Clear Airway Apnea increases as OAA decreases

I cruised around reports looking for periodic breathing for a few minutes. I see where one is about a minute and a half and another is 4:44 or something like that. I also notice that they are usually at the beginning of a sleep cycle and there's not many of them. I don't understand exactly what they are though. I mean, I know they can be indicators of other issues, but what, exactly is period breathing?

Last night, I set my machine to our agreed upon setting of 11/15. It turns out, It was an excellent starting point. When EPAP was at 11, I felt like I was suffocating, so fairly early on, I changed it to 10. I tolerated it until I couldn't anymore. Again, I felt like I was suffocating, so, at 5:50am, I changed it to 9. From that point on, it felt great and it was well within normal range. You can see when I woke up a couple of times after 5:50am, but when I add all of the sleep time from that point forward, my total is about 3:45 hours. During that time, I had zero CA, 1 OA and 8 Hypopneas. That's an AHI during those hours of 2.40. That's half a night of sleep, so, while it's not conclusive, It's certainly a positive result and it's low enough to just stop there. I want to learn so I don't wanna stop there. The following is what I've learned so far: 1) Any EPAP number 10 and over is too high. 2) 8 EPAP is too low. 3) The only potentially valid numbers on the Dream Station that we haven't tried are 9.5 and 8.5. If you want me just to cruise along with 9/15 for a while, so that we'll have some data I'll be happy to accommodate, but I'd like to eventually (If not tonight) try both of those numbers.

On the issue of comfort, are you using a timed ramp? Do you have a ramp start pressure set? These settings should be in the Comfort section of the setup menu. And also in the Comfort section of setup do you see a setting for Bi-Flex or Bi-Flex Comfort? Is it turned on or off and if on what is it set at?

SUCCESS! I thought that it might be going along with your philosophy, to move EPAP from 9 to 9.5. My opinion is that IPAP doesn't need to change. Please let me know if you think that's okay. At this point I want to make sure I do exactly whatever you think I should do. I have this crazy urge to bring the AHI as low as possible. I would still be struggling if you never decided to help people in this way. I know it takes up a lot of your time and I appreciate it more than I can express. You're helping me live a life I didn't know I could live 3 months ago.

Okay. Tonight's a waste, partially to this 9.5 epap, and partially because I can't sleep, so I'm going to change the settings. I've been comparing tonight's brief report with yesterday's success, There are some things I observed that lead me into thoughts of changing EPAP and IPAP. 1)AHI stays lowest with a 9 Epap. 9 epap tends to hover around 1 and 2 AHI, 9.5 seems pretty stable too, but 9.0 has been the champ, so I shouldn't exclude it as a minimum. Also, just from looking at the graphs, I get the feeling that 9.5 Epap is , sort of pushing the IPAP as high as possible (11) and 11 is four time worse for AHI as 9. So my opinion is a range from 9.0 Epap to 10.0 Ipap, with 1 Bi-Flex, is where our next test should be. I believe it's possible that a 9.0 Epap and 9.5 Ipap could be the sweet spot, but I prefer to work in the gradual mode. May not seem gradual by going from 11 to 10 instead of stepping it down to 10.5 Ipap. That's because I haven't seen a favorable AHI during a 10.5 pressure, so why go visit the disaster? Also, as I said before, leaking masks produce lower AHI. Seems like too much pressure. One more thing. It's only hypopneas that survived tonight. That makes me think that the airway is being cleared too well. Pressure is too high. Both Epap pressure and Ipap pressure. Going back to sleep (briefly, because of job) and setting the auto bipap to Epap: 9, Ipap 10, Bilflex: 1.

I know that report is not correct. I moved some graphs around to group pressure, leakage and AHI together. I'll put them back.

I was moving the AHI up, just to have pressure, leakage and AHI together, since I was comparing them. I will go back to normal before I send you anything again. When I went to 10 Ipap, AHI went to 4 and I couldn't stay asleep. Same thing with Ipap at 10.5. Unfortunately, I can't get SleepyHead to download anything, so until I figure that out, I'll use the much less reliable dreammapper that just gives you almost nothing, but, at least it keeps up with the three AHI fields. Hopefully, I can fix it today. I have another computer, I can download the software on. I ended up back at 2.1 AHI after I returned to ipap of 11 and kept epap at 9 with bi-flex at one.

I went back to the Dreamstation and couldn't find anything to indicate a way to lock the sd card from the Dreamstation. The card is lockable by using a slide on the card. Could it be that only my provider can lock it and that he has done that? Not sure why he would do it, but I've looked all over for it and can't find anything.

Okay. I've been very tired lately. I'm going to leave the machine at 9/11-biflex-1. I slept fifteen hours total yesterday. I'm gonna take a couple of days off of experimentation to just leave it on that setting and be sure to get some sleep. I'm very interested in seeing if I can continue to bring my numbers down, but I know now that I have the machine to the point where I can get a lot of good sleep and I need that right now. I'll come back and attack the rest of this sometime later this week and I'll be more clear headed, and maybe less manic about it.

One thing to keep in mind is that with apnea and in particular complex apnea with a significant portion of central apnea one night to the next night variability can be quite high. In statistical terms standard deviation is very high. It takes many nights to see if there really has been a change in the average results when you make a change in treatment pressures. As an example I will post my last 3 month Overview from SleepyHead. I suspect my apnea severity and yours are not all that different, so my guess is that your long term ability to control AHI is likely to be quite similar in variability. This Overview includes my last three changes to treatment which in the scheme of things are pretty small.

Sep 26 - Oct 10 - Pressure at 12 min and 12.2 max essentially fixed - AHI 2.34

Oct 11 - Oct 17 - Pressure in CPAP mode fixed at 12.2 - AHI 2.64

Oct 18 - Nov 6 - Pressure at 12.2 min and 13 max - AHI 2.49

So on average pretty subtle changes. However over that time AHI has been as low as 0.6 and as high as 7.0. So I guess my point is that don't take one or two bad nights as a trend. You need quite a few nights at a setting to see what it will do in the longer term. I think it makes sense to make changes fairly quickly at first, and then after you get close to the optimum settings, then slow down and be patient to see what is happening. Hope that helps some. You have come a long way from the first settings you had, and have made excellent progress!

That's very helpful. I totally agree with you as far as how far I've come in a short period of time. It's very good to know I'm at a safe AHI. It only took us a couple of nights to get to less than five AHI. It has been hard for me to sleep through the night, but then, that's an old habit. Maybe in time. I'm willing to try anything you might suggest, including moving to the one of the other modes to see if it there are better settings that will drop my AHI. That includes raising or lowering pressure settings. I don't believe I gave that a fair chance, because a good night's sleep became more important. We are of the same mind when it comes to keeping this exact setting for a while. I see what you mean with all your ups and downs. I got a new SD card reader which fixed the import problem. In just a minute, I'm going to sent last night, separately. By the way, the next three nights might be useless as far as data because I'm taking care of my daughter's dog's and I'm mildly allergic. Enough to disturb my sleep.

Just a little update: I've had a toothache that kept me all night, was babysitting daughter's two dogs and I'm mildly allergic, have had blockage in right nostril that wakes me up or doesn't allow me to sleep. I think the season change is part of it. True to form at this time of year, I'm getting slightly wheezy. All these things on a consecutive day basis has made data useless. This is not ordinary. I'm not gonna waste your time until I can get back to more normal sleep. It's just been weird. Still, I pretty much stay under 5 AHI when I DO sleep and generally, I have zero CAAs. Plus, I'm tired and don't feel like doing much. Not negative though. Counting my blessings. Anyway, I'll send you some data, when my sleep settles down. Meantime I'm unchanged: 9.0-11.0. No Bi-flex, no PS. Auto Bipap.

My only CA was because of a really bad leak and it was when I was waking up so I didn't bother sending a zoomed screen shot for a throw away central. During a two and a half hour stretch, I slept without a single ap or hypop. How about that?!! It will be so much better when I can string more than three hours of sleep at a stretch. Still, this machine is already the best thing that's ever happened to me,

So right about comfort issue. It makes sense. Gotta figure out some way of getting more time out of it by being more comfortable. 1.99 AHI is not common. 3.4 is more common, but if I can manage to not get a clogged nostril, 1.99 is easier. I think my nostrils are always inflamed and it doesn't take much to close one up. I take Claritin D to clear my airway and because of some bad nights, I've added Flonase. I want to ditch the Claritin D and just stay on the Flonase, but since I just started on the Flonase, I'm not gonna rock the boat just yet. I'm open to any ideas on how to breath better on the machine. I just realized that there's enough room in my mask to use a Breath Right strip and I've been doing that with some success. Change of seasons has created a few congestion probs.

I just looked back for the first time in a while. I haven't had much of value to send you because there's something about this change of seasons that's causing my nostrils to clog. I've been lucky to get two consecutive hours. My breathing is so erratic, it's hard to pile up usable data. Last night (hated to do it) I added Afrin to my allergy regimen. I slept for 6 and a half hours, but more telling is that I slept 5 hours in a row (minus a bathroom break). I am only using one squirt and only using it if a nostril clogs up. I used one squirt per notril last night. I had a 2.32 AHI which is the second lowest I've produced. I've had some lower numbers but I don't count a two hour nap. Last thing I want is to be dependent on Afrin. Hopefully whatever is in the Middle Georgia air right now is going to pass soon. If my nose is completely clear, I think i'm about a 2.0 AFI patient, which is obviously great. I'm not positive the Flonase is helping and may drop it. I certainly don't need to be on three different medications if I can help it. Hope YOU are sleeping well.

I believe I've mentioned how I don't trust the guy who runs the medical supply store that I've been getting my cpap supplies from. He sold me a DreamStation for 1400 dollars and told me I was getting a good deal. He never told me he was selling me a used (possibly refurbished) machine. I'm not sure I'm right, but I started using this unit in the middle of September of this year, but there is certain information that goes back to 2010. If I have any recourse, I surely would like to force this guy to give me a proper discount since he was dishonest and since a used unit goes for so much less. Do you know, if I can prove that this is a used unit with the information I'm sending you. If not, can do you have any ideas on how I can find out. This guy keeps looking more and more like a sleeze to me.

I realized I didn't send you the most important part. This screenshot shows many entries from 2010, 11, and 16. Shouldn't that prove that this machine was owned by maybe a couple of people?

Bill, I am going to be away for a couple of weeks, and may not be checking in. Lately I have been trying a fixed CPAP mode to see what it can do compared to giving the Auto mode a range and letting it adjust pressure. My pressures run about the same as yours do, and in the past I have gone as high as 15 cm. But when I have done the fixed pressure testing I have gone as low as 8 cm. It didn't turn out real well (AHI 6+), but with 9 cm, 10 cm, 11 cm, and 12 cm, there is not a huge difference in AHI. It seems to be a bit of a mushy range where the proportion of central, obstructive, and hypopnea events show no real clear trend, and the total does not change much. But one of the things I have learned is that you need a lot of data to determine what pressure is best. 2-3 days is not enough. My thoughts now are that you need 2 weeks minimum at one fixed pressure to try and evaluate what it can do. So it would take a long time, but you may want to consider trying two weeks at each single fixed pressure for 8 cm, 9 cm, and 10 cm to see what may work best for you. I think there can be some comfort as well as AHI advantages of using a single pressure over an automatic range. For example if all of those pressures give you basically the same total AHI, then why not use the lowest one, and get more comfort?