Show me a "Healthy" Sleepyhead Graph Please

Hello,
Working on the Sleepyhead, APAP, improving goals over the past 60+ days. Slowing moving the base .cm pressure up (currently 9cm). Question: Can someone post what they would determine as reasonably "healthy" night's sleep (print-screen). I would like a benchmark to shoot for. Not really sure what I'm looking at. The AHI's are dropping down into acceptable rates, but the wife (actual patient here) continues to say "Horrible night last night, many wake-ups". So, AHI of course would be almost perfect if she's laying there staring at the night light, wide awake. The only clear indications we have that Janine is sleeping is the "snore events"?
Here's last night... show me yours:

Pretend there is only one pressure line. I can't seem to find one of my old APAP reports using SleepyHead. I have plenty using Encore.

Thanks, Pugsy
We will try to figure this all out.
She (Janine) immediately noticed: 1) You never take your mask off to pee during the night? 2) You don't ever temporarily change the 10cm base pressure down in the first 1/2 hour to initially get to sleep? Janine turns this down every night as she lays down. Says: "The little elbow 90 vents off and blows into my eyes while I'm trying to get to sleep"
Kip

Nope...I don't use the ramp feature. Never have. When I first started therapy my starting pressure was 8 cm and I really didn't need the ramp and starting out at 4 cm for ramp actually caused me more discomfort (suffocated feeling) than just dealing with 8 cm right from the start. Going from 8 cm to 10 cm was a walk in the park...I went up in 0.5 cm stages over about 10 days.

Nope...don't get up to pee during the night anymore. Nocturia was the first sleep apnea symptom that went totally away once my therapy was optimal. Before cpap therapy I was getting up to pee about every hour to 90 minutes and with a painfully full bladder each time and that was with fluid restriction for 4 hours before bedtime.
Nocturia is a common symptom of sleep apnea....but sleep apnea isn't the only cause of nocturia so if there's another reason for the nocturia the optimal cpap therapy isn't likely going to help.

CPAP therapy fixes sleep apnea issues...it can't fix issues that aren't caused by sleep apnea. We often expect it to do more than it can do. We like to blame sleep apnea for all our sleep problems and expect the machine to fix them...but it can't and there's a long list of other things that mess with our sleep that are unrelated to sleep apnea.

What is the vented air hitting so that the air goes back into the eyes? Vented air shouldn't be blowing into the eyes unless it's bouncing off of something. No mask that I know of can be turned so that the vent blows into the eyes.

Could you replace the Resp Rate graph with the leak line graph next time? The leak line graph is much more important than the resp rate graph.
Though I can see that no large leak times were flagged and for 95% of the time leaks were well below large leak territory.

Does Janine have to pee often during the day also?
Does she have to pee with a full bladder during the night with each awakening we see? Or is it more of an "I'm awake and might as well go pee" thing but the bladder isn't uncomfortably full?

Quattro Air is listed as her mask.

I'd bet that the exhaust air is being reflected off of the pillow / pillow case or possibly the bedding covers if she sleeps with them near her face.

Dave

Try this, Includes "Leak Rate" in place of "Resp Rate"


Janine is telling me that no, her bladders not full, but it's a tiny visit annoying enough to walk to the loo.

Dave, I will ask more about the "reflecting" blasts of air possibly off pillows or bed covers. I suspect this is the case since she is on her side in these hours, and later on her back.

The only clear indications we have that Janine is sleeping is the "snore events"?

The only clear indications of sleep that I can get out of my charts is when the flow chart shows a low and steady breathing. I feel pretty sure I am sleeping at those times. You might get the same indication from the respiratory rate chart but I have never spent much time looking at that chart.

Of course you need EEG to really know if you are sleeping.

She's using a really long ramp time....is she awake the entire time?

During the day....does she have to pee often or can she go hours between pee breaks? I am trying to ascertain if we have tiny bladder syndrome in general or over active bladder syndrome. The number of apnea events now are reduced to the point that it would be unusual for the pee breaks to be from the ANP stress hormone causing the kidneys to produce massive amounts of urine...but I suppose it wouldn't be impossible..but she reports not a painfully full bladder...so I don't know.

When she wasn't on the cpap machine....did she sleep more soundly with less wake ups? Or is what she is doing now pretty much what she did pre cpap?

I think this is a healthy one... AHI = 0.95

Wow, MaxDarkside..... with a chart like that, not sure why one like you would even visit a CPAP forum,

OK, Pugsy:
Janine hasn't noticed any oddities with her bathroom visits. She's neither a camel or a minnow in the frequency of loo visits. Many night we go ballroom dancing and drink lots of bottled water (no booze).
In the Pre-CPAP days she did wake up more often and lay awake longer. She believe that there is some improvement with the CPAP therapy... just not the immediate miracles we've heard from others. This of course could have everything to do with other stresses in life like family, finance, and an overactive mind.

So, since we've moved the Base Pressure up from it's original 6.cm to the current .9cm we are seeing almost all the days looking like this (below), The difference is there is rarely those boosts up into the 16cm and 20cm, and with very long stretched at 9'ish with those funny "spikes" every 1/2 hour or so.
These hours have me curious, wondering if she's sleeping (see red arrows). (I used to think that those big ramp-ups to 16-20cm were her REM sleep, and probably on her back)
Also... Is there any understanding of the erratic respiratory chart where my "?" mark is? It seems associated with a basically flat pressure graph?

The little spikes are normal for the machine when in auto adjusting pressure mode. Those are test pressure probes where the machine increase the pressure a little and uses its sensors to see if anything is going on and if not then it drops the pressure back down.

I can barely hazard a guess on sleep status with the flow rate (zoomed way in) and don't even try with the respiration rate.
There's always a normal variation in respiratory rate anyway.
I don't know that there is any correlation regarding the increased respiration at the time frame where the machine didn't seem to need to do the pressure probes. I don't think it means much of anything one way or the other.

The pressure isn't going to 16 to 20 as much because the increased minimum pressure is doing a better job preventing whatever it was that the machine was trying to fix at the higher pressures. We really can't infer from the lack of the big increases that there is no longer any REM sleep or supine sleeping...about all we can infer is that the machine doesn't need to go there because the airway isn't collapsing as much since the base pressure is doing a better job of holding the airway open.

How long does she stay awake after one of those wakeups during the middle of the night? If it is for a prolonged period of time that time with the flat line and the ragged resp rate might simply be awake breathing.

the ragged resp rate might simply be awake breathing.

Zoom in in the flow rate graph and look at individual breaths. If breathing is not low and steady, she could be awake during this time. Maybe not remembering the next morning that she was awake, but still awake.

Here's a zoom in on Resp Rate & Flow Rate for the same period last night. Looks like she was laying awake as per your theory on normal steady breathing. Is this breathing one of our ways of knowing when she's sleeping. Last night I suggested a DropCam (it's web cam that we watch our sleeping grandchildren with). Then we would know what's up at 1 AM
FLOW

RESP

That looks more like nice normal asleep breathing to me.
Awake breathing isn't normally so repetitive and even.
I am not the best at evaluating at this level though. One has to take known awake breathing and compare it with the breathing in question and see what it looks like.