Trying to understand my results. {UPDATE}

Morning folks,
I recently acquired a CPAP machine and picked up a new ResMed Airfit P10 and hose for it. Overall I feel this is helping me and the misses has commented on me not snoring or waking up constantly. But, I'm looking to see if I can tune things a bit better. Have a look at my past week of results and help me understand things.

Link to album is below.
http://imgur.com/a/6C0fT

Quick question - have you tried wearing a soft cervical collar - it would keep your head up and your airway more open if your head normally falls to your chest and cuts off your air flow, And is there a reason you're on plain Cpap rather than Apap?

In your examples, several of your events take place shortly after you turn on the machine...possibly because of the ramp starting at 4 and continuing a slow increase for 20 minutes. Personally, I would turn off the ramp so the machine starts your pressure at 8.5 rather than 4. This should bring down your AHI. If that doesn't work, I would increase your pressure to 9.

If you have the APAP why are you using it as a CPAP? (I might be missing something here??) You started out at 6 and have slowly moved it up to 8 but why not put into auto mode (since you obviously are setting new levels) and set it between like 6 and 16 just to see if the machine working for you as an APAP might help with these?

Or maybe I am missing something here in what is showing (I am new to all of this....)

Divinitous wrote:Morning folks,
I recently acquired a CPAP machine and picked up a new ResMed Airfit P10 and hose for it. Overall I feel this is helping me and the misses has commented on me not snoring or waking up constantly. But, I'm looking to see if I can tune things a bit better. Have a look at my past week of results and help me understand things.

Sorry for the size.

First the easy thing: To control the size of the image in the forum, it's usually best to select "Large Thumbnail" for the size over at imgur.

Now for your real question of what you might do to better fine tune things.

The first thing I notice in your data are the gaps in usage. Some nights there are gaps that total as much as one to two hours in length. What's your normal bedtime? What's your normal wake up time? And how often are you aware that you are taking the mask off during the night? And what do you do after you take the mask off? Do you get out of bed and do something until you start feeling sleepy? Or do you go back to sleep without the mask on?

Next: Your leak graphs indicate that you have a good seal on your mask. So you don't need to worry about mouth breathing issues. If your mask is comfortable, you don't need to worry about mask issues. If your mask is not comfortable enough, the question is what could you do to improve your comfort level.

Finally the efficacy of your therapy: Your AHIs are technically low enough to consider your OSA "treated", but as you suspect, there is some room for improvement. Many people find that getting their treated AHI below 2.5 or so leads to feeling better than when the treated AHI is up in the 4.0-5.0 range. There is some residual snoring being scored on some nights. More on this in a bit.

The data for 4/16, 4/18, 4/19, 4/21, and maybe 4/22 all show some evidence of what we often call "sleep-wake-junk", or SWJ breathing, near the end of the night. Normal wake breathing is much less stable than normal sleep breathing is, and the transition between wake breathing and sleep breathing can look particularly "unstable" to the CPAP even when it's perfectly normal transition breathing. So when you have extended periods of time where you're drifting in and out of sleep or if you're trying unsuccessfully get back to sleep in the morning just before you decide to go ahead and get out of bed, it is possible for the machine to score some "false events"---i.e. score breathing patterns as Hs and OAs and (particularly) CAs that would not be scored on an in-lab sleep test as a sleep disordered breathing event. In evaluating your data for 4/16, 4/18 and 4/19 it's important to ask: Were you awake or asleep during the last short session when a lot of events are scored? On 4/21 and 4/22 it's worth asking yourself: Were you drifting in and out of a light doze during the last hour of PAPing?

As for suggested tweaks: If you are not dealing with aerophagia issues and if you are not struggling to get to sleep and to stay asleep with the machine, then a small 0.5-1.0 cm increase in pressure may help eliminate some or most of the residual snoring. A small increase in pressure may also help bring down that treated AHI for the parts of the night when you are sound asleep.

So my advice is this: Increase the pressure a smidge (as long as you're not dealing with aerophagia) and see if that helps. Also work on addressing the usage gaps if they represent times when you are asleep, but not using the mask---CPAP is not a part time therapy and you will only feel at your best once you are using CPAP all night long. If those gaps represent times you got out of bed because you were not sleeping AND if you feel like the "not sleeping time" is adversely affecting how you feel during the daytime, then you also need to address an insomnia issue as well. But note: Some people have a natural sleep pattern that divides into two main chunks where they frequently do get out of bed for an hour or two in the middle of the night, do some things while they are awake, and then return to bed after they get sleepy, and they feel just find during the daytime. The best thing those people can do about their middle of the night wakes is to not worry about them.

LSAT wrote:In your examples, several of your events take place shortly after you turn on the machine...possibly because of the ramp starting at 4 and continuing a slow increase for 20 minutes. Personally, I would turn off the ramp so the machine starts your pressure at 8.5 rather than 4. This should bring down your AHI. If that doesn't work, I would increase your pressure to 9.

Since the min pressure in settings and the min pressure given below the pie chart agree, there's no evidence that a ramp is being used. The min pressure in the Min Pressure number in the summary data under the pie chart includes ramp pressures for the DreamStations.

gregoryjames wrote:If you have the APAP why are you using it as a CPAP? (I might be missing something here??) You started out at 6 and have slowly moved it up to 8 but why not put into auto mode (since you obviously are setting new levels) and set it between like 6 and 16 just to see if the machine working for you as an APAP might help with these?

Or maybe I am missing something here in what is showing (I am new to all of this....)

SleepyHead reports the machine as a PR Dreamstation Pro, which is a fixed pressure machine, not an APAP.

Poster doesn't exactly have an AUTO. This is the machine he shows in his profile...cpap.com classifies it as fixed pressure.

Philips Respironics 60 Series Pro with Bluetooth uses C-Flex Plus to soften the transition between inhalation and exhalation to help the user adjust to CPAP pressure. Auto-Trial mode and CPAP-Check mode are additional features used to provide pressure relief. Pair the 60 Series Pro using Bluetooth to the SleepMapper app to review therapy results the next morning.
The smart technology of Auto-Trial Mode and CPAP-Check Mode offer up to 30 nights of auto adjusting capability. During that period of use the system functions as an Auto CPAP delivering an adaptive pressure on a breath by breath basis. Following the set time of the Auto-Trial mode, the machine functions as a CPAP delivering one set pressure that the patient was at or below 90% of the time.

robysue wrote:

LSAT wrote:In your examples, several of your events take place shortly after you turn on the machine...possibly because of the ramp starting at 4 and continuing a slow increase for 20 minutes. Personally, I would turn off the ramp so the machine starts your pressure at 8.5 rather than 4. This should bring down your AHI. If that doesn't work, I would increase your pressure to 9.

Since the min pressure in settings and the min pressure given below the pie chart agree, there's no evidence that a ramp is being used. The min pressure in the Min Pressure number in the summary data under the pie chart includes ramp pressures for the DreamStations.

In the example shown, the "settings" area shows Ramp time 20 minutes...ramp pressure 4.0. (?)

First, thank you everyone for taking the time to look at the results. I'm kinda handling this on my own and it's hard to understand everything all at once. I've read up on the forums but just picking brains always seems to get the best results and understanding on my end.

robysue wrote: First the easy thing: To control the size of the image in the forum, it's usually best to select "Large Thumbnail" for the size over at imgur.

Looks like the forum resized the pictures to the users monitor resolution.

robysue wrote: The first thing I notice in your data are the gaps in usage. Some nights there are gaps that total as much as one to two hours in length. What's your normal bedtime? What's your normal wake up time? And how often are you aware that you are taking the mask off during the night? And what do you do after you take the mask off? Do you get out of bed and do something until you start feeling sleepy? Or do you go back to sleep without the mask on?

My normal bedtime is around 10:30 but I prefer to be in bed before 9:45. I've always been one to fall sleep easily. I generally wake up around 5:30 due to two cats demanding that I feed them.
Sometimes I'll wake up around midnight, grab a drink, and go back to sleep. Those may be the periods where nothing is plotted. However, sometimes i don't remember waking up at all and am surprised in the morning to see that the machine stopped recording for periods.

robysue wrote: Next: Your leak graphs indicate that you have a good seal on your mask. So you don't need to worry about mouth breathing issues. If your mask is comfortable, you don't need to worry about mask issues. If your mask is not comfortable enough, the question is what could you do to improve your comfort level.

Mask feels good and comfortable. I haven't had any issues with this so far.

robysue wrote: Finally the efficacy of your therapy: Your AHIs are technically low enough to consider your OSA "treated", but as you suspect, there is some room for improvement. Many people find that getting their treated AHI below 2.5 or so leads to feeling better than when the treated AHI is up in the 4.0-5.0 range. There is some residual snoring being scored on some nights. More on this in a bit.

Since I've started this I have to say that I've noticed some good changes. It's been ~20 years since I feel I've dreamt. Now I'm starting to dream.

robysue wrote: The data for 4/16, 4/18, 4/19, 4/21, and maybe 4/22 all show some evidence of what we often call "sleep-wake-junk", or SWJ breathing, near the end of the night. Normal wake breathing is much less stable than normal sleep breathing is, and the transition between wake breathing and sleep breathing can look particularly "unstable" to the CPAP even when it's perfectly normal transition breathing. So when you have extended periods of time where you're drifting in and out of sleep or if you're trying unsuccessfully get back to sleep in the morning just before you decide to go ahead and get out of bed, it is possible for the machine to score some "false events"---i.e. score breathing patterns as Hs and OAs and (particularly) CAs that would not be scored on an in-lab sleep test as a sleep disordered breathing event. In evaluating your data for 4/16, 4/18 and 4/19 it's important to ask: Were you awake or asleep during the last short session when a lot of events are scored? On 4/21 and 4/22 it's worth asking yourself: Were you drifting in and out of a light doze during the last hour of PAPing?

This is very possible as the cats will sometimes start bugging us for food as early as 4:30 in the morning. Both Saturday (4/15) and Sunday (4/16) I would feed the cats and then try to get back to sleep for an hour or two if possible.

robysue wrote: As for suggested tweaks: If you are not dealing with aerophagia issues and if you are not struggling to get to sleep and to stay asleep with the machine, then a small 0.5-1.0 cm increase in pressure may help eliminate some or most of the residual snoring. A small increase in pressure may also help bring down that treated AHI for the parts of the night when you are sound asleep.

I will give this a try. I don't seem to have any issues with the higher pressure. I had originally started at 6, made an increase to 7, and then once turning to 8.5 I felt even more of an improvement.

robysue wrote: So my advice is this: Increase the pressure a smidge (as long as you're not dealing with aerophagia) and see if that helps. Also work on addressing the usage gaps if they represent times when you are asleep, but not using the mask---CPAP is not a part time therapy and you will only feel at your best once you are using CPAP all night long. If those gaps represent times you got out of bed because you were not sleeping AND if you feel like the "not sleeping time" is adversely affecting how you feel during the daytime, then you also need to address an insomnia issue as well. But note: Some people have a natural sleep pattern that divides into two main chunks where they frequently do get out of bed for an hour or two in the middle of the night, do some things while they are awake, and then return to bed after they get sleepy, and they feel just find during the daytime. The best thing those people can do about their middle of the night wakes is to not worry about them.

The system does have the option to ramp and it is set to on but it does not ramp unless I press the ramp at the beginning. The pressure is at a fixed value.
My machine is a Phillips Respironics System One Remstar Pro with C-Flex+ (Model 450P) This is an older model from what LSAT posted.

I just realized I never quite added an intro. A little about me...
I'm 35 years old, 165-175 lbs, 5'9", don't smoke, very rarely drink (lightweight, 1 beer is good), physically active (bike, hike, kayal), have seasonal allergies, diagnosed with exertional asthma, and in relatively healthy shape.
Regarding sleeping through, I've snored my whole life and can fall sleep anytime my mind isn't running. There have been many times where I'll fall sleep on the floor, sitting in a hospital waiting room, and even during conversations. I can also recall times where I would complete long drives and get into the driveway with no recollection of the past hour.

It's normal for me to have to take a mid-day nap in my car for lunch during the weekdays or on the couch on the weekend. Even still hours after I can still feel tired.

Overall, as mentioned before I am starting to notice a difference. I've begun dreaming and on somedays it feels like my brain isn't gasping for neurons like it used to be. But I also still feel pretty damn tired during the day and know that there's more room for improvement. I'm hoping to get to where I feel like a normal human being.

Divinitous wrote:The system does have the option to ramp and it is set to on but it does not ramp unless I press the ramp at the beginning. The pressure is at a fixed value.
My machine is a Phillips Respironics System One Remstar Pro with C-Flex+ (Model 450P) This is an older model from what LSAT posted.

That's how my cpaps all worked - you have to press the "Ramp" button to turn Ramp ON.

While the 450 is not yesterdays model it is certainly a good machine. It has data and if it works for you that is all that really matters. It does have good features and works with Sleepyhead - what more do you need?

Some here are still using M series or tanks and while those may still supply data they don't work with Sleepyhead but are still good cpaps - you just need a special card reader and Encore to read the data, if you have all that so what.

There have been some enhancements in the algorithm since days gone by but like I said if you feel good and it is treating your events who cares. Do you get a new car every time they change things or a new computer, or how about new software every time Microsoft changes things? I sure don't.

Divinitous wrote:First, thank you everyone for taking the time to look at the results. I'm kinda handling this on my own and it's hard to understand everything all at once. I've read up on the forums but just picking brains always seems to get the best results and understanding on my end.

robysue wrote: First the easy thing: To control the size of the image in the forum, it's usually best to select "Large Thumbnail" for the size over at imgur.

Looks like the forum resized the pictures to the users monitor resolution.

Yes, but posting a "Large Thumbnail" keeps the image from becoming too large for us to see the whole thing.

You write:

Sometimes I'll wake up around midnight, grab a drink, and go back to sleep. Those may be the periods where nothing is plotted. However, sometimes i don't remember waking up at all and am surprised in the morning to see that the machine stopped recording for periods.

This brings up some additional questions about those gaps in your data on three of the days you posted:

4/18: Looks like you took an evening nap between 7:00pm and 8:00pm. Then went to bed for the night around 11:45. I'm assuming the cats woke you up around 4:30. And you stayed out of bed all the way until 6:15, when you went to bed, masked up, but couldn't get back to sleep, so you just got up again. Any of that accurate?

4/19: Looks like you went to bed around 11:00pm, you may have fallen asleep for a bit more than hour or so. But something happens around 12:15 (fifteen minutes after midnight). Do you think you got up for a drink and then went back to bed? Or do you think you were up for an hour and a half? Because the machine was turned off between 12:15 and 1:50. If you got the drink and then went immediately back to bed, it could be that you just plain didn't mask up at that point. And that after you woke up at 1:50 you realized the mask was not on, and so you put it back on to go back to sleep.

4/21: Shows a similar pattern to 4/19. The data says you went to bed around 11:20 and then woke up and took the mask off around 1:10. If you got up to get a drink, then one of two things must have happened. Either you stayed up for 90 minutes or you went back to bed and forgot to mask back up after getting your drink. I know this because the machine was off between 1:10 and 2:40 according to the data. Any idea which it was?

You may need to be a bit more proactive in making sure that you put the mask back on after you get up for a drink of water. The data for the week you posted does reveal that you usually do have a break in usage that corresponds to your memories of getting up for a drink. Some days you return to bed and mask up and sleep until the cats wake you up. But on many days, there's a large gap in your data that starts at the time you got up for the drink. And you say that you are puzzled by the gaps. So it seems reasonable to assume that you are just falling back asleep without the mask on after the break for the drink. Also note that since the mask is off for about 90 minutes a lot of the time, it appears that you're getting one sleep cycle in before you wake up and realize the mask is not on your face. Then you put it back on (GOOD FOR YOU!) and go back to sleep until the cats wake you up.

robysue wrote: Finally the efficacy of your therapy: Your AHIs are technically low enough to consider your OSA "treated", but as you suspect, there is some room for improvement. Many people find that getting their treated AHI below 2.5 or so leads to feeling better than when the treated AHI is up in the 4.0-5.0 range. There is some residual snoring being scored on some nights. More on this in a bit.

Since I've started this I have to say that I've noticed some good changes. It's been ~20 years since I feel I've dreamt. Now I'm starting to dream.

Dreaming is good.

I just realized I never quite added an intro. A little about me...
I'm 35 years old, 165-175 lbs, 5'9", don't smoke, very rarely drink (lightweight, 1 beer is good), physically active (bike, hike, kayal), have seasonal allergies, diagnosed with exertional asthma, and in relatively healthy shape.
Regarding sleeping through, I've snored my whole life and can fall sleep anytime my mind isn't running. There have been many times where I'll fall sleep on the floor, sitting in a hospital waiting room, and even during conversations. I can also recall times where I would complete long drives and get into the driveway with no recollection of the past hour.

All of these are pretty common symptoms of untreated obstructive sleep apnea.

It's normal for me to have to take a mid-day nap in my car for lunch during the weekdays or on the couch on the weekend. Even still hours after I can still feel tired.

Do you nap with the PAP? If not, try to get into the habit of always using the CPAP whenever you are sleeping. Yes, it's a PITA, but naps without PAP can be full of OSA events and hence be counterproductive in terms of how you are feeling.

Thanks for taking the moment to look through the data again Robysue.

I"m sure you're right with me being interrupted many times. I suspect that this might happen but in the morning I have no recollection of this. I've added a link to my album up top and will continue to add my results every few days.

I'm making sure that I use the CPAP whenever I'm taking a nap.