New Sleepyhead User

[Corban76]

Hi, I'm using sleepyhead (with a dreamstation set to auto) for the first time and see that my ahi is going through the roof several times a week. I know the goal is around 5 ahi, but I'm hitting 15, 20 and 30 at random points throughout the night. Anyone have any insight? Thanks for any help you can offer!

[Pugsy]

Please post an image of the detailed report from SleepyHead for one of those high AHI nights.

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

How to organize...3 pages so read all of them
https://sleep.tnet.com/resources/sleepyhead/shorganize
Please note if you are using a Windows computer do NOT do the SleepyHead full image toggle...there's a bug in SH that makes it extremely difficult.

For examples of what we like to see
viewtopic/t103468/Need-help-with-screen-shots.html

[Julie]

Actually the 'goal' is 1) for you to feel as well as possible, and 2) fo have your AHI as close to 0 as possible, within reason. '5' is the arbitrary # below which you are considered to not need Cpap, but in fact most of us feel much better at around 1 or 2, and not so good closer to 5.

[Corban76]

Hi, I think I got it right. Thanks for replying. This is from the other night where my AHI was well over ten near the middle of the night and then over 17 before I woke up.

http://imgur.com/7XhRV29

[Pugsy]

How did it come to be that these settings were chosen for you?
How did you end up with this machine? It's nice machine but unusual to have this machine with your pressure settings.
Are you sleeping soundly for the most part when you are asleep or do you have times with the mask and machine on that you are laying there wide awake?
I see one therapy break at 2:00 where it's obvious you turned the machine off for a short time. Why? Is this common for you and is there other times where you were awake but didn't turn the machine off?

Quit worrying about the AHI graph (it's just an hourly AHI average) and it isn't needed in the screen shot...nor is the snore graph.
If you do future screen shots omit those 2 graphs. No need to redo this one though.

Your settings are pretty much wide open and not doing you any favors.
EPAP min is 4.0
Min PS is 2
Max PS is 8
IPAP max is 25

The PS max of 8 is especially not doing you any favors (you did hit 6 of that and in fact may be a factor in some of the CAs/Centrals popping up. When PS is a bit too high people can experience a little bit of unstable breathing that results in centrals popping up because with PS too high they blow off too much carbon dioxide and the result is the carbon dioxide levels in the blood stream don't get high enough for the brain to say "OMG I need to breathe" and centrals happen. I am not 100 % sure that is what is happening in your situation especially if you tell me you spent a lot of awake time with the machine on but if you slept fairly soundly then the PS could very well be a factor in the centrals. The bulk of the centrals are shown at times with high PS.

Are you comfortable making setting changes or would you feel better if your medical care team did it?
First thing I would suggest for consideration is limit PS max to 4.
Second thing is change EPAP min to 6.0.
That's all I would suggest for consideration to change at this time.
Maybe change PS min from 2 to 3 or 4 depending on comfort level and what shows up after just changing max PS and min EPAP.

[Corban76]

How did it come to be that these settings were chosen for you?
How did you end up with this machine? It's nice machine but unusual to have this machine with your pressure settings.
Are you sleeping soundly for the most part when you are asleep or do you have times with the mask and machine on that you are laying there wide awake?
I see one therapy break at 2:00 where it's obvious you turned the machine off for a short time. Why? Is this common for you and is there other times where you were awake but didn't turn the machine off?

Quit worrying about the AHI graph (it's just an hourly AHI average) and it isn't needed in the screen shot...nor is the snore graph.
If you do future screen shots omit those 2 graphs. No need to redo this one though.

Your settings are pretty much wide open and not doing you any favors.
EPAP min is 4.0
Min PS is 2
Max PS is 8
IPAP max is 25

The PS max of 8 is especially not doing you any favors (you did hit 6 of that and in fact may be a factor in some of the CAs/Centrals popping up. When PS is a bit too high people can experience a little bit of unstable breathing that results in centrals popping up because with PS too high they blow off too much carbon dioxide and the result is the carbon dioxide levels in the blood stream don't get high enough for the brain to say "OMG I need to breathe" and centrals happen. I am not 100 % sure that is what is happening in your situation especially if you tell me you spent a lot of awake time with the machine on but if you slept fairly soundly then the PS could very well be a factor in the centrals. The bulk of the centrals are shown at times with high PS.

Are you comfortable making setting changes or would you feel better if your medical care team did it?
First thing I would suggest for consideration is limit PS max to 4.
Second thing is change EPAP min to 6.0.
That's all I would suggest for consideration to change at this time.
Maybe change PS min from 2 to 3 or 4 depending on comfort level and what shows up after just changing max PS and min EPAP.

Hi, my settings were chosen by my sleep doctor. I don't know how to change settings and seem to be locked out of doing anything meaningful on the machine. Is there a way in without hacking it? I am asleep most of the time, except for the block where it is gray. Sometimes I wake up in the middle of the night and turn the machine off if I don't think I'm going to go back to sleep right away. I'm trying to be good about good sleep hygiene since I developed middle-of-the-night insomnia a little over a month ago, but am fine now after being prescribed lunesta. I pretty much never lie awake with the machine on.

As to the AHI graph, that's my main question and why I included it. I'll post several more days with similar spikes. The reason I am bothering with it is because I'm at 9 months now of apnea treatment and still have AHI's averaging 6-12 most days while feeling tired every morning. I'm trying to see if I can figure out the root cause. Even the dental appliance didn't bring any relief. You pointed to the high pressure and CA's happening then and I get how that could work, but isn't the point of higher pressure to force open the throat so I can breathe? I'd appreciate any insight you can offer on that point.

Here are a few more charts including last night:

http://imgur.com/a/vIZ8W
http://imgur.com/a/Un3TT
http://imgur.com/a/ngR7V
http://imgur.com/a/q17Be

[Corban76]

The PS max of 8 is especially not doing you any favors (you did hit 6 of that and in fact may be a factor in some of the CAs/Centrals popping up.

Okay, I found the way to access provider settings on another post and set it to 4, so at least that is taken care of. Let's see if I have less CA's tonight? As I review all of my data, though, I notice that CA's seem randomly higher and lower. I can't see any correlations. Thanks for taking a look!

[palerider]

Hi, my settings were chosen by my sleep doctor. I don't know how to change settings and seem to be locked out of doing anything meaningful on the machine. Is there a way in without hacking it?

your doctor is either lazy, ignorant, or if you're very very lucky, gathering data, and wants you back inside of a week from the first appointment.
To get manual with the secret handshake in it: go to apneaboard.com, link at the top, follow the instructions to request a clinical manual by mail.

As to the AHI graph, that's my main question and why I included it.

best to just turn off the AHI graph, it's got nothing useful in it.

[Pugsy]

isn't the point of higher pressure to force open the throat so I can breathe?

No. The pressure doesn't force anything and besides with Clear Airway/Central apneas the airway isn't closed off...it's already open and more pressure won't/can't fix it anyway.

Is there a way in without hacking it?

Of course there is and it's easy to do.

See here.
http://www.apneaboard.com/dreamstation- ... structions

You probably should request the provider/clinical manual via email. Instructions about 2/3 down the page. There's some information in it that is useful and not included in the patient user manual.

http://www.apneaboard.com/adjust-cpap-p ... tup-manual

The most critical pressure setting for your machine is that minimum EPAP pressure. It is the baseline pressure that does the bulk of the work of holding the airway open for the prevention of the OA and IPAP (that's what you have when PS gets added to EPAP) takes care of the hyponea stuff. The EPAP needs to be close enough to whatever pressure is needed to hold the airway open (there is no force it open and in fact when an apnea is actually occurring the machine does nothing but twiddle its little thumbs until normal breathing has resumed and then it tries to decide how to best prevent the next one) so that it can get to that needed pressure quickly enough. When we have that baseline pressure too low the machine can't get to where it needs to be soon enough. We have to help it out by giving it a little better head start.

I really think that increasing that minimum EPAP to around 6 maybe 7 would make a significant difference in your overall reports.
I don't know for sure if PS is a problem or not as in causing the centrals. Those centrals could easily be post arousal centrals secondary to the obstructive stuff still going on.
Your PS is variable...min 2 with max of 8 but it doesn't seem to go much above 6. For some people that 6 ish PS can trigger centrals because breathing becomes unstable and they sort of like hyperventilate...frequent shallow breaths which blow off carbon dioxide too much and the blood levels of carbon dioxide don't get high enough to tell the brain to tell the body to breath. That's what central apnea is...your airway is open but you just don't breath. Hold your breath for 10 seconds....that's pretty much a central apnea but you did it on purpose.
It's actually the carbon dioxide levels in our blood stream that tell the brain it needs to send the signals to breathe. People often think it is oxygen levels being low that trigger the brain to send the breathe signal but it's not.
I don't know that this is happening in your situation. I just mention it as a possible explanation for the centrals.

If you feel comfortable changing that minimum EPAP from 4 to say 6 (maybe 7)...and leaving everything else the same...it's easy to do.
Worry about PS later if the centrals don't reduce by reducing the chance of the centrals being secondary to the obstructive stuff that is going on.
Better prevent the obstructive stuff from happening...and maybe the centrals will reduce too.

If you aren't comfortable making that little change yourself then by all means get with your doctor because it is painfully obvious this isn't working out so well as it is.

[palerider]

but isn't the point of higher pressure to force open the throat so I can breathe?

Pugsy already touched on this, but no, no home cpap ever 'forces your throat open', once you have an apnea, nothing is going to make a difference. more pressure may make it worse, like leaning on a door that opens towards you.

what cpap does, and that more pressure... is hold an already open airway open, so it doesn't close in the first place. if you can keep it open, then things are good, if it closes, then the machine can sense that, and increase the pressure to try and prevent further apneas after your airway opens up again.

[palerider]

Here are a few more charts including last night:

http://imgur.com/a/vIZ8W
http://imgur.com/a/Un3TT
http://imgur.com/a/ngR7V
http://imgur.com/a/q17Be

also, please post according to the following example: https://sleep.tnet.com/reference/tips/imgur

[Corban76]

Okay, I adjusted the settings again. I'm going to try reducing the ps slightly and increasing epep to 6. Maybe that will be enough to reduce the apneas and then the CA's as well. I asked my doctor a couple of weeks ago what clear airways were since I had just pulled data for myself from sleepyhead and she said she had never heard of it before. I think that's enough information on that topic, ha! I'll ignore my high AHI for now, but I feel like something has to change and soon. Thanks!

[Pugsy]

That AHI graph is really a misleading graph. It's an AHI on a 60 minute cycle and not really what we focus on. We focus on the overall AHI or average for the entire night.
The AHI graph...really isn't even needed and all it does is scare the bejeezus out of someone and it doesn't really carry that much importance.
It's not unusual to have an occasion "bad" time frame or cluster of events for any number of reasons. Sometimes it's related to REM sleep or maybe we are on our backs and with either it's common for our OSA to be worse. As long as it isn't happening all that often it really isn't alarming.

Besides...if you have a better baseline pressure your overall AHI will usually reduce and that will usually fix those ugly hourly AHI numbers anyway.

I once had 17 events within 17 minutes...bam bam bam...one right after another for 17 minutes. Ugly AHI for that hour of 17 but those were the only events I had over the entire night. Now why? We don't always know why but for some reason things got a little whacky for me.
Since that was an extremely rare occurrence for me I just shrugged my shoulders but if I had seen it happen often then I would have increased that baseline pressure so the machine could better prevent them from happening again.

These machines work best by preventing the collapse from ever happening in the first place. Playing catch up and trying to fix after the fact is a harder job.

If your overall AHI will come down with a more optimal baseline pressure those ugly hourly AHI numbers will also come down.

[palerider]

I asked my doctor a couple of weeks ago what clear airways were since I had just pulled data for myself from sleepyhead and she said she had never heard of it before.

"clear airway apnea" is a term that was made up by respironics because they're "special", (as in short bus), apparently just to confuse people. the rest of the medical industry uses the term "central apnea".

I'll ignore my high AHI for now, but I feel like something has to change and soon. Thanks!

ignore the stupid AHI chart(discussion with developer: "the AHI chart is dumb, what's it good for" "it makes it easy to see clusters of events" "I can see the bloody clusters on the flags chart!" "shut up"), focus on the nightly AHI, which is too high, and follow pugsy's advice to make it lower.

[Pugsy]

ignore the stupid AHI chart(discussion with developer: "the AHI chart is dumb, what's it good for" "it makes it easy to see clusters of events" "I can see the bloody clusters on the flags chart!" "shut up"), focus on the nightly AHI, which is too high,

I can just hear that discussion. I wish Mark hadn't ever included that damn AHI graph but he just had to put it in there because Encore offered something similar but worse because it could really scare the crap out of someone with their crappy Respironics math calculations.
But he asked people and some people shouted out "yeah, include it" and they drowned out my "don't you dare"