Sierra

No problem, I often do the dyslexic thing. However in this case did mean a higher maximum pressure. The machine was bumping into the max of 14 cm, and events were still occurring at 14 cm. This is most often a sign the pressure max is too low. The OP has done that and increased the max to 18, and got an improvement. The remaining issue is that AHI is still a bit high with a pressure of 18 cm, and the machine is not even trying to go higher. I would hope things improve by shutting off Flex. The next step may be to reduce the maximum some to see if there is a "happy spot" in there somewhere that will minimize OA events while limiting CA events. The other tool still left in the toolbox is the cervical collar trick suggested by bonjour in another thread.

The changes you made to max and min pressure have helped. The next thing I would do is turn off the Flex. If you look at the Pressure chart, the red line shows pressure on inhale (IPAP). The green line is kind of the pressure on exhale (EPAP). As you move your cursor across the screen, the numbers above the pressure graph will show the pressure at that specific time. So, if you match the cursor up with an event you can see at what pressure it occurs at. The issue with leaving Flex turned on is that events can occur on exhale as well as inhale. The lower pressure can create events. My experience is that it is best to turn Flex off on a DreamStation. This may reduce your event frequency, and possibly your pressure too.

The other point of significance in this chart and the other one from Jan 7, are the green highlighted areas which Respironics calls periodic breathing. ResMed flags something similar as Cheyne Stokes Respiration (CSR). This is what CSR looks like on a close up breath by breath basis.

What you should do is put your cursor over one of those areas where there is green highlighting and CA events flagged. Then left click repeatedly or use the up arrow to expand the scale to see the breath by breath detail. If looks like the CSR image above this is something to discuss with your GP, and/or cardiologist. It could be heart issues, or heart medication, other medication, etc. You do not happen to live at a higher elevation? That can aggravate it too. If you can post a zoomed in screen of the periodic breathing area including the central events, I can give you my thoughts on how it compares to what I am seeing in my own charts.

I have seen a very small amount of CSR flagged in my charts, but over time I see a very small amount. The last time I saw it was over two months ago. With a ResMed the CPAP stats page in SleepyHead includes the % of CSR.

As far as your settings go the only change I would make now would be to turn Flex off. Future opportunities may be to lower the max pressure below 18 cm, but I wouldn't jump into that until you see what setting flex to zero or shutting it off does.

What this chart shows is that your 95% pressure is equal to your maximum pressure of 14 cm. You are also getting many of your events, mainly obstructive, but a significant number of CA events too at maximum pressure. In short it is showing you would benefit from a higher maximum pressure. I have never found the AHI graph because of the way it records to be really helpful. The Event flags show just as well where the events are occurring. Instead of the AHI graph you may want to bring up the Minute Ventilation graph if DreamStation provides that data. I am finding it useful in identifying areas of interest with my own central apnea issues.

I would suggest cleaning up the format so more information can show in more detail. Use File, Preferences, Appearances, to uncheck the box that says "Show AHI breakdown Pie Chart", or something like that. It is kind of redundant. Same with the Navigation tool bar on the right. It just takes up space. F10 to toggle it off on a PC. F8 or Shift F8 to toggle it off on a Mac I believe. And if you use the Orange "Write a reply" button at the bottom of the thread you get a full width window to post an image in.

I practice the tongue trick every night when I go to bed. Works perfectly until I go to sleep. My brain doesn't listen to reason when I am sleeping and kind of does its own thing! My wife tried to tell me to suck it up and quit complaining and that a woman could easily learn to keep their mouth closed so a man should too! Well with the help of SleepyHead graphs showing leaks, my complaining about the noise of her mouth leaks, and admitting she was waking up with a sore throat she finally admitted she had a mouth leak problem. The dentist video was the final straw. She uses a TMJ appliance and the video dentist said some things that matched with what her own dentist was saying. After that she become a mouth taping convert...

I have actually found benefit in raising the minimum pressure while leaving the maximum pressure fixed. I only like to raise maximum pressure as a last resort. Raising minimum pressure often eliminates the trigger events which the auto machine needs to be prompted to raise the pressure.

However in this case, with a fixed 14 cm not achieving <5 AHI kind of indicates max pressure will have to be increased at some point. If Flex is being used, I would discontinue that first though.

My current efforts are to get away from using a chinstrap. I dislike it, and I suspect I would equally dislike a cervical collar. I managed to locate a source of the 3M Micropore 2" wide tape locally for a good price of $2.67 for a 10 yard roll. Plan to try that next to see if lets me get away without needing a chin strap. Of all the CPAP tricks I find mouth taping to be the least objectionable. It is much more comfortable than using a full face mask for me. The risk of vomiting with mouth tape seems much lower than filling a full face mask with vomit in my opinion.

I tried 1 1/2" plain masking tape last night as a test thinking it might stick better. I found it did not for me. The glue on the tape seems to soften with moisture and it lost the grip on my face. I wish I could find the Nexcare Gentle Paper tape in a wider size, but for now it seems to work the best of what I have tried. Have never tried the blue making tape, and perhaps it has better glue. I have never like the green painters masking tape, even for painting. It never seems to have enough stick to stay on.

I tried 1 1/2" plain masking tape last night as a test thinking it might stick better. I found it did not. The glue on the tape seems to soften with moisture and it lost the grip on my face. I wish I could find the Nexcare Gentle Paper tape in a wider size, but for now it seems to work the best of what I have tried.

I use a heated hose which has wire in it and is relatively heavy. I started out by leaving it off to the side of the bed where the machine was, but found that it was constantly falling down and the weight of it was pulling on my mask and making it leak. Now what I do is loop it through the headboard so it is supported, and then route it down the center of the bed. I keep it under the covers in a big U shaped loop, so it goes down to about the tummy area and then back up to my mask. I mainly side sleep and when I face the center of the bed, I just leave it there in a big loop under the covers and supported by the bed. When I roll over to face the outside of the bed and the machine I let it cross my body in the tummy area and then route it up my other side still under the covers and supported by the bed. With a headboard that does not allow the looping of the hose, the alternative is to run it between the pillow and headboard and then bring it down the middle of the bed.

There are some masks like the DreamWear system that route the hose up over your head. I have not used one of those types. However, I wonder what they do with all that hose. I find that was my main problem, too much hose, and finding a place for it that was supported and not pulling on my mask.

Hope that helps some,

Your next best step may now be to download SleepyHead and view what you machine is doing during the night. The machine can provide you with some summary numbers, but to see the real detail you need to use SleepyHead. It is free software and runs on a PC or Mac, and needs a SD card reader to get the data off the SD card in the machine. If you don't have a SD card reader, you can get small portable ones that plug into your USB port for as little as $5 at places like Walmart. If you are interested here are some links:

SleepyHead Download

SleepyHead Basic Manual

The value in looking at your data is that you can see when you are having apnea events and at what pressure. If for example you see that your machine is running about 10 cm over the night, then you know you will have room to move up your minimum pressure and ramp start pressure a little higher still. I started with my ramp start pressure as low as 5 cm and that was not comfortable. Over time I have increased that based on comfort in going to sleep and now have it set at 9 cm.