3 days in. Trying to understand SleepyHead data.

Hi everyone. I am trying to understand an event from last nights data.
I think my pressure is too low. First nights set to max 20 but felt like I was being blasted and could not breath out.
Set max down to 12 from 20.
The screenshot is a small portion of my night leading up to me subconsciously removing my mask. I woke up 2 hours later and put it back on.

I am not working with any professional help so would love some feedback as what, if anything can be gained from this snapshot.

I also use an app on my android phone. It shows that I snored like a train while the mask was off.
But encouragingly, this is by far the best result from this android app than I have ever had.
It's showing lots of sleep cycles with lots of rem. Usually it records very little rem.

Your data is zoomed in to show only 1-hour - 10 minutes, so hard to say what's going on the rest of the night. If the data we're seeing is while you're awake, then it may not be a good idea to rely on it very heavily.

I notice you do not have EPR set to provide exhale pressure relief. The feature is on, but set to zero. The EPR provides up to 3 cm pressure relief during exhalation and might allow you to tolerate somewhat higher pressure. I think you should turn up the EPR setting, especially as you seem to have clear airway apnea as pressures rise.

Your machine is currently set at 4 min, 12 max. You are reaching 12 cm at 1:08, and remove the mask shortly afterward. You look like you're doing fine at 6 cm pressure. I think if you change the minimum pressure to 6.0 and turn EPR to 3.0 you may tolerate higher pressure if they are needed, and it might reduce some of the CA activity.

Hi - what is your low pressure set at - that's the one that does all the work. Your machine recorded central apneas, but that's more likely due to the time you had the mask off and/or how much you may have leaked overnight. Were you ever diagnosed with central apnea? Or diagnosed at all with obstructive? Were you ever told to not sleep on your back as it provokes many more apneas (and snores) than side sleeping? You need to sort out what's happening, but it's hard to do it based on what you provided because of the mask-off time. I agree that you need to raise your low pressure setting - 4 is literally useless either to be able to breathe at or as therapy for anything. Using EPR may raise your AHI a bit - that's usual, but unless it makes a large difference, I wouldn't worry too much.

The data here is almost certainly when I was asleep. I don't recall waking at this time and removing the mask.

The sleep study did indicate problems were all related to being on my back.

This is very helpful. I am going to raise min pressure to 6 and from what I gather, make no setting changes to max pressure yet.
I will change EPR to 3.

The fact that most events coincide with a small mask leak seems interesting. But those leaks look very tiny. Can they really be causing the events?

See how things go for a couple of nights - making every effort to not back-sleep (you can even buy foam wedges to put behind you, or attach a ball to the back of your PJs ), and come back with results.

SailorJerry wrote: The fact that most events coincide with a small mask leak seems interesting. But those leaks look very tiny. Can they really be causing the events?

It's difficult to evaluate your leak graph due to the scale involved.
Your leak number to avoid with your ResMed machine is 24 L/min....we can fudge with a little above 24 L/min but over 30 L/min and things get real iffy and over 35 L/min and all bets are off. Change your leak graph so you can see the lower numbers on the graph.
Right now that massive leak spike has the scale off to the point you can evaluate things.
Short big spikes won't be that big of a deal so that one big spike I would ignore but it is totally screwing up the scale for better more accurate evaluation. They look tiny due to scale involved because of the max 170 L/min dictating the scale.
The other may be tiny but I can't tell with this leak graph. Need one that easily shows the 24 L/min mark.

Min pressure raised from 4 to 6.
EPR increased from 0 to 3

A much different experience. The EPR changed everything about the feel. It was so much easier to breath. I felt the machine was dictating my breaths.
Kept the mask on all night except for quick removal for a drink of water. So sounds good right?
Not so much:



AHI of 9.56 is by far the highest in my 4 days of usage. And all those events!
Pugsy I have changed the scale on my leak graph as suggested.

My observations:
My pressure is maxing out so I think I should increase it.
Mask leaks accompany events.
I don't think EPR is a good setting for me, unless using EPR allows me to tolerate higher pressures.
Had a few drinks last night and took over an hour to drift off to sleep.

SailorJerry wrote: My observations:
My pressure is maxing out so I think I should increase it.
Mask leaks accompany events.
I don't think EPR is a good setting for me, unless using EPR allows me to tolerate higher pressures.
Had a few drinks last night and took over an hour to drift off to sleep.

EPR reduces your effective pressure so often you have to raise the set pressure to compensate.

6 is much too low a starting pressure.

your higher epr settings may be causing more central events, I would try raising pressure and lowering the epr by 1.

The bulk of the AHI is the events that happened during that first hour or so when you said you had trouble getting to sleep.
The machine will flag awake breathing irregularities and that will totally screw up AHI evaluation.
So just ignore those events during that time frame when you were awake. You can manually highlight (click and drag the cursor over the time from around 2:40 to end of the night) and in the little box above the flow rate graph you can see an adjusted AHI that doesn't include the awake time and I bet it will be a lot better.

Keep EPR but let's just adjust the minimum upwards a little to allow for it to be used...say around 7 or 7.5...I think it will help a lot.
I assume you mean you had a bit of alcohol (or a lot) and that will mess with things so don't base all your decisions on last night.
Actually after around 2:40 it looks not bad at all.
Leak graph is fine. A few spikes but no big deal as long as slept.

You can turn off the AHI graph on the graphs on the right side (it isn't needed). You can turn off unneeded graphs in Preferences/graphs simply by removing check mark. You can always turn them back on if you wish.
Unneeded graphs take up space on your images and make for smaller (harder to see graphs).
Mask pressure is also another graph that isn't really needed. It mimics the pressure graph which I prefer to see as it is clearer.
Flow limitation graph might be of better use than the AHI or Mask Pressure graph.

Actually I am glad you said you had trouble sleeping...otherwise I was worried about all those clear airway events (centrals).
Take away the awake time....and your report last night actually looks quite decent.

AHI from 2:20 onwards is 8.5

I tweaked my graph layouts as suggested.

SailorJerry,
I had much of the same problems as you. I found that the EPR was hurting rather than helping. It felt better while I was awake but it caused my airway to collapse while asleep. I found that I required the resistance of the back pressure during exhale to keep my airway open. When I did away with the EPR my AHI's went from the 9's to the 2's and 3's.

And I hope you realize that alcohol close to bedtime will make a difference in sleep and to your numbers, no question. Really not a good idea under the circumstances.

Try doing the highlighting after 2:40 and that way the probable awake time is for sure omitted.

You still have some OA clusters later in the night and that really isn't unexpected when someone goes from no EPR to 3 EPR. That drop in pressure when EPR engages allows the airway to collapse. The fix is simple though. Just use a little more base pressure to accommodate that drop and in your case your minimum (base) pressure is so low you have lots of room to increase it without having to give up EPR if you don't want to.

Several ways to go....drop EPR a little or increase minimum or do a little of both. Use whatever EPR setting lets you feel like your breathing is more natural...whatever is more comfortable to you because comfort will equate to better sleep eventually.
We can adjust the minimum to cover what is needed to prevent the collapse allowed by the EPR drop.
Also...hard to know since alcohol was involved. Alcohol can cause the airway to collapse more easily so hard to say how much of those OA clusters is related to EPR and how much related to floppy airway tissues from alcohol.

You can use EPR if you wish...or not...but if you like it...we can fix it so the OA clusters won't happen. Not hard at all.

This is encouraging. Thanks everyone.
tonight's plan.
Raise min from 6 to 7.5
lower epr from 3 to 2
raise max pressure from 12 to 14.
no drinking. I can't find the setting for no drinking. Guess I have to do that manually.