Sierra

I can only really guess, but I think you may have good odds of testing below 5.0 for AHI. But, the only way to find out is with a sleep test where they use zero pressure instead of the 4 cm which is the minimum on an APAP.

That is excellent. And the really good news is that your results seem consistent from night to night. 6:54 minutes would be your total time with the machine on. Just above the green CSA label on the left side of the screen. The bottom left if you scroll down further than what your screen shot is showing will list your "sessions" which are the individual times without breaks. It looks like you had three sessions. If a session is a wipe out there should be an on off switch beside each one where you can include it (green) or not (red).

I would suggest leaving your settings like this for a while. Feel free to keep posting and I will give you my comments.

I have lost track of how many people I have helped. I see I am at over 3,000 posts. Most turn out well, but not all do. Sometimes you just cannot get the CA events down to a reasonable number without OA events going too high. There is an ASV machine that sometimes has to be resorted to in the difficult cases. Good to see that along with the cervical collar you have gotten down to a good space with just the APAP.

With 10 min and 11 max a ramp start pressure at 9 should be fine with the ramp in Auto for time. That is what I use and find it quite comfortable. One of the tests I do to set the ramp start pressure is to take quick deep breaths when it is in ramp to see if the flow responds quickly and you get no feeling of air flow restriction. For me 9 cm is what it took. I am amazed that some sleep clinics send their patients home with the machine having the out of the box settings; 4 cm min, and 20 max. Trying to go to sleep with only 4 cm pressure would make me feel like I was suffocating.

I suspect you must be in an environment where the humidity is higher. The device on my desk says the humidity is 33% here. With a 7.5 hour sleep I use nearly all the water with Climate Control in Auto and humidity set at 4.

All considered that is a very good result with the lowest amount of central apnea that I recall seeing in your results. Your OA events are actually higher than the CA ones, so we have reached the point where it does not make sense to try going lower. My thoughts are there are two different ways you could go at this point. One would be to leave the maximum pressure at 11 cm, and increase the minimum pressure from 9 cm to 10 cm. The hope would be that CA events do not increase but OA events go down just a bit more. This is probably the fastest way to get to a final stable setting. It may be just fine to leave the machine in AutoSet and let it adjust pressure in this fairly narrow range.

The other way to go would be to switch to CPAP mode on your machine and go with a fixed pressure. One of the methods used by some sleep clinics to avoid the cost of a full in clinic sleep test where they titrate the pressures is to put the machine in AutoSet for some time and then go to a fixed pressure equal to the 95% pressure point indicated in Auto. In your case for this night this 95% pressure was 10.6 cm. You would run that way for a week or more to see what you get for a longer term average. Then you would try a pressure on each side of that pressure for a week at each pressure. This is fairly time consuming, but that is the way I went to settle on my fixed pressure of 11 cm.

Your choice as to which way you want to go. You of course could try both ways to see which works better. We do have to sleep every night, so there is nothing but time for testing. You seem to have reached a very stable condition which is much better than where you were when you first started posting.... The soft collar seems to have been the silver bullet in your case.

In the last three years or so, I have had two bronchoscopies, and 2 cataract surgeries. None of the anesthesiologists asked about sleep apnea.

Millions of people have sleep apnea and 8 of 10 are undiagnosed.

https://www.cbc.ca/radio/whitecoat/sleep-apnea-canada-challenges-diagnosis-cpap-machine-1.7108832

I find that the shorter I sleep the lower my AHI score. When I get apneas they seem to get concentrated to the last part of my sleep, especially if I try to oversleep. I consider 7 to 7.5 hours per night, ideally in one stretch, to be the best for me. What I have read is that we need to build up sleep demand during the day, and get one good sleep at night. Naps during the day should be avoided, but I confess to dozing off in front of the TV from time to time. But, I never lie down on a bed during the day. I also avoid all caffeinated beverages after 10:00 AM. I also try to avoid all liquids after about 8:00 PM to reduce the need to get up during the night. That works most nights but not all...

That still looks pretty good with only one OA event that looks like it happened at 10 cm pressure. Still no indication that CA events are coming down with the decreased pressure. I think the next step would be to decrease both min and max pressures by 1 cm to 9 cm and 11 cm to see what happens. Lower pressure should helps with leaks too. I see this night was excellent for leaks.

I see your Ramp start pressure is at 9 cm and you should be able to keep it there. However, if pressure is lowered more, it may have to be reduced, as I think the Ramp start has to be equal or lower than the minimum pressure.

That reminds me of what I think was an extremely rare and close to fatal complication of diabetes. I use insulin and have gotten into the habit of holding the very small plastic cap that goes over the insulin needle in my teeth while I set the correct amount and administer the insulin. I've done it thousands of times. On this occasion I had the unfortunate luck to have an uncontrolled sneeze. I gasped and inhaled this little plastic cap. I went to the hospital emerg and got some X-rays. They of course did not detect anything and they did their best to convince me that I had swallowed it and it would pass. I knew that was wrong and could feel the restriction and noise this cap was causing in my lungs. My doc prescribed more X-rays and of course found nothing. You can't see a tiny plastic item with an X-ray.

The reader's digest version is that I saw an ENT who did the endoscope thing in my nose and found nothing. Then I saw two pulmonologists and both prescribed pulmonary function tests (all during COVID). Finally one got me in for a bronchoscopy at our university hospital. They used fentanyl and other stuff and that went well. They had success in finding and taking a picture of the cap in my lungs, but could not get it out. Then I was referred to the hospital that specializes in pulmonary issues. They used a full general sedation and got the cap out. However, there was an issue. They used a drug to immobilize my muscles to allow the tools to go down into my lungs. It was supposed to act for a few seconds. But, it turns out I have a genetic issue called a Pseudocholinesterase deficiency which made the succinylcholine drug they used act for hours instead of seconds. Essentially I was unable to breathe for about 2.5 hours. They got me through it, which was somewhat amazing as this was at the height of COVID and my daughter, who works at the hospital, told me that they were down to 1 or 2 ventilators.

I am not sure what I cost our healthcare system with my dumb mistake, but I'm sure it was many thousands of dollars, and it near cost me my life. It sure makes me think twice about agreeing to a general. I had my last cataract surgery with just a Ativan tablet under my tongue and the numbing drops.

So I do have a medic alert bracelet that warns I am a Type 2 on insulin, and also about the Pseudocholinesterase deficiency. However, it does not mention sleep apnea. I don't consider that a life and death critical condition. The effect of sleep apnea is long term, and not an immediate critical condition.

I think we are now officially way off topic!

That stuff is all in my "been there, done that" bucket. I was diagnosed with very high BG levels, and quickly got it under control and in the process lost something like 70 lbs. It did not cure my diabetes or even come close to that. Unfortunately the weight has slowly come back. But, my BG is best control it has ever been in.

That is looking pretty good. I now see one OA event which you have zoomed in on. I suspect you may have woken up during that zoomed in portion and the three CA and one OA vent is probably what some call "Sleep Wake Junk). I think you are reaching the optimum point for pressure. However, to confirm you should probably try just lowering the minimum pressure from 11 down to 10 to see if OA becomes a bigger issue, and if lower pressure may reduce CA events.

I have been a type 2 diabetic for nearly 25 years now. I currently treat it with metformin and two types of insulin. I also wear a FreeStyle Libre 2 sensor to constantly track my BG levels. This helps me a lot in controlling BG. For a while I tried the 20/30 Far & Fiber Plan by Gabe Mirkin. I think it is a very healthy diet, but it makes it harder to control BG for diabetics. However, I still try to minimize foods that have high glycemic index carbs.