bonjour

Dreamstation is a model series, which 1 do you have?

I would suggest posting the daily detailed view from Sleepyhead. The data will help you to get much better advice. How are your Flow Limits and RERAs? One other thing prediabetes is to diabetes what Stage 1 is to cancer. You HAVE diabetes, just at an early stage.

Get Sleepyhead so YOU can look at the details of what is going on. You will need an SD card if one is not already in the machine. \I do suggest trying auto mode too while you have the machine.

[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3459210/]

towards the bottom.

Sleeptech, this one you are wrong about. Central Hypopneas are optional to report from a sleep studies (I have yet to see one that does.) They are part of the criteria that medicare uses when determining qualifical=tion for bilevel with backup. here is the definition.

[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3459210/]

towards the bottom.

Hypopneas - Obstructive and Central To determine the statistics for Central apneas and Central hypopneas >50% of total AHI above we need to determine which hypopneas are central in nature. The description below defines the difference between obstructive and central hypopneas.

An obstructive hypopnea contains one or more of the following:

An increase in PAP flow signal Snoring during the event Paradoxical breathing A central hypopnea will have none of the above.

Central Hypopnea. Central hypopneas are associated with reductions of purely in-phase thoracic and abdominal effort or movement signals, followed by an increase in chest and belly movements at the end. There is no evidence of phase shifting or paradoxical breathing, no airflow flattening, and no snoring throughout the entire central hypopnea.

A Central AHI is composed of Central Apnea and Central Hypopnea. The Central Apnea numbers are easily extracted from modern PAP machines which report detailed efficacy data. We need to concentrate on Central Hypopnea numbers to demonstrate a Central AHI >5 and that Central apneas and Central hypopneas >50% of total AHI

Central Hypopnea. Central hypopneas are associated with reductions of purely in-phase thoracic and abdominal effort or movement signals, followed by an increase in chest and belly movements at the end. There is no evidence of phase shifting or paradoxical breathing, no airflow flattening, and no snoring throughout the entire central hypopnea.

Paradoxical Breathing explanation: The chest and abdomen should expand when they inhale and contract when they exhale. If the chest and abdomen contract while inhaling and expand while breathing out, a person may have paradoxical breathing.

The problem with this is the new apnea patient is so inexperienced that the "system" takes advantage of them. There is way too much time between a diagnostic study and getting a machine, and the DME doesn't help either, 6-8 WEEKS is just too long. Their interest is typically getting the patient the cheapest (to them) available machine to the patient that makes them the most profit. That machine is typically a brick, a machine with no detailed data on it, but wouldn't make any difference because the patient is never informed that anything other than that one machine is even available. And to get an adjustment with that machine would require another sleep study. Most doctors, if you can get in to see them before 3 months, just look at summary data and say you are meeting compliance and your numbers look good. See me in a year. The best machine to provide a patient is generally an auto-CPAP because it is more flexible and most of them do provide detailed data, often down to the breath by breath level. But alas it costs the DME more and it is classified the same as a brick CPAP by the insurance. Better would be a general CPAP class where the different machines are discussed and even a proper mask fitting session with a variety of masks. A class designed to make the patient informed. Now that is a novel idea in this field. Most people would be better benefited by going directly from the diagnostic study to an APAP with an SD card which is evaluated no more than 3 days after starting and pressures reset to appropriate for them values. This would save the insurance companies a ton of money.

Jim, first you have to realize that CPAP pressures are very low, allow me to have you demonstrate. I want you to get a tall glass of water and a straw. Now into that 8 inches of water, I want you to blow thru the straw. THAT is if highest pressure a CPAP can generate. Breathe thru your nose with your full face mask on. That would be, pressure wise the same as with a Pillow or Nasal mask. Any pressure wants to go somewhere, that is what will work thru the congestion, you just have to let it, and you already are using that pressure, just to both your mouth and nose.

Left to right

• RERA a series of Inspiratory flow limited breaths followed by an OA then ending with a recovery Breath
• a series of irregular breaths like what happens during an arousal also common following a RERA
• Finally, some periodic breathing separated by Obstructive Apneas

The "Pressure Pulse 14" is Philips method of checking for obstructions, the machines way of checking for Centrals.

txmnjim: Try an Amara View mask. it is a Hybrid mask that sits under the nose and around the mouth designed so nasal breathing enters the mask. you could easily wear even very bulky glasses with this one.

That said I used to say that every pap user should have a full face mask for the very reasons you just cited. Can you normally breathe out thru your nose with your mouth shut? If so you should be able to use the nasal pillow mask. What happens when I am badly congested is I initially do a lot of mouth breathing just trying to breathe thru my nose, after a few minutes, rarely 10 the CPAP pressure is just too much for the congestion to hold back and there is a breakthrough. From that point on I have no problem until I wake up and I ask myself, "How the H*** did I use this thing thru the night. It has never failed me, but getting to that breakthrough is not easy, is if hard.

All masks (with the exception of a few that are specific for a travel or mini CPAP machine) are 100% compatible and will connect to your existing CPAP tubing. When getting the P10 mask for the first time get the "Fit kit" as it contains 3 different pillow sizes. The "Pillow" is intended to fit ON the nares of the nose and should not go in them, a common error is to use too small of a pillow. I won't say I sleep on my side a lot, but I do side sleep and I use the P10 Pillows (Large).

Fred

MyAir can be used as a guide to measure effectiveness, but different treatments, applying pressure in different ways, may be better able to treat your apnea. What does My Air say about Central Apnea, Obstructive Apnea, Hypopnea, Flow Limits, Snoring? Each of these are tweaked differently. Sleepyhead lets you focus on your events, not just your average. And yes, sometimes it is a balancing act, especially when you have both Obstructive and Central events as the ROT treatments for these are in general the opposite of each other.