Sleepyhead shows AHI above 5

[TedVPAP]

Ted.....I am not so sure that those events shown are real. There's a good chance that they are SWJ and the Icon could just be reacting to false events.
OP had a sleep study that didn't document many OSA events at all. Not enough to earn the diagnosis so it just isn't logical that now with the machine at these pressures that the AHI would be higher than without a machine.
Since he reported multiple awakenings and poor sleep in general that's what makes me wonder if those flagged events and the machine's response is even accurate or not.
Hence the recommendation to back up and get used to the machine and the mask and actually get some solid sleep and then worry about tweaking the pressures.

If he has anything it is UARS most likely. He didn't have enough obstructive apnea events to earn even a mild diagnosis.
The F & P trial is just his wish to try something to see if it helps him feel better.

Now once he can say he slept decently with the mask and machine...then we look closer at what the pressures are doing and what might be needed.
I don't trust the response of the Icon in this situation which is why I won't/can't advise such a big high starting pressure for someone brand new to therapy and doesn't even have a diagnosis of OSA. It's a maybe that his problems are even related to sleep disordered breathing.
Won't hurt a thing to back up and take a slower approach...he's got to get the sleep first.
He didn't have a titration study either. This is all DIYing things.

All good points. I forgot that is seems his starting lower pressure came from nowhere. He did mention having similar hypopneas during his sleep study and a very similar AHI so his machine data is consistent with his study. Starting over with a low pressure is always a good place to start. Hopefully he will post results so we can see.

[Pugsy]

He did mention having similar hypopneas during his sleep study and a very similar AHI so his machine data is consistent with his study.

Yeah but without flow rate we can't look at the graphs and make any sort of educated guess as to whether those flagged events are real or SWJ events.
All we can go on is his saying he slept poorly so we have to assume some SWJ at a minimum.

This is another reason why I stick with recommending ResMed or Respironics machines...more comprehensive data available just in case it is ever needed.

[Mark55]

Ted.....I am not so sure that those events shown are real. There's a good chance that they are SWJ and the Icon could just be reacting to false events.
OP had a sleep study that didn't document many OSA events at all. Not enough to earn the diagnosis so it just isn't logical that now with the machine at these pressures that the AHI would be higher than without a machine.
Since he reported multiple awakenings and poor sleep in general that's what makes me wonder if those flagged events and the machine's response is even accurate or not.
Hence the recommendation to back up and get used to the machine and the mask and actually get some solid sleep and then worry about tweaking the pressures.

If he has anything it is UARS most likely. He didn't have enough obstructive apnea events to earn even a mild diagnosis.
The F & P trial is just his wish to try something to see if it helps him feel better.

Now once he can say he slept decently with the mask and machine...then we look closer at what the pressures are doing and what might be needed.
I don't trust the response of the Icon in this situation which is why I won't/can't advise such a big high starting pressure for someone brand new to therapy and doesn't even have a diagnosis of OSA. It's a maybe that his problems are even related to sleep disordered breathing.
Won't hurt a thing to back up and take a slower approach...he's got to get the sleep first.
He didn't have a titration study either. This is all DIYing things.

I am not knowledgeable enough at this point to get involved with machine settings for a situation like this, but IF I was to make a recommendation,....this is what it would be.

[Pugsy]

There were no desats of any significance on the diagnostic sleep study....that's part of the reason no official OSA diagnosis.

F & P machines are notorious for flagging hyponeas when they aren't necessarily a problem and they don't respond well to more pressure.
Meaning people go from a F & P machine to a ResMed or Respironics machine and the hyponeas aren't a problem with those brands at the same pressures.
I have seen people with F & P machines try some significant minimum pressure increases in an effort to reduce hyponea numbers and not have any reduction in the numbers. Not sure why unless there's something in the algorithm that makes it so that the usual way of dealing with hyponeas doesn't seem to work for some people. And all this is assuming the hyponeas are real and not SWJ.

[TedVPAP]

... It looks like my sleep study where I have like 16 hypoapnea's in 45 minutes that last for 40 seconds. I just can not believe nothing is wrong with me during sleep.

16 hypopneas in 45 minutes and yet no diagnosis of OSA is puzzling. When I read that I thought that maybe his problem is only during REM and there was enough non-REM time to dilute the numbers to an overall AHI of less than 5 (4.4).
It would be nice to see the report but the language difference could be a challenge.

[Pugsy]

16 hypopneas in 45 minutes and yet no diagnosis of OSA is puzzling. When I read that I thought that maybe his problem is only during REM and there was enough non-REM time to dilute the numbers to an overall AHI of less than 5 (4.4).
It would be nice to see the report but the language difference could be a challenge.

Might have been REM and might have been related to supine sleeping causing the clustering.
It was a home study but a full channel home study complete with EEG for sleep status...don't know about sleep position though.
And yes...the language barrier along with however the study was scored could be a challenge and I don't know that we would know a lot more than we do right now anyway.
The end result was overall AHI not making the diagnosis criteria where he lives to get him a machine and doctors to help him out.

[TASmart]

AASM recommended procedure for scoring does not require desaturations. Attached is the latest from the AASM website. The second option that excludes arousals from the scoring criteria is subservient to the recommended scoring criteria.

AASM clarifies hypopnea scoring criteria
In August members were notified that the AASM has suspended indefinitely the requirement for accredited sleep centers to score hypopneas in adult patients according to the 3 percent oxygen desaturation criterion in the new AASM scoring manual.
The AASM continues to recommend scoring hypopneas in adults when there is a ≥ 3% oxygen desaturation from pre-event baseline and/or the event is associated with an arousal. However, it is acceptable for accredited sleep centers to score hypopneas in adults when there is a ≥ 4% oxygen desaturation from pre-event baseline.
AASM sleep centers must specify in the PSG report whether hypopneas were scored using the recommended rule 1A or the acceptable rule 1B:
Recommended
1A. Score a respiratory event as a hypopnea if ALL of the following criteria are met:
a. The peak signal excursions drop by ≥30% of pre-event baseline using nasal pressure (diagnostic study), PAP device flow (titration study), or an alternative hypopnea sensor (diagnostic study).
b. The duration of the ≥30% drop in signal excursion is ≥10 seconds.
c. There is a ≥3% oxygen desaturation from pre-event baseline and/or the event is associated with an arousal.
OR
Acceptable
1B. Score a respiratory event as a hypopnea if ALL of the following criteria are met:
a. The peak signal excursions drop by ≥30% of pre-event baseline using nasal pressure (diagnostic study), PAP device flow (titration study), or an alternative hypopnea sensor (diagnostic study).
b. The duration of the ≥30% drop in signal excursion is ≥10 seconds.
c. There is a ≥ 4% oxygen desaturation from pre-event baseline.
Please note that the criterion involving arousals is included in 1A and excluded from 1B.

Although it really does not matter as the OP is Dutch, so AASM standards don't apply.

[TASmart]

What about that part where it says and/or arousal is present? It does not seem to be my reading that is a problem.

[emreee93]

These are my sleep study results

You can see that in the first 4 hours I have all the events then I wake up and cant go back to sleep beceause of the shitty matrass at my moms place. And then only sleep for 1:20 minutes with almost no event

https://www.dropbox.com/s/n5sdngvo21qdo ... 9.png?dl=0

https://www.dropbox.com/s/j7b1hazn1iqsm ... 9.png?dl=0

Here everything is in Dutch but the most important thing are the AHI of 4,3 and RERA index of 1,3

https://www.dropbox.com/s/bnycejr4wp4wn ... 2.png?dl=0

[TASmart]

This paper attempts to differentiate sleep apnea effects on the brain between arousals and desaturations. Interestingly, the authors conclude that it is the desaturations that cause changes in white and gray matter volumes. Arousals do not. What is interesting here in addition to the effect of desaturation n brain structure is that arousals are and can be separate. Which is what I have maintained. In fact, in my own sleep studies, I have had many respiratory-related arousals but little to no desaturations, at least in the titration study. In my diagnostic study I had lots of both, but many more arousals than desaturations.

http://www.sciencedirect.com/science/ar ... 441530002X

[TASmart]

Look at the paper. Only components of the AHI are included, so by definition, the events that do not lead to desaturations are either Apnea or Hypopnea. It is wrong to claim that you cannot have hypopneas without desaturation. You may or may not have desaturations with hypopnea. Maybe it's like xxyzx says, you cannot have hypops without desaturation but his definition is truncated just like his spelling. Hypopneas can be with or without desaturations. Last I have today on this.