Sleepyhead and my statistics

New to the forum, not new to sleep apnea.
I downloaded the "Sleepyhead" software and inserted the sd card this morning.
Here are my stats:
Avg hours per night Most recent last week last 30 days
6:57 6:39 6:19
Compliance 100%
AHI 18.98 32.71 33.30
Obstructive Index 5.61 9.45 8.13
Hypopnea index 4.75 5.71 5.89
Clear Airway Index 8.63 17.56 19.28
Flow limitation 0 .13 .07
RERA Index 0.00 0.60 0.87
Average leak rate 1.40 0.95 0.51
90% leak rate 4.0 3.0 2.0
% of time above leak rate threshold-0 0% 0%
Average EPAP 8.12 7.80 7.78
Min EPAP 4.0 4.0 4.0
Max EPAP 13.0 13.0 13.0
Average IPAP 10.38 10.17 10.12
90% IPAP 15.0 13.8 13.8
Min IPAP 6.0 6.0 6.0
Max IPAP 15.0 15.0 15.0

Changes to prescription settings
First Last Days AHI FL Machine Pressure relief mode pressure settings
3-18-15 6-20-17 779 30.62 0.08 RemStar BiPap Auto with Bi-Flex 760p >BiFlex 42 Auto Bi-Level Variable ps min 6.0 max 15.0 ps 2.0-4.0

I have not had any supervision. It looks like I need to discuss these stats with somebody but who?
I bought the machine after all the labs and the grueling adjustment period. The insurance through Peak Sleep asked me to send in the sd card on two occasions.
I feel tired all the time. Maybe I would sleep better if I stopped using it.
Thank you for your advice

Do you spend a lot of time awake with the mask and machine on?

Can you confirm what the PS min and max are by looking in the machine settings? One thing says 2 to 4 and the other says 6 to 15...which is it?
Don't know how to do that? It involves going to the clinical setup menu and how to get you can find here as well as request the provider/clinical manual if you don't have it already.
http://www.apneaboard.com/adjust-cpap-p ... tup-manual

Model 760 Respironics would be a PR System One BiPap Auto.

You have too many obstructive apneas and hyponeas which points to the EPAP pressures not being optimal.
You have too many clear airway apneas/centrals which points to maybe arousals from the too many OAs and hyponeas or if they are real...don't know what is causing them.

Who decided on these settings?

Do you have copies of your sleep studies both diagnostic and titration if you had a titration study where they hook you up to mask and machine while trying to find optimal pressure settings? If not...get them.

Please register and log in (registering takes a few days) so that you can insert images of what you are seeing on those SH reports. It helps us a lot if we can see what you are seeing.

As to who should be made aware that things aren't going so well....your doctor.

It's possible that if the OAs and hyponeas were better prevented that the CAs/centrals will reduce. It's worth trying because the OAs and hyponeas need to be addressed anyway. I would try to fix those with more EPAP baseline if it were me and then see what happens with the centrals. If they increase instead of decrease (and we can't blame them on awake breathing irregularities) then the doctor needs to be made aware ASAP.

If your PS min and max is indeed 6 to 10....I would reduce the minimum to 4 and the max to 5 if it were my report.
EPAP minimum...maybe 8.0
IPAP max...20 or 25 and see where the machine wants to go. It won't go up there without what it thinks is a good reason.

The format changed from the way I set it up in the text box.
The figures are represented as Most Recent-Last Week-Last 30 Days
If you see 3 figures this should make more sense.
The pressures are 6 min and 15 max.
I usually put my mask on and go to sleep. No I don't spend much time awake with it on.

Guest wrote:The pressures are 6 min and 15 max.

Please clarify....is it PS minimum that is 6 and PS maximum that is 15?
If so...that high of a PS could maybe be responsible for the ClearAirway/Central events.
Too high of a PS can cause us to blow off too much carbon dioxide and it doesn't get built up to levels in the blood stream where the brain says "OMG too much carbon dioxide I better send the signal to breathe" ... It's actually the carbon dioxide level in the blood stream that tells the brain to send the signal to breathe...it's not the O2 level like some people think.

Now sometimes doctors use higher PS (PS or Pressure support is the difference between inhale and exhale) when people have some sort of specific lung problem...like COPD and they will utilize higher PS in an effort to help ventilate a person. Those are special situations though.
Unless you have some sort of lung issue...the higher PS could be a factor in those centrals you are seeing on the report and I would at least try reducing PS to see if it made a difference or not in the centrals...
Like PS min of 4 and max of 5.

Yes, you are correct. The PS minimum is 6 and the max is 15.
Can I adjust the max? to say 12?
I have no lung issues at all.

Guest wrote:Can I adjust the max? to say 12?

I wouldn't.
I would use PS minimum of 4 and PS maximum at 5.
I wouldn't let the machine give me a high PS.
I doubt that you ever came close to the max anyway and without seeing the software detailed graphs I can't say for sure but I imagine it probably started at the 6 difference between inhale and exhale and maybe increased it a little bit.

Some people find that having even a small difference between inhale and exhale will trigger centrals...don't know if you are one of those...very small percent of people who have pressure triggered centrals will have it happen.
Most people do very well with a mode PS...like 4 or 5. When you start going 6 or higher it can trigger centrals. Now I don't know if that is what is going on with your centrals or not. For all we know you might have had centrals on the sleep studies and if that's the case we have a different discussion but for now I would increase EPAP minimum maybe 2 or 3 cm and limit PS to the 4 to 5 range. Live IPAP max alone if you wish unless you see it maxed out a lot on the software reports but I doubt that is happening.

You have 2 issues...
Centrals/Clear Airway events where the airway is open and no air is moving
and
Obstructive events (those OAs and hyponeas) where the airway is trying to collapse and block the air.

Reducing PS so it isn't so high and can't go so high might help with the centrals.....worth trying.
For the Obstructive stuff you need more EPAP.

Thank you,
I am now registered. I will attempt to attach my SleepyHead report.
OOPS, no way to attach?
I'll research this and get back

How to insert images
https://sleep.tnet.com/reference/tips/imgur

Don't insert all the graphs...only need the basics.
Examples here
viewtopic/t103468/Need-help-with-screen-shots.html

and how to organize those basics.....3 pages...be sure to read all 3 pages
https://sleep.tnet.com/resources/sleepyhead/shorganize

http://imgur.com/a/uTN4M

http://imgur.com/a/uTN4M

This is the imgur image of the stats.

cookie42 wrote:http://imgur.com/a/uTN4M

http://imgur.com/a/uTN4M

This is the imgur image of the stats.

sorry, that's all useless... do it like Pugsy said.

I thought I followed the directions carefully.
Oh well, I tried.
Thanks for the help

cookie42 wrote:I thought I followed the directions carefully.
Oh well, I tried.
Thanks for the help

did what you posted look even remotely like the examples she gave?

NO

did you even look at the examples she gave?

https://sleep.tnet.com/resources/sleepyhead/shorganize
https://sleep.tnet.com/reference/tips/imgur

cookie42 wrote:http://imgur.com/a/uTN4M

http://imgur.com/a/uTN4M

This is the imgur image of the stats.

Those are the summary statistics and they aren't particularly useful and to top it off the image is sideways and I simply can't read it and I couldn't figure out how to rotate it.

There is a reason I asked for images to contain certain information and pointed you to this thread with some examples
viewtopic/t103468/Need-help-with-screen-shots.html
and that reason is the detailed reports are the most useful and if we want something different we will ask.
We need things in a certain format to be able to help you the best. Without seeing certain things that are needed in a certain way then we are just guessing and I don't like guessing when the information that I need is readily available and not difficult to get.

Let's see if this works.

http://imgur.com/a/KUHQc

Do you need the ramp? It's okay if you do because my idea means an even higher minimum pressure.

In general it's a pretty ugly report but then you already knew that. AHI is too high and it's about half central/CA and half obstructive but given all the other stuff going on and the for sure wake ups it makes us wonder if those CAs are real or not..or if they are related to arousals or awake breathing.

So...not ignoring the CAs at the moment..keep one eye on them but see about fixing what is obviously needing fixing, that we can fix with this machine, and see what happens to the CAs after the other stuff gets fixed.

Your minimum EPAP pressure and your maximum IPAP pressure need to be increased. The machine can't get to where it needs to be quickly enough and it can't go high enough with the limit of 15 max IPAP.
Any special reason you have it set to 15?

If this were my report I would increase minimum EPAP to 8 and increase maximum IPAP to 20 and leave PS alone.
While I suspect there's a good chance that you will need a little more than 8 EPAP...2 cm is a big enough jump at one time and going up slowly is often easier. Besides...sometimes we get lucky and don't end up needing as much as I originally thought we would need.

I am not ignoring the CAs...they are on the back burner. Can't do anything about them with this machine and if they are related to arousals caused by the obstructive stuff going on they should reduce if the obstructive stuff reduces.
So keep one eye on them but address the stuff we can actually fix with this machine first and then see what's left (if anything).

Your leaks are well within acceptable limits...don't even come remotely close to large leak territory so large leaks aren't an issue.
Now if even small leaks are waking you up...then they need to be fixed
and that brings me to the question
Why the breaks in therapy that are shown by turning the machine off and back on? Any special reason? Were there other wake ups where you didn't turn the machine off and back on again?

What sleeping position do you usually start the night at? Do you ever wake up and realize you are on your back? If so, that might explain why some of the night your pressures are doing a decent job and some of the time it's obvious it isn't.
If your OSA is worse in REM the same thing can happen...need more pressure in REM and not in the other times.