Sierra

1. Mask pressure is a nice to have. The pressure graph is really a setpoint pressure (what the machine is trying to deliver), while the mask pressure is what is actually delivered. It is interesting but not critical.
2. Central apnea and obstructive apnea are a full interruption of flow for at least 10 seconds, so they are more concerning than hypopnea. Hypopnea is a partial reduction flow for at least 10 seconds.
3. Yes, I would use a humidifier. I use one with a heated supply hose with automatic humidity control. Not essential but is nice. I use reverse osmosis purified water.
4. I should flip the protection switch, but I admit that I don't. I believe that was mainly a concern for Windows 8 which I have never used.
5. First I see your leaks are good. That is usually the first priority. Second would be comfort. Is the mask comfortable so you can get an undisturbed sleep?
6. With the right pressure you should be be able to sleep in any position.
7. That one is not so simple. Usually obstructive apnea is caused by the tongue and back of the airway relaxing and blocking the flow. A CPAP is most effective in correcting this using pressure. Central apnea or complex apnea (mix of obstructive and central) is the most difficult. And, it appears you may be partly affected this way. Have a look at this article in the blog section of this site. Complex Sleep Apnea

On the order of layout I always use the Pin function to keep the events bar at the top. Then when I scroll down to see the other graphs it always stays there so I can compare the other graphs to when the events occur. The order I put them it is:

1. Events Bar
2. Pressure
3. Mask Pressure (but I don't believe that is available on a DreamStation)
4. Flow Rate
5. Minute Ventilation
6. Flow Limitation
7. Leak Rate

I find the minute ventilation can be helpful when looking at the issues around central apnea and periodic breathing. It is kind of a rolling average of flow rate. If it cycles up and down periodically it can cause central events.

Your results do not look unlike mine. You are having some central apnea, more hypopnea, and some obstructive apnea. As a general rule central apnea can increase as the pressure increases. The first step in trying to minimize central apnea is to minimize the pressure to the point where obstructive apnea is just controlled with the minimum possible pressure. One possible way you could reduce your pressure would be to turn off the Flex feature. The red pressure trace is the pressure on inhale and the green is on exhale. The idea is that it is easier to breath if pressure is reduced on exhale, and it does help. However, it is double edged sword. When pressure is reduced on exhale you can get OA and H events on the exhale. The green pressure is your effective pressure in preventing OA. I turn this feature off on my machine and find that I can get away with less pressure on inhale (red trace). So that would be my first suggestion. Turn off the Flex for a while and see if the red pressure line and hopefully CA events go down. With a little luck both your CA and OA events may go down just by turning off Flex. The next step if you are still seeing OA events is to increase the minimum pressure a bit more. I do see a bit of a pattern in your CA events occurring at the higher pressures (red). If that continues to be a problem after turning off Flex then I would be tempted to reduce the maximum pressure. The idea is to reduce the CA events, but not reduce pressure so much that OA events start to occur. Hypopnea events are the most difficult to figure out. I generally assume they will go down if OA events go down.

The end result of these kinds of adjustments may be that there is not a lot of range left between minimum and maximum pressure. That is not a bad thing. And at some point you might even want to consider a single fixed CPAP pressure, once you figure out what that pressure may be.

Hope that helps some. But, first I would turn off Flex and then post what you get.

You may want to look into using OSCAR which is a free open source software used mainly to display data from a CPAP. However, it is also capable of displaying data from an Oximiter if the model is compatible. OSCAR can be downloaded here. You need a PC or Mac and a SD card reader to use it for the CPAP data. OSCAR used to be called SleepyHead and here is a screen shot from SleepyHead that shows what meters it supports. I believe OSCAR supports the same ones. While I don't use an oximiter, it does seem like it would be a good idea if you have one to display the CPAP data along with the Oxy data. If you download OSCAR it may have a more updated list of Oxy meters it supports.

The main way the CPAP works is in using pressure to keep the airway open to avoid obstructive apnea. So the benefits would be related to the number of obstructive apnea events that are avoided. Avoiding longer events would have more benefit than avoiding short events. A CPAP essentially ignores events less than 10 seconds.

I am not a medical professional, but from what I know it sounds more like coincidence. I would hang in there for a few days without the Flex, to see if the pressures being reached during the night are better. Next I would move to slowly increasing the minimum pressure.

Some tips on the layout:

1. When you post a graph it is best to start a full width window by using the orange "Write a Reply" button in the bottom left of the screen. It will make the image larger and wider.
2. There are some funny things happening with your graph titles and other things. Under the File tab you may find some options on font size etc that might help
3. The biggest issue however is that when you did the print screen of the graph you had the display zoomed in to a very short window of time. By using the up and down arrow you can control the time width of the window. The best display to start with is to show the whole window width for the whole night. The purpose is to see when you are having events during the night, and what the pressure is when each event happens.

You certainly do have some issues to address. However before I can comment, I need to see the full width screen for the whole night.

If you check what the flow curve looks like when expanded for the PB area you will get some idea what it looks like. Then if you check your hypopnea events you may find some of them that look like the PB but are flagged as H events. So the issue may be a bit more significant than it looks at first look. That said, it is difficult to do anything about it with a CPAP. I get the issue about once a month also, and don't worry about it a lot. This is what my last Cheyne-Stokes event looked like. The part I circled in red is pretty classic.

Yes, for new users there does seem to be a bit of a delay when images are posted. After you make a few posts it should go away. That image you posted is a bit unusual. The daily report screen shot is the most useful to post. See this thread for an example of what the screenshot should look like. The originator of that thread also has a DreamStation so the comments in that thread should be useful to you also. You do look like you have room for improvement, but until I can see the Daily Report graph I cannot suggest much. Just post one from a typical night, and hopefully it does not get delayed too long...

Some thoughts:

1. Did turning the Flex off not work for you? It might let you get better results without increasing the minimum pressure. Think of the green pressure line as your effective pressure to prevent obstructive apnea. Turning Flex off increases your effective pressure without increasing the red pressure line.
2. It looks like your leaks are well controlled. One feature I like is displaying the leak red line. It becomes a choice when you right click on the leak rate graph scale.
3. I think there is a little room to reduce AHI with increased minimum pressure up to 9 cm or so. Not sure what the minimum increment is on a DreamStation, but I would just increase it the minimum amount over time. I suspect you will not notice the increase if you do it slowly.
4. You may want to explore that area flagged in green for periodic breathing. It can be an indicator of Cheyne–Stokes respiration. If you google it you will see examples of what it looks like. If it only happens occasionally I would not be too worried about it. If it is happening all the time, it is something to discuss with your doctor.

Hi Jason,

A good starting point would be to post your typical Daily Report screen from SleepyHead. That gives the best snapshot of where you are. On a PC you just maximize the daily report and press F12 to capture the screen shot. In the bottom right of the screen a pop up will let you know where it is saved. With File Explorer just left click on this file and drag it into the body of a post. It should upload. Just do the one Daily Report screen. That is enough infor for now. Also trying to post multiple screen images in a post can trigger the spam filter here and your post will be delayed.