Need DreamStation settings advice

I need help understanding how to proceed with my DreamStation CPAP. I have been using it for 6 months and while after adjustments I can get several consecutive days of sub 1.0 AHIs I also get long strings of days with AHIs (OAs) above 10.0 sometimes as high as 30.0. I have attached a SleepyHead output (I hope) which seems to show that the machine is giving up trying to resolve a cluster of OAs. I would like some advice on how I can proceed. Thanks.

[img]http://C:\Users\Stephen\Desktop\SleepyHead2016.png[/img]

Well I see that an image did not post. Can I get advice on how to add an image?

I received some kind advice so maybe this will work.

sbutterf wrote:I need help understanding how to proceed with my DreamStation CPAP. I have been using it for 6 months and while after adjustments I can get several consecutive days of sub 1.0 AHIs I also get long strings of days with AHIs (OAs) above 10.0 sometimes as high as 30.0. I have attached a SleepyHead output (I hope) which seems to show that the machine is giving up trying to resolve a cluster of OAs. I would like some advice on how I can proceed. Thanks.

[img]http://C:\Users\Stephen\Desktop\SleepyHead2016.png[/img]

Well I see that an image did not post. Can I get advice on how to add an image?

Maybe this will work.

please don't play clip art, it makes things almost completely useless. arrange your charts like this:
https://sleep.tnet.com/resources/sleepyhead/shorganize click on the link at the bottom of the page to get another page that tells how to do a proper screenshot, and then click on the link at the bottom of THAT page to show how to paste the link the best way to here.

your first link above didn't work because you put in the location of the picture on your computer, which we don't have access to.

Do you have chronic sinusitis? maybe allergy?

I have never been told I have sinusitis. I guess it is a possibility. I have the ususal allergies. Would that explain a series of low AHIs followed by one of high AHIs?

So I upped my low pressure from 14 to 16 and saw no change in results. I did hit 20 pressure a few times, but the apneas continued and the machine eventually gave up. I wonder if I need a bipap machine?

Increased pressure will not help eliminate CAs...It may make it worse

Sorry I was not clear, virtually all of my apnea are obstructive

sbutterf wrote:So I upped my low pressure from 14 to 16 and saw no change in results. I did hit 20 pressure a few times, but the apneas continued and the machine eventually gave up. I wonder if I need a bipap machine?

Can you post the detailed graph for the new minimum?

Did you want this graph?

Yes, that report, thank you.

Weird that other than the really ugly time frame for about an hour starting around 2 AM the results looked really good but that is one ugly cluster for that approx 1 hour from 2 to shortly after 3 AM.

Makes me wonder what changed and the 2 most common culprits are sleeping on your back (supine) or REM stage sleep or a little of both.
Something changed to cause the pressure to be sub optimal during that time frame.

Do you end up on your back often? Is it possible you were on your back during this time frame?

It's also possible that this is REM stage sleep. This time of the night is when we typically have more REM but to have it last for a full hour is a bit unusual. REM stages don't typically last so long.

If it is REM related...need more minimum pressure
If it is related to sleeping supine...either need to stay off the back (easier said than done) or more minimum pressure

In terms of pressure needs and maybe needing a bilevel device that will go over 20 cm...you may need it for comfort at the apparent pressures you seem to need to hold the airway open.
In terms of needing over 20 cm...the machine just barely kissed 20 cm so I don't know that you need the ability to go over 20 cm.

You are fast approaching pressures where bilevel exhale relief is going to be more comfortable for sure.

So....is it possible you were on your back from 2 to 3 AM?

I take off the mask at some point in the night when it becomes uncomfortable. When I awake later I am often on my back. What surprises me is that the machine doesn't continuously increase pressure during the event,and that it seems to only try for a bit before it returns to lower pressure. Most of my high AHI nights show one or more of these long events and the machine behaves similarly. Would it be dangerous to up the low pressure again?

BTW, thanks for the reply an info, I was looking forward to some good advice.

I have pretty much been of the opinion that people should be able to sleep in whatever position they wish and let the machine adjust accordingly unless there's a really significant pressure difference and that difference creates potential issues.

Your pressure needs are already fairly significant and you are running out of room in terms of pressure choices. It's very possible that you need a lot more pressure when on your back and attaining that amount of pressure could present problems.

All I know to offer is try more minimum pressure and see if the ugly clusters can be broken up or try doing something to stay off one's back. It's not always possible to stay off one's back though....been there and done that myself but in my situation supine sleeping never seemed to drive the pressures up. It was REM sleep itself that drove the pressures (spent a month on my side after building a wall to make sure I was on my side all night) significantly higher which went along with my sleep study showing REM sleep was where my OSA was so much worse.

You could at least try to confirm that supine sleeping is the culprit by fixing up something to keep you off your back and then you can decide what you want to do about it.
Either just use more minimum pressure or work on staying off your back.
I think it is most likely supine sleeping going on here but it wouldn't be impossible for it to be REM or maybe a little of both and while we have some chance of controlling sleep position we have no chance of controlling REM and when it's REM we pretty much have to let the machine sort it out.

So last night I bumped my low pressure from 16 to 18 (of 20) and recorded an AHI of 15 and a single cluster of AHIs lasting 90 minutes, with pressure at 20 for 60 minutes. I can confirm that the cluster began at a time when I was sleeping on my back. So it looks like I need to find a method to keep me on my side.

While I don't just have to stay off my back because of pressure reasons, I did do an experiment where I went to extra effort to stay off my back to see if my pressure needs varied much and I found it really hard to stay off my back with the traditional measures.

First...the idea to put tennis balls in something so you wake up when you roll back onto the tennis balls just seem rather pointless to me...yeah...do something to cause pain so that you wake up to relieve the pain. My sleep is already fragile enough without doing something on purpose to cause pain.
So I targeted more "comfortable" ways of staying on my side.
I found that bed pillows move out from under me too easily...so did piles of bed linens as well as the foam wedges. I would wake up flat on my back with whatever "wall" I had built either on the floor or on the other side of the bed.

So I looked at what I had and what I needed.
I needed something that wouldn't move out from under me but was still comfortable to have it against me or have me sort of lay on it. I was using a buckwheat pillow for my head/neck at the time. It's heavy and doesn't move easily. So I transferred it to be my "wall" behind my back while I was on my side.
It worked really well...it didn't slide out from under me nearly so easily and it was super comfortable if I ended up laying against it sort of half way on my side/back.

So look for something that is comfortable and won't move so easily if you end up against it.
You can try the torture way if you wish...the tennis ball trick but I have a friend who tried that ...put 17 tennis balls in a backpack and woke up flat on her back on top of the backpack with all the tennis balls in it.