Requesting feedback on Sleepy Head daily view and Stats

Hey folks,

This board has been an awesome resource. Wish I had found it last December -- been learning by trial and terror.. Would love any feedback on these screenshots.

<link removed -- let me try again>

I started on a CPAP in December and then was switched to an APAP. My first PSG showed Hypopnea events with AHI of 6, which is low, but I hardly slept at that overnight study. I have had months of consistent overwhelming daytime sleepiness and lack of concentration, but sometimes I wonder if I even have sleep apnea because I figured the machine would have made me a new person by now... or am I one of those folks for whom it requires months of therapy first.

a) In particular, is the mask leaking too much? I wonder if I should switch to a 'M' mask cushion because I am using an 'L', and when I printed out a Resmed fitting template and held it to my face, it appears 'L' is too large. I might be borderline 'M'/'S' in fact. Is the best source of mask supplies those online discount web sites?

b) I notice that when I am lying awake (insomnia usually in the early morning), the machine is scoring a lot of events. I am definitely awake after that big spike in Flow Rate -- when I got out of bed. Also, I turned off the machine briefly and then back on. Pretty sure I did not fall asleep the remainder of the morning.

c) I think the machine is increasing the pressure due to these clusters of perceived "events" although I am awake. I wonder if that is making it more difficult for me to fall back asleep? If I turn the machine off and then on, will that start me back at 5.0 cm H2O? Or is the algorithm too smart for that?

d) I ran the PR S1 without water in the humidifer for a couple of days, and then I found either calcium deposits or mold in the tank... So, that's not a good idea, huh?

e) Any other insights or feedback from the charts and stats?

f) For reasons I won't go into here, I need to find a doctor to manage care going forward. I read on these posts that some people have found their primary care physician to be of more help than the sleep specialist. I've also learned that there is a sleep medicine certification. Is that a worthwhile credential in people's experience? Also, any difference between seeing a neurologist vs. pulmonolgist? I have significant insomnia as well.

Thank you!

InsomniacGuy wrote:Hey folks,

This board has been an awesome resource. Wish I had found it last December -- been learning by trial and terror.. Would love any feedback on these screenshots.

http://imgur.com/a/SAkGv
!

please take all those down, and post a single, full screen, not cropped, screenshot showing the detail tab on the left, no calendar, and the event flags, flow, pressure, leaks, (and if they'll fit) snore and flow limitation charts on the right.

you're hiding a lot of useful info by not getting the detail tab and left panel.

To help you out with posting the screenshots and formatting, follow this tutorial: https://sleep.tnet.com/reference/tips/imgur

I agree a lot of valuable information is missing. Only one chart had leak data, and it was acceptable with room for improvement. Getting a second cushion to verify the best fit is not very expensive, just do it. Your comfort is half the equation. I'm pretty sure you can order from CPAP.com and have a 30 day return period in case it's not right. Either way, you'll get what you need.

You are spending a lot of the night a 5 cm pressure. This is pretty minimal, and it would help if you would take a couple of close-up screenshots of the events with pressure and wave-form data. This does a couple things. We see the duration of events and the pressure at the time of the event. You are showing periods of periodic breathing that correlate with hypopnea. Are you aware of this? Anyway, you may want to take a look at the Event by Pressure graph on daily details to see where most of these events are occurring.

Just a short observation: your HI may be reduced just by setting your minimum pressure to 6, instead of 4. 6-Set 6-8 range for your CPAP and see how it goes.

Appreciate the guidance. This is one day's chart. The next two charts are close-ups of a few events in succession. I picked a different day to display than the one I posted previously b/c that day showed a lot of events when I was lying awake.

I set the scale of the pressure graph so that 5.0cm H2O is the lowest shown because that is the minimum pressure set. (Some notes: I don't snore. The two PSGs didn't show Central Apneas to be an issue so I am surprised they show up here on this chart.)

Don't know why the right edges of my screen shots are cut off, but if you press CTRL- , the web browser will zoom out so you can see the whole image.

Daily chart:




Closeups on a few events in succession:

Palerider wrote: (and if they'll fit) snore and flow limitation charts on the right.

I'm not understanding which chart is supposed to be the "flow limitation" chart because I don't see that label on any of the charts... Is it called something else?

Sleeprider wrote: You are showing periods of periodic breathing that correlate with hypopnea. Are you aware of this? Anyway, you may want to take a look at the Event by Pressure graph on daily details to see where most of these events are occurring.

Thanks for point out the periodic breathing correlating with hypopnea. Does that mean anything?

I'm not quite following "Event by Pressure graph on daily details" -- does that mean expand the charts so I can see the individual breaths and then look at the pressure chart to see if the pressure is too low when the events occur? Oh, I think you're saying that I should click on the "Events" tab on the left panel...

InsomniacGuy wrote:I'm not understanding which chart is supposed to be the "flow limitation" chart because I don't see that label on any of the charts... Is it called something else?

Flow limitation graph charts are only available with the ResMed machines.
You have a Respironics machine which shows flow limitations as an event which shows on the events graph on the top.
Flagged similarly to hyponeas and OAs....as a specific event.
From what I can see on the report shows the flow limitations are unremarkable and not overly exciting.

I am not sure that the periodic breathing warrants concern. Can you grab a close up screen shot of an area flagged as PB (in green) and try to include a couple of hyponeas in it?
Use the Events tab on the left side....go to PB flagged times and click on a time that has a few hyponeas in it. Then grab the screen shot at that scale please.

Oh, got it. Thanks for click-by-click the directions. Again, if you zoom out (CTRL-), you can see the right edge of the chart. There's an interesting wave form there...

If your other PB flagged air flow looks similar to this one above I don't know that I would worry about it at this time. It barely meets the definition of periodic breathing which is just a waxing and waning of the air flow that lasts for at least 2 minutes.

How is your sleep quality? Are you waking frequently during the night for whatever reason?
I haven't had a chance to go read any other of your posts to know more history but as I have time I will try to catch up.

What are your main questions or concerns about what is shown in this thread?
Is this report a typical report for you in terms of AHI?

Disregard the centrals (Clear Airway events) at this time. To have an occasional central is normal and you would need to see a lot more of them before you start worrying.

Appreciate the help!

PB events look pretty similar.

Sleep quality: have insomnia in terms of waking in middle of night or too early in the morning, usually around 4 or 5 AM. Sometimes lay awake for a long time. Main complaint is daytime sleepiness. (Thought it would have improved by now with almost 2 months on therapy.) Starting to wonder if insomnia isn't caused by events because there seem to be more events in the latter half of the daily charts, generally speaking.

Regarding main concerns with charts, was just curious what insights folks might have on the charts in terms of what's going on. Someone suggested changing pressure to 6-8. Mask leak isn't too bad on this chart? {Just read your tutorial, which covered mask leaks.}

On the other daily chart I posted and then removed, I thought it was strange that I had a ton of OA and H and CA events scored while lying awake after 5:30 AM. Doesn't make sense to me that the machine should be scoring awake events. It appears that the machine then increases the pressure accordingly, which in turn may make it more difficult to fall back asleep. I asked a "repiratory care specialist" today whether the machine might score events incorrectly while I was lying awake, but they said no. They suggested I press the 'ramp' button to see if that might help. {Just read your tutorial which covered the issue of machines not knowing whether we're awake or not...}

AHI ranges from 2 to 12.

Will keep at it. Thanks again!

The machine doesn't know if you are awake or asleep and it can and will flag awake breathing irregularities as some sort of apnea event. Happens all the time. Remember it is only measuring air flow and not sleep stage.
If you see events flagged during known awake times then you have to mentally remove those events from any AHI evaluation....they don't count.
The reason I asked about the sleep quality is often it seems like when I see PB flagged like yours the person tells me that they didn't sleep so great and makes me wonder if the PB flagged times are simply nothing more than awake breathing irregularities getting flagged by mistake.

I wish all insomnia issues were easy to fix with good cpap therapy but it isn't that simple. Insomnia has any number of causes besides sleep apnea and cpap therapy can only fix the sleep apnea side of the cause. If someone has some other reason for insomnia the machine can't do much to fix it no matter how good the AHI might be. Getting a nice low AHI is really fairly simple. Getting good solid hours of sleep isn't hardly ever simple.

Do you take any meds of any kind? If so, what?

In terms of your reports.....the hyponea count might be just a wee bit higher than I would like to see if it were my report...it's the bulk of your AHI it seems like and if you were for sure asleep during those time frames then maybe a little increase in that minimum pressure might help reduce the chances of those hyponeas happening. It probably won't fix the insomnia but sure wouldn't hurt to do it and cross your fingers to see if it helps. Probably wouldn't need much more and I tend to go along with the previous suggestion of going from 5 minimum to 6 minimum and see what happens.

About the leak line. You know it looks really good the first half of the night then it starts getting a bit leaky the second half and seems to run along with the increase in hyponeas and all that other activity. It isn't horrible at its worst though. Makes me again wonder if a lot of tossing and turning is involved along with maybe not so great sleep quality.
Remember part of that increase in leak line is due to the increase in pressure and is normal and expected...more pressure means more venting so we expect some increase in that leak line on the top.

In those wee hours of the morning we have more REM stage sleep....so that might also explain the increase in events and pressure during those late hours and then with more pressure we have a greater chance for mask to leak.

Your leaks are still within the machine's ability to compensate even when at its worst though so unless the leaks are waking you up then I wouldn't worry about them but if the leaks are waking you up then they need to be fixed because anything (even tiny leaks) that wake us up need to be fixed because of it affecting sleep itself more so than the therapy.
Good sleep is number one priority.

Well, hello there, Pugsy!!

Drowsy Dancer wrote:Well, hello there, Pugsy!!

see??? I haven't kidnapped her!!!!