Interpreting Results in SleepyHead - Not Sure If Good or Bad

[wad06]

I was diagnosed with obstructive apnea about a month ago, and I received my cpap about two weeks ago (s9 autoset - I asked for it after reading posts on this forum - and a nasal mask). The first week was awful. The mask was insanely uncomfortable (it felt fine sitting up in the DME office, but laying down, it dug into the skin below my nose). I never got more than two hours with it on, before just throwing it off and going to sleep. Then, the DME gave me pillows. They are much more comfortable, but I still wasn't able to fall asleep (I'm a very light sleeper, and stuff attached to me wasn't making it easy). Then, I bought some Sleepinol to see if that would help. It helped a little. I still end up taking the mask off at night. Once I wake up with it on, I can't fall back asleep.

Anyway, last night, after two weeks, I was able to make it four hours (not sure I was actually asleep for most of that, but definitely some). I imported the results into SleepyHead, and I'm trying to figure out what it all means.

Under the Daily tab, with details selected, it says:

AHI 13.63
Hypopnea .74
Apnea 0.00
Obstructive 2.73
Clear Airway 10.16

Under Event Breakdown, it says:

Presssure: 4.42 7.44 8.77 9.00
EPAP: 4.00 5.74 6.96 7.00
Minute Vent 0.00 5.50 10.62 15.25
Resp Rate 0.00 12.80 16.60 23.60
Flow Limit 0.00 0.18 0.60 6.67
Leaks 0.00 1.20 4.80 7.20
Snore 0.00 0.04 0.10 0.12
Insp Time 0.26 2.32 3.46 13.32
Exp Time 0.08 2.00 2.84 4.66
Tidal Volume 0.00 420 860 1280

Under Machine Settings, it says:

Pr. Relief EPR x2


Under the Events Tab, it says:

41 Clear Airway Apnea Events
3 Hypopnea Events
11 Obstructive Apnea Events

I would really appreciate any feedback you guys can give me based on these numbers.

[Pugsy]

I was able to make it four hours (not sure I was actually asleep for most of that, but definitely some)

I bet a bunch of those clear airway events (centrals) were while you were awake and they are causing the elevated AHI.
I would bet that if we saw your detailed report that a good number of those centrals were all clustered together.
It's common when we are trying to adjust to having the alien stuck on our face all night. Let's face it...no matter how comfortable we can make it...there still that "thing" stuck on our face. Some people get used to it fairly quickly and some people it takes a lot of time before the brain starts to look at the "alien" as being a normal part of the sleep process.
Some people are just particularly sensitive to things in general and get a double whammy making it difficult to sleep with all this stuff on us.

So...first of all can you find out if you had any centrals in your diagnostic sleep study? This helps us maybe eliminate the centrals being real and lets us maybe explain them away with being "awake centrals".
Did you have an in lab sleep study where they actually did a titration to find the best pressure? If so this also helps eliminate those centrals as being a problem because if they were a problem they should have shown up during the titration study.

Other than the number of "centrals"...clear airway events...you report for your 4 hours of maybe sleep are quite decent.
Leaks are well controlled and all that.

You are using APAP mode with a range of pressures???? Kind of hard to tell from what you have posted but it looks like you start out at 4 something and the max is 9.00. Of course this could also be related to ramp time.
What are your pressure settings? I see EPR is 2 and that means during exhale your pressure drops by 2 cm. Are you comfortable breathing on the machine?

Main things to look at on those numbers..
Pressure
Leaks
Flow Limitations
Snores
The other stuff don't worry about.

I have a SleepyHead under construction thread (link in my signature line) which I think will help you understand some of what you see if you will read it.

If you could post an image of last night's detailed graph for that 4 hours it would help if we could see what you are seeing.
Here's how if you don't know how.
viewtopic.php?f=1&t=81072&p=737779#p737779

Assuming those clear airway events are awake stuff getting flagged...I think that your biggest issue is going to be figuring out some way to get more sleep and better quality sleep. Easier said than done I know. Lots of detective work sometimes.
Is your doctor aware of this problem since trying cpap?

Oh...do you take any meds...even OTC meds? If so what are they and dosage and time you take them???
Also...how is your sleep hygiene in general? Got any bad habits? I know I do
If you don't know what I mean just google "good sleep hygiene" and you will get lots of reading.

[wad06]

Thanks, Pugsy.

I never saw the results of my sleep study. In fact, I didn't know much about any of this until I got my CPAP.

I'm not sure I know what APAP mode is. I know that I was told that pressure would be set to 9, and it would ramp up from 4 for the first 10 minutes.

As far as breathing, it's not super-comfortable when I exhale, but I was told that should be normal.

I gave my doctor's office a heads up yesterday about the issues with actually sleeping. Someone from there should be calling today.

I don't take any other meds (OTC or otherwise). I've actually been told I don't fit the profile of people with obstructive apnea. I'm in my 30's; I'm something between skinny and of average build; I'm not on any other meds; and I have no history of depression. All of that said, apnea runs in my family (dad and two uncles).

Here is an image from the snippet I took (thanks for the instructions).

Thanks again.

[Pugsy]

They probably have the machine set in cpap mode with ramp to 9 cm and from then on the pressure stays the same except for exhale time.

APAP mode is where the pressures auto adjust as needed.

The snippet thing...you have to upload the image and then copy the url address including the IMG brackets and paste it into the body of your text here. When you do that you see the code only...won't see the actual image unless you do the preview or submit button and then view your post.
Sounds like a lot of work but once you do it a few times it is no big deal.
A lot of people expect the image to show up immediately while they are composing but it won't...you only see the address in code until you either click on preview or submit for final posting.

If exhale is not comfortable...try EPR at 3. It's a comfort setting and you may like it better. Anything to allow you to relax more to help you get to sleep and stay asleep.
Right now...your most important thing to work on is getting to sleep and staying asleep and having 4 hours being the minimum and not the maximum you use the machine.

[wad06]

For some reason, the Dropbox link didn't work. I'm trying photobucket now.

Here is the screen capture:

[Pugsy]

You can go to Preferences and turn off the AHI and mask pressure graph...they are redundant information and not needed.
Main graphs to look at
Events graph
Pressure graph
Leak graph
Snore and Flow limitation graphs if they are exciting.
You can resize the graphs and do some turning off of unneeded graphs so that all you see is on one nice quick image.
To resize just hover the mouse cursor on the bottom of the graph line till you see a little short double line...click and drag.
SleepyHead will remember what you do.

Your central clusters appear to be likely in some sort of awake/semi awake stage..not evenly spread throughout the night.
I bet you were awake when those popped up.
Especially the 20:00 and 20:10 clusters. If you dozed in and out of sleep...probably a few sleep onset centrals.

I really think that once you can get to sleep and stay asleep...the bulk of those centrals will go away.
If they don't we get to have a different discussion but you need more hours of sleep (and not with little mini arousals) so that you can accurately gauge what is going on.
If you had told me that you slept soundly for this 4 hours it would be a different story but you are having multiple wake ups which totally mess with the reports.

Is this something that you had problems with before cpap? CPAP made it worse? Hoping that multiple awakenings in the past were all OSA related and thus effective therapy would fix it?

Not all sleep insomnia issues are related to OSA but they can be made worse by OSA but even if OSA is well treated people can have some serious insomnia issues.

[wad06]

I guess I'll just keep working on getting comfortable and falling asleep.

As to the past, I was a very sound sleeper until about 26. Starting around then, I would find myself dozing in and out of sleep throughout the night (usually not fully waking up). Every once in a while, I would completely wake, out of breathe, with my heart "pounding".

After falling asleep in front of some family members, they saw the whole stop breathing thing. I didn't worry about it, until a year ago. I finally got tired enough during the day to want to get it fixed. Went to the sleep lab, got a study, and was diagnosed with mild obstructive apnea. I doubted I could actually sleep with the whole thing on my face, so I went another year dealing with the tiredness. A month ago, I caved. I went and had another sleep study and got setup with the cpap.

Here I am now.

Anyway, like I said, I'll keep working on getting to sleep. If I can get a decent night, I'll post the results for additional feedback. Thanks a million for being so helpful. I appreciate it very much.

[wad06]

Ok, so with the help of some ambien, I got a little over five hours in last night. I've attached the SleepyHead results. I don't remember waking up a single time before the morning.

Any thoughts? There still seem to be some clear airway events (19) and some obstructive events (4).

[Pugsy]

The obstructive events...nothing to worry about at all.

The Clear airway events...I don't think there's enough of them for a doctor to worry about and they may come and go as you get used to the machine. Right now..just keep doing what you are doing and keep an eye on those clear airway events.
If we start seeing an increase in them and you know you were asleep and they start pushing 5 per hour every night then for sure talk to your doctor about them.
So just keep one eye on them for now. They are not in great enough numbers now that a doctor would do much other than see if it continues...gets worse..or gets better. Sometimes people do have a few centrals pop up when starting treatment but they disappear after a few weeks or so.

Are you schedule for a follow up appointment anytime soon?

[wad06]

I've got a follow-up scheduled for about four weeks from now.

I am hoping to get off the ambien in the next couple of days (although it did feel good to sleep a little bit, which I hadn't done with the mask on).

Thanks for the helpful info. I do appreciate it.

Will

[Pugsy]

If the centrals haven't abated somewhat and are pretty consistent in 4 weeks talk to you doctor about them.
It's normal to see them come and go...some nights minimal to none and some nights with more than a few.
It's when they stay consistent or increase and stay consistent that we need to look closer.
I might have zero centrals tonight and a truck load of them tomorrow night.

Oh...are you taking any pain meds or muscle relaxers for any reason?
Pain meds in the opiate family can cause a few extra centrals.
The Ambien shouldn't but you can evaluate that when you don't take it.

[Nooblakahn]

Okay.. I'm not crazy. Sleepyhead should show a clear airway or an obstructive apnea. Mine just shows Unspecified. What gives here? I this a setting the DME has disabled on my machine.. or something i'm missing in sleepyhead?

[Pugsy]

Okay.. I'm not crazy. Sleepyhead should show a clear airway or an obstructive apnea. Mine just shows Unspecified. What gives here? I this a setting the DME has disabled on my machine.. or something i'm missing in sleepyhead?

SleepyHead doesn't names the events...the machine does.
You have the S9 Adapt...ASV line...they don't flag centrals at all if I remember right.
Do you have ResScan that you can use so you can see what it shows.
With SleepyHead if an event doesn't happen..on the events graph that category just doesn't show up.
The S9 can and will flag unknowns in their machines.
SleepyHead and the ASV machines....I would check with ResScan for confirmation because SH and the ASV machines as they have changed SH has had a few problems.

Remember...SleepyHead is showing whatever is on the SD card. It doesn't take the breathing pattern and analyze it. That's the machine's job.