settings as well over the last 2 months, lower pressure support, high pressure support, fixed pressure, auto pressure with no pressure support.  it seems to me the best luck i have had with low numbers is that 4.0PS over 15-25.  

Last night just trying 0 PS and wide open auto range
[attachment=7547]

here's a PS of 8 over 8.0-17.0 which didn't seem too bad either
[attachment=7548]



I'm really not sure which direction to head now other than pick what has worked best, and roll with that.  I still wonder if an ASV machine would have worked better for me.....

[jaswilliams]

The next step would be to use an oximeter to check for desaturations if you oxygen levels are stable then your sorted

[Sleeprider]

The Vauto is working pretty well for you. The PS 8.0 over 8-17 left you with OA because it appears you need a higher EPAP pressure to prevent the OA events, and you only left 1-cm of potential auto pressure adjustment (8.0 EPAP + 8.0 PS = 16 cm with max IPAP 17). The strategy needs to to be establishing that minimum EPAP which effectively prevents OA events, then working to use PS for residual flow limits and hypopnea. 8.0 is not too far off, but you need to allow the pressure to increase so we can see the break-point.

Lets try EPAP min 9.0, IPAP max 18.0, PS 5.0 I think that may tell us what we need to know.

[jgrizz80]

The Vauto is working pretty well for you.  The PS 8.0 over 8-17 left you with OA because it appears you need a higher EPAP pressure to prevent the OA events, and you only left 1-cm of potential auto pressure adjustment (8.0 EPAP + 8.0 PS = 16 cm with max IPAP 17).  The strategy needs to to be establishing that minimum EPAP which effectively prevents OA events, then working to use PS for residual flow limits and hypopnea.   8.0 is not too far off, but you need to allow the pressure to increase so we can see the break-point.

Lets try EPAP min 9.0, IPAP max 18.0,  PS 5.0  I think that may tell us what we need to know.

I went with your recommendations last night and here are the results.

here is the entire night overview
[attachment=7577]

and here are some other zoomed in areas that i feel may be of interest.  let me know if there is anywhere else you'd like me to zoom in on.  I know it doesn't register as periodic breathing, but could some of these be borderline PB?

[jgrizz80]

The Vauto is working pretty well for you.  The PS 8.0 over 8-17 left you with OA because it appears you need a higher EPAP pressure to prevent the OA events, and you only left 1-cm of potential auto pressure adjustment (8.0 EPAP + 8.0 PS = 16 cm with max IPAP 17).  The strategy needs to to be establishing that minimum EPAP which effectively prevents OA events, then working to use PS for residual flow limits and hypopnea.   8.0 is not too far off, but you need to allow the pressure to increase so we can see the break-point.

Lets try EPAP min 9.0, IPAP max 18.0,  PS 5.0  I think that may tell us what we need to know.

So here is another night with those settings you recommended i work with...and here is the first time i have seen this cluster of central like i have here, although i suspect with my old brick machine, this would happen on nights when i had a high AHI.  Where do i go from here???

[zzzZorro]

So i have left the machine alone now for 3 nights straight at 15cm and here are the results.  Apparently i can't get the mask to seal to save my life.  How inaccurate do you think the data is with all of these leaks, and where do i head next with this?

[Hope this helps] At pressures over 20cm I struggled with both the F-20 AirTouch and AirSeal and wanted one of them to work so I could wear my reading glasses.  The AirSeal (silicone) would never work for me.  The AirTouch (foam seal) will work but in 7-10 days it will make my nose bridge raw.  May be a reaction to the foam.  Tried several other ff masks from the 'try and return' online sources which also would not seal for me. 
I have found that the old- original QuattroAir to be the best for me.  It has minimal leakage and allows for cranking back the strap tension so it has less force against the nose bridge area.

The QA has a forehead pad that, unlike the F-20, is a stand-off helping to keep the top of the seal (where the nose bridge is) from crushing down on the top of my nose lessening morning pressure soreness and helping to maintain the seal during sleep.  The F-20 is designed with the top straps mounting onto drop-links that require more pressure to seal it as they anchor lower on the mask frame, where the QA is high and above the frame.

I believe this is probably not so much a problem with those who run at lower pressures, but at higher pressures I believe it is an issue.  Remember what works for one does not work for others..