First CPAP night, questions about Sleepyhead data

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
lrob123
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First CPAP night, questions about Sleepyhead data

Post by lrob123 » Sun Apr 02, 2017 2:43 pm

I just spent my first two nights with a CPAP machine, it is a Philips Respironics Dreamstation Auto (Auto-pap). I have a Resmed Swift nasal pillow mask.

I was recently diagnosed with sleep apnea via a home study (15 AHI) and an in-lab PSG (11 AHI). My sleep doctor (neurologist) said my apnea was mild. However, I was concerned that the sleep tests might not have been too accurate since those nights I hardly slept. The in-lab test was a disaster, I only slept for 20 minutes the whole night. I did not have a CPAP during the tests (I just picked up my CPAP 2 days ago).

Before getting a CPAP machine, based on reading this forum and other internet forums, I ordered a Contec CMS50I oximeter (from ebay). The oximeter data said I have some dips around 85% SPO2. I could see that my worst apnea problems are later in the night (not the first 3 hours of deep sleep) and the problems get worse towards morning, probably during REM periods since I have nightmares and wake often.

I then requested that my doctor prescribe a CPAP machine for me and he did.

He prescribed an APAP pressure range of 4cm to 8cm.

I felt I did OK compared to some other first time users from what I've read, I really didn't like the creepy feeling of trying to exhale into the nasal pillow, but I kept the mask on anyway and the 2nd night was better.

I downloaded SleepyHead software so I can see my data. When I imported my first two nights of data into Sleepyhead, it told me my results were 'horrible' and to talk to my doctor :-<

I've uploaded a screenshot of the sleepyhead data:
Image

The number of AHIs seems worse than the home or lab study said. Do you think I need to ask my doctor to raise my pressure range?

I don't know if the number of central apneas should be of concern, i.e. how does one tell if one really has a problem with central apnea and might need a different type of machine?

One thing that surprised me was that when I woke up in the morning, was wide awake reading, the machine stayed at the high end of the range 8cm (for many minutes, never went down until I turned it off for a while at 9:30am). I knew I was breathing normally so I expected the machine to drop back down to 4cm but it did not. It seemed to flag events and raise the pressure again when I was fully awake (just reading in bed, left it on for curiosity sake) from 9:45-10:48am. Is this to be expected?

I might ask this same question on other apnea forums. This is the forum I've browsed the most often but I've never posted to any. I wonder how this forum compares to other sleep apnea forums - is one forum known to be have the most Sleepyhead users for instance? Has anyone started out at a different apnea forum and decided to switch to this one?

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D.H.
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Re: First CPAP night, questions about Sleepyhead data

Post by D.H. » Sun Apr 02, 2017 2:58 pm

You spent quite a bit of time at the max. You should not increase the max without speaking to your doctor as you are experiencing "Clear Airway" events.

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Pugsy
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Re: First CPAP night, questions about Sleepyhead data

Post by Pugsy » Sun Apr 02, 2017 2:58 pm

lrob123 wrote:One thing that surprised me was that when I woke up in the morning, was wide awake reading, the machine stayed at the high end of the range 8cm (for many minutes, never went down until I turned it off for a while at 9:30am). I knew I was breathing normally so I expected the machine to drop back down to 4cm but it did not. It seemed to flag events and raise the pressure again when I was fully awake (just reading in bed, left it on for curiosity sake) from 9:45-10:48am. Is this to be expected?
These machines can't/don't drop the pressure immediately upon awakening and breathing supposedly returns to normal. The go up slowly and they come down slowly. Eventually it will return to normal but most of us can't/won't wait that long.
In addition sometimes the machine will sense what actually normal awake/semi awake breathing irregularities as some sort of apnea events.
They don't know if we are awake or not. They only measure air flow and awake/semi awake breathing can confuse the machine. Our awake/semi awake breathing is a lot more irregular than we might think and certainly never notice.
lrob123 wrote:Do you think I need to ask my doctor to raise my pressure range?
Yes...or do it yourself if you are comfortable doing it yourself.

These settings are allowing the airway to collapse to easily...everything except the CA/Centrals point to the airway trying to close off. So all that other stuff...OA, hyponea, FL, snore, RERA all point to the airway trying to close off.

The centrals...don't know what to make of them but they could easily be awake/semi awake breathing getting flagged by mistake or they could simply be post arousal centrals because of all the obstructive stuff going on. Usually we suggest to fix what is obviously needing fixing and see the centrals persist (they might go away if they are post arousal centrals if you fix the reason for the arousal) or increase in numbers.

Based on your reports...how much to increase...I would say start with a minimum of 8 and maybe set the max to 12 or 16 or even 20...see where it wants to go. If the centrals increase dramatically then we step back but I doubt they will. The bulk of your AHI is obstructive in nature and I think that once you are sleeping better with less chance of arousals with a more optimal minimum pressure that you will see the CAs reduce.
If they don't or really worsen then we have a different discussion about them and this machine but try the easy fix first and see if you get lucky.
Odds are that you will.

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palerider
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Re: First CPAP night, questions about Sleepyhead data

Post by palerider » Sun Apr 02, 2017 3:01 pm

lrob123 wrote:I was recently diagnosed with sleep apnea via a home study (15 AHI) and an in-lab PSG (11 AHI). My sleep doctor (neurologist) said my apnea was mild. However, I was concerned that the sleep tests might not have been too accurate since those nights I hardly slept. The in-lab test was a disaster, I only slept for 20 minutes the whole night. I did not have a CPAP during the tests (I just picked up my CPAP 2 days ago).
lab studies are often wrong, because of the alien environment and brief period, like yours.
lrob123 wrote:I downloaded SleepyHead software so I can see my data. When I imported my first two nights of data into Sleepyhead, it told me my results were 'horrible' and to talk to my doctor :-<

The number of AHIs seems worse than the home or lab study said. Do you think I need to ask my doctor to raise my pressure range?
your pressure is definitely too low, either raise it yourself or hope your doctor will be responsive.
lrob123 wrote:I don't know if the number of central apneas should be of concern, i.e. how does one tell if one really has a problem with central apnea and might need a different type of machine?
it's too early to tell, they may be transitional centrals due to the other problems you're having, I wouldn't worry about it until the obstructive issues are tamed, they may resolve on their own.
lrob123 wrote:One thing that surprised me was that when I woke up in the morning, was wide awake reading, the machine stayed at the high end of the range 8cm (for many minutes, never went down until I turned it off for a while at 9:30am). I knew I was breathing normally so I expected the machine to drop back down to 4cm but it did not. It seemed to flag events and raise the pressure again when I was fully awake (just reading in bed, left it on for curiosity sake) from 9:45-10:48am. Is this to be expected?
it's not unexpected, the machine you have is slow to raise pressure, and slow to lower it, plus, awake breathing is typically very chaotic compared to normal sleep breathing, and can and does confuse machines. you can zoom in on the flow line and look at how you were breathing, and perhaps see what was confusing the machine.
lrob123 wrote:I might ask this same question on other apnea forums. This is the forum I've browsed the most often but I've never posted to any. I wonder how this forum compares to other sleep apnea forums - is one forum known to be have the most Sleepyhead users for instance? Has anyone started out at a different apnea forum and decided to switch to this one?
this is the most active forum, and where you'll get the best answers fastest, and even though there are quite a number of people that contribute nothing useful, there are plenty of people that will jump in and say "NO, that's wrong".

freecpapadvice.com/forum is another great place for information, it's run by a smart sleep tech, who's also posted a lot of videos on youtube, but the volume is much lower, so you may have to wait longer for an answer.

apneabored is a great place if you're got delicate feelings because it's HIGHLY moderated, and there is more concern for peoples feelings than accurate information, so there's often misleading info that's posted, and people have to tiptoe around it, lest the offend someone. the forum moderators restrict expression to be suitable for eight year olds, because the owners young nice liked to sit and read with him... and he didn't want to have to explain anything grown up. the main advantage of apneabored is that they provide links for clinical software and manuals.

find whatever place best suits you.

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lrob123
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Re: First CPAP night, questions about Sleepyhead data

Post by lrob123 » Sun Apr 02, 2017 4:44 pm

D.H. wrote:You spent quite a bit of time at the max. You should not increase the max without speaking to your doctor as you are experiencing "Clear Airway" events.
Thanks. I will definitely talk with my doctor and the RT at the DME. I figure it is probably best for a new CPAP user to not change settings yourself for the first few months, during the early adapting period where you try to figure out your optimal pressure and maybe during the rent to buy period of the machine.

But if I don't get helpful responses from the medical people e.g. If they told me to just sit and wait 3 months until I was next scheduled for a doctor appointment and wouldn't change pressure range via the modem, I would advocate more strongly or eventually learn how to change the settings myself.

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palerider
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Re: First CPAP night, questions about Sleepyhead data

Post by palerider » Sun Apr 02, 2017 4:50 pm

lrob123 wrote:
. wrote:You spent quite a bit of time at the max. You should not increase the max without speaking to your doctor as you are experiencing "Clear Airway" events.
Thanks. I will definitely talk with my doctor and the RT at the DME.
bear in mind that the person giving you that advice is one of the forum idiots. doesn't know a thousandth of what he thinks he does... but never, ever shuts up.

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lrob123
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Re: First CPAP night, questions about Sleepyhead data

Post by lrob123 » Sun Apr 02, 2017 5:06 pm

Pugsy wrote:
These machines can't/don't drop the pressure immediately upon awakening and breathing supposedly returns to normal. The go up slowly and they come down slowly. Eventually it will return to normal but most of us can't/won't wait that long.
In addition sometimes the machine will sense what actually normal awake/semi awake breathing irregularities as some sort of apnea events.
They don't know if we are awake or not. They only measure air flow and awake/semi awake breathing can confuse the machine. Our awake/semi awake breathing is a lot more irregular than we might think and certainly never notice.

...

The centrals...don't know what to make of them but they could easily be awake/semi awake breathing getting flagged by mistake or they could simply be post arousal centrals because of all the obstructive stuff going on. Usually we suggest to fix what is obviously needing fixing and see the centrals persist (they might go away if they are post arousal centrals if you fix the reason for the arousal) or increase in numbers.

Based on your reports...how much to increase...I would say start with a minimum of 8 and maybe set the max to 12 or 16 or even 20...see where it wants to go. If the centrals increase dramatically then we step back but I doubt they will. The bulk of your AHI is obstructive in nature and I think that once you are sleeping better with less chance of arousals with a more optimal minimum pressure that you will see the CAs reduce.
If they don't or really worsen then we have a different discussion about them and this machine but try the easy fix first and see if you get lucky.
Odds are that you will.
Thanks this is interesting and makes a lot of sense.

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lrob123
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Re: First CPAP night, questions about Sleepyhead data

Post by lrob123 » Sun Apr 02, 2017 5:17 pm

palerider wrote:
lrob123 wrote:
. wrote:You spent quite a bit of time at the max. You should not increase the max without speaking to your doctor as you are experiencing "Clear Airway" events.
Thanks. I will definitely talk with my doctor and the RT at the DME.
bear in mind that the person giving you that advice is one of the forum idiots. doesn't know a thousandth of what he thinks he does... but never, ever shuts up.

Since I'm new here, I appreciate all advice. Reading different opinions can be educational for me.

I like that the people here want to understand their data e.g. use Sleepyhead, and are informed and proactive participants in their health care.

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palerider
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Re: First CPAP night, questions about Sleepyhead data

Post by palerider » Sun Apr 02, 2017 7:03 pm

lrob123 wrote:Since I'm new here, I appreciate all advice.
not all advice is good advice, something to keep in mind.

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