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General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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Headintheclouds
 
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How to read Sleepyhead data?

Postby Headintheclouds on Sun Aug 05, 2012 3:42 am

Hi there. Just downloaded the Sleepyhead software and can't really make heads of tails...(I'm not too familiar as I'm new)

On the Events panel for last night it says thisL
• Clear Airway Apnea 26 events
• Flow Limitation 14 events
• Hypopnea 10 events
• Obstructive Apnea 2 events
• Pressure Pulse 100 events
• Resp. Effort Related Arousal 7 events
• Vibratory Snore #2 17 events
• Vibratory Snore 6 events

What does that mean? There're rather a lot of Pressure Pulse events and Clear Airway Apnea
What are Pressure Pulse events?
Does that mean I have Central Apnea as opposed to obstructive sleep apnea?
If so would CPAP be effective treatment in the future?

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Re: How to read Sleepyhead data?

Postby silentsinger21 on Sun Aug 05, 2012 4:50 am

I would like to know too... acutally I would like to know the "normal" sleep report, so that way when I look at mine I can actually tell if I'm getting good sleep or not. :)

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Re: How to read Sleepyhead data?

Postby Headintheclouds on Sun Aug 05, 2012 5:15 am

My AHI is below 5 or just about it every night I'm using the CPAP. But a third of my pie chart is occupied by 'Clear Airway Apnea'. What does that mean?

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Re: How to read Sleepyhead data?

Postby BasementDwellingGeek on Sun Aug 05, 2012 5:42 am

The yellow light bulb in the banner at the top of the page will allow you too look up most of the terms.

Resmed and Respironics have different standards for classifying events and methods for detecting Clear Airway/Central Apneas from Obstructive Apnea. As the name implies, the airway is either clear, or open vs Obstructed or closed. Clear Airway apneas often occur as part of rolling over as we tend to hold our breath while doing so. They also tend to happen when transitioning from/to sleep. Some people suffer from pressure induced CAs and others are diagnosed with CA as their primary ailment. The latter would be noted on your Sleep Study report. You should get a copy, from your PC physician or sleep doctor/lab, and familiarize your self with it.

Pressure pulses are used to test the airway and depending on the result of that test a determination is made as to whether the airway was open or obstructed. Resmed uses a different technique referred to as FOT, or Forced Oscillation Technique, to test the airway. The latter are not reported to the use but are easy enough to see on the pressure graph. Both are initialed about 5 or 6 seconds after the machine has detected what "thinks" is the begnning of an Apnea, a severe flattening of the flow to 20% or so of it's previous average. If normal flow resumes before 10 seconds has expired no event is reported. After 10 seconds either a CA, Clear airway Apnea, or OA, Obstructive Apnea will be reported. You can think of a Pressure Pulse or FOT as a mini-indicator of disturbed breathing.

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Re: How to read Sleepyhead data?

Postby Headintheclouds on Sun Aug 05, 2012 6:02 am

umm....OK, then I have disturbed breathing over 100 times a night :(

Since using the mask I've twisted and turn less than before. I'm in the same position all night.

That just leaves the wake/sleep transition thing. I get these hypnic jerks which is a central nervous system respond that jerk me awake repeatedly at sleep onset, like a shot of electricity to the brain. Been having these for four months and I think something I took at the time (a strong antibiotic that crosses the blood brain barrier called Clarythromycin) did something to me. These jerks coincide with the 'Clear Airway Apnea' events on the graph. I think the sympathetic nervous system is saying 'wake up! not enough oxygen!'

This all makes sense. Question is, how can I address this problem? Sounds like I have Central as well as Obstructive Sleep Apnea...

Would a BiPaP machine work?

During the day I feel better than I was after using CPAP, but not fantastic because I get repeatedly woken up in the morning. I manage to sleep untroubled at night because I use sleeping tablets and an anticonvulsant that has sedating quality.

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Re: How to read Sleepyhead data?

Postby BasementDwellingGeek on Sun Aug 05, 2012 6:40 am

umm....OK, then I have disturbed breathing over 100 times a night

Is that the norm or just an isolated night? Do they come in clumps/clusters or are the spread evenly? I had one night of 188 and a few nights of only 3. When "new" there tended to more. After 6 months I was down to a few dozen a night. I wouldn't fret over it yet.

Many of us have occasional "jerks" in stage one sleep. It sounds like yours are more than occasional. Are the jolts a result of the apnea or do the jolts cause the apnea? It may be that there is a sharp air intake at the the jolt and the body doesn't need to breath (it has plenty of O2 and you just diluted your CO2) so you don't. How long do these events last? There is a parameter in parenthesis that gives the value.

Your high CA count could also be when you are awake. I forgot to mention earlier that the machine is tuned to detecting sleeping breathing abnormalities. While we are are asleep we tend do be more uniform and consistent then we are awake. My flow graph shows a fairly marked difference between awake, asleep and dreaming waveforms. Algorithms are designed for the sleeping pattern and can be confused by the more erratic awake breathing.

A goodly number of us use a Zeo sleep monitor to help correlate events and sleep states. A few of use body position monitoring as well. I have a min-sleep lab every night. It may seem unthinkable when "new" and still getting acclimated to hose clinging to you face. But it will most likely get better given time.

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Re: How to read Sleepyhead data?

Postby rich0 on Sun Aug 05, 2012 6:44 am

What are your prescription settings? It would probably help to put those numbers in context.

I wouldn't read too much into the pressure pulses - that is the machine trying to figure out what is going on, and it isn't necessarily an indicator that anything is wrong. The other events matter more - especially apneas/hypopneas.

Generally the more you increase pressure the fewer obstructive events you'll have, and the more likely you'll be to have central events (especially in some individuals like myself). BiPAP might help with that, but if the central apneas are bad enough only an ASV machine will fix the problem (it basically is like a combination APAP/BiPAP that automatically adjusts pressures to address both problems).

The issue you're likely to run into is that your AHI is under 5. For whatever reason this is considered the target for therapy, and it is unlikely your insurance will pay for a $5000 ASV machine if your AHI is under 5 without one. They probably wouldn't even want to pay for a much cheaper BiPAP. You could of course pay cash, but they're still very pricey (maybe you could get it for $3500 from someplace like cpap.com).

I've struggled with this a bit as well - once your numbers are under 5 doctors are loathe to touch anything - and in the traditional visit-every-six-months-and-don't-touch-anything-without-a-study system it would be hard to do anything about it anyway. I'll probably have to tweak my own settings to get the numbers down further - with an ASV the system will adjust automatically, but it is always after-the-fact so you'll always have some events unless you adjust the minimums.

I agree with BasementDwellingGeek as well - you need to see when these events are happening. If you're just getting centrals when you transition that isn't a big deal at all. I have an ASV and I still get really erratic breathing when I dream (I think - I don't have any EEG data so I can only go up from memories of dreaming when I awake which isn't terribly reliable).

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Re: How to read Sleepyhead data?

Postby Headintheclouds on Sun Aug 05, 2012 7:34 am

The Clear Airway Apnea events happens through the night, but with a huge cluster at the morning end of the sleep. I don't tend to draw breaths when a hypnic jerk happens so I tend to think the apneas cause them.

My machine setting starts at 4 on a ramp to 8.

And thanks for the heads up re cost of machine. They're much more expensive than CPAP ones. Gosh. I need to hospital to lend one to me as a trial first so I know it works before buying one....

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Re: How to read Sleepyhead data?

Postby robysue on Sun Aug 05, 2012 12:02 pm

Headintheclouds wrote:umm....OK, then I have disturbed breathing over 100 times a night :(
Nope, that's not quite the right interpretation of your numbers. Technically the "disturbed breathing" includes the CAs, the OAs, the Hs, and the RERAs. The FLs and snoring are called "precursor events"---they indicate that the airway may be in some danger of collapsing. The PPs are nothing more than the System One's way of testing whether the airway is open or obstructed. The first PP is usually sent out about 6-7 seconds after the airflow into/out of the lungs drops to almost 0. And it repeats the PP about ever 7-8 seconds until breathing resumes. So a typical 15 second apnea will likely have two PP.

Headintheclouds wrote:Hi there. Just downloaded the Sleepyhead software and can't really make heads of tails...(I'm not too familiar as I'm new)

On the Events panel for last night it says thisL
• Clear Airway Apnea 26 events
• Flow Limitation 14 events
• Hypopnea 10 events
• Obstructive Apnea 2 events
• Pressure Pulse 100 events
• Resp. Effort Related Arousal 7 events
• Vibratory Snore #2 17 events
• Vibratory Snore 6 events

What does that mean? There're rather a lot of Pressure Pulse events and Clear Airway Apnea
What are Pressure Pulse events?
Does that mean I have Central Apnea as opposed to obstructive sleep apnea?
If so would CPAP be effective treatment in the future?

How long did you sleep for the night? We need that to put these numbers in context. If you slept for at least 5-6 hours, all the numbers except for the CAs look very reasonable, and the OAs look excellent since the numbers under the events tab are the actual numbers of the events for the whole night, and not the "indices" that measure average number of events per hour.

Yes, the CAs look a bit high. But it is hard to tease apart "real CAs" from "false CAs" based on just the airflow. Wake breathing is quite different from sleep breathing, and it is pretty common to have what are call "transition centrals" as you are dropping off to sleep or just waking up. On a PSG these kinds of CAs aren't even scored as part of sleep disordered breathing---if they are relatively few in number and don't seem to interfere with dropping off to sleep. But in some people, apneas during that period can lead to sleep instability and real problems with finally getting into a real sleep. Is this the case with you? It's impossible for us to say---particularly since we have not seen the results of your sleep test nor the wave form data from your CPAP.

Question is, how can I address this problem? Sounds like I have Central as well as Obstructive Sleep Apnea...
It's way too early to start worrying about whether you've got Central Sleep Apnea or Complex Sleep Apnea yet---unless your diagnostic sleep test mentioned CAs being a problem.

Yes, a small number of new CPAPers (10-15%) develop problems with "emergent central apneas" (Complex Sleep Apnea) once they start CPAP. But unless the problem is very severe, docs tend to take a "prudent watchfulness" approach since sometimes the centrals disappear on their own as the patient's brain relearns how to interpret the nighttime CO2 levels while PAPing. (It's the CO2 levels that are the trigger the brain uses to send the message "Inhale" to the lungs and diaphragm.)

And at this point, your CA numbers are nowhere close to severe. The usual point where docs here in the states start to worry about CAs in patients on CPAP is when the CAI (all by itself) is consistently above 5 (for several weeks) AND when the CAs make up at least 50% of all the events in the overall AHI. Since your CAI < 5 and your CAs make up only 1/3 of your events, there's no need to jump to the conclusion that you need to be put on an ASV machine yet. Give it some more time to see if your body adjusts. And keep in mind that ASV machines are not only significantly more expensive than CPAPs and BiPAPs, they are much trickier to set up and they can be much, much harder to adjust to since they use very large pressure variations on each breath cycle as a way of breaking the so-called overshoot/undershoot cycle that is at the heart of CSA and CompSA.


During the day I feel better than I was after using CPAP, but not fantastic because I get repeatedly woken up in the morning.
I know that you're saying the real problem with your sleep continuity are those pesky "hypnic jerks" that kick in when you are trying to get back to sleep towards morning. Some important questions to ask yourself and your sleep doc (and other docs) about those jerks, the early morning restlessness/wakefulness, and the early morning clusters of what your machine is labeling CAs:

1) Did your diagnostic sleep study mention anything about centrals? If not, then you don't need to be worried about CSA.

2) Did your titration sleep study (if you had one) say anything about CAs? If you had some CAs scored on that study, then the possibility of developing CompSA is higher.

3) Did either sleep study say anything at all about the hypnic jerks? What about PLMD? What about restless legs?

4) Have you mentioned the frequency of the jerks to your docs? As others have said, a jerk or two now and then is perfectly normal. (I had one last night just as I was drifting off.) But a whole series of them in a 15-30 minute period every night probably does indicate some kind of a problem. And if there's usually a cluster of machine-recorded CAs at the same time as the jerks, some detective work may need to be done to get an idea of whether there are two independent problems or whether the CAs and the jerks are relate. And if they are related, then the causation relation will need to be determined: Does a CA cause the jerk which causes the wake? Or does the jerk cause the wake which then results in a (normal) transitional CA being scored by the machine?

5) Did the jerks start after you startedf CPAP? Did they get worse after you started CPAP?

6) You write:
I manage to sleep untroubled at night because I use sleeping tablets and an anticonvulsant that has sedating quality.
There's also a chance that either the sleeping tablets or the anticonvulsant drug is adversely affecting the quality of your sleep towards the end of your sleep period. Discuss the effects of both meds on your sleep patterns for the whole night. Many people find commonly prescribed sleeping pills help with getting to sleep, but do not help keep them asleep all night. And anticonvulsants are strong meds with lots of potential side effects. It may be that your dose needs to be adjusted. Or that you need a different anticonvulsant altogether. Please discuss the sleep situation with thd doc who prescribed the anticonvulsant.

7) This will sound like a truly crazy idea, but I have to say it: Perhaps you are trying too hard in the morning to squeeze out just a bit more sleep---sleep that your body doesn't actually need now that it no longer has to wake itself up repeatedly to open up the airway. If this restless period with all the hypnic jerks and CAs starts 30-60 minutes before you want to get up, perhaps the real solution is to just go ahead and get up for the day instead of trying to force a bit more sleep to happen. If you get up and function decently in the day, then you can conclude that maybe you just don't need that last hour of really bad quality sleep.

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Re: How to read Sleepyhead data?

Postby robysue on Sun Aug 05, 2012 12:32 pm

rich0 wrote: if the central apneas are bad enough only an ASV machine will fix the problem (it basically is like a combination APAP/BiPAP that automatically adjusts pressures to address both problems).
An ASV machine is NOT "like a combination APAP/BiPAP".

CPAPs, APAPs, BiPAPs (bilevels), and Auto BiPAPs cannot be set up to occasionally act as a noninvasive ventilator. ASV and bilevel ST machines can be set up to (occasionally) act as noninvasive ventilators. And it is that capability that makes them useful in treating central and complex sleep apnea.

The point behind xPAP for OSA is to provide enough pressure to keep the airway open most of the time. On the OAs that sneak through the defenses, the machine makes NO attempt to force you to inhale. It waits for you to start rebreathing on your own. (APAPs and Auto bilevels increase the pressure after the OA is over, they do NOT increase pressure in an attempt to get you to inhale.)

ASV and bilevel ST machines, on the other hand, can and do use pressure to force the patient to inhale---that is why they are considered noninvasive ventilators. Their algorthims for "triggering" inhalations are designed to short circuit the overshoot/undershoot cycle of blowing off too much CO2 which suppresses the "urge" to breath which leads to not blowing off enough CO2 (and a central apnea) which triggers a bit of hyperventilation which leads to blowing off too much CO2 which ... Essentially, ASV and bilvel ST machines trigger enough inhalation during the period when the tidal volume is at its lowest to prevent the undershoot (not blowing off enough CO2) part of the cycle from occurring.

The issue you're likely to run into is that your AHI is under 5. For whatever reason this is considered the target for therapy, and it is unlikely your insurance will pay for a $5000 ASV machine if your AHI is under 5 without one. They probably wouldn't even want to pay for a much cheaper BiPAP. You could of course pay cash, but they're still very pricey (maybe you could get it for $3500 from someplace like cpap.com).
In order to purchase a bilevel or a bilevel ST or an ASV machine from a place like cpap.com, you need a prescription for that particular type of machine. A prescription for a CPAP or an APAP won't be enough.

An ordinary old bilevel (a PR BiPAP or a Resmed VPAP) can be prescribed for a number of reasons, including patient comfort. In my case I was switched to bilevel to see if it would decrease my problems with aerophagia and spontaneous arousals caused by my body overreacting to the physical stimuli coming from my APAP/CPAP.

But prescriptions for bilevel ST and ASV machines are going to require some documented evidence of Central Sleep Apnea or Complex Sleep Apnea. And they'll require an in-lab sleep test for determining the appropriate settings---which are more complex than the settings on CPAPs, APAPs, and bilevels.

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Re: How to read Sleepyhead data?

Postby rich0 on Sun Aug 05, 2012 12:53 pm

robysue wrote:But prescriptions for bilevel ST and ASV machines are going to require some documented evidence of Central Sleep Apnea or Complex Sleep Apnea. And they'll require an in-lab sleep test for determining the appropriate settings---which are more complex than the settings on CPAPs, APAPs, and bilevels.


I'll agree with everything you've said up until the last sentence. The settings on an ASV are certainly more complex, but at least in my case they basically just set all the minimums to the minimums and the maximums to the maximums and let the machine figure everything out. That would probably work for most people. In fact, rather than spending a fortune on sleep studies I'm not sure why they don't just lend out an AutoSV for a week and then check the memory and see how things went. That alone wouldn't solve all sleep problems, but looking at how the machine handled the situation for a week would probably allow a technician to pick the appropriate machine to use, or refer the patient for a study if treating apneas alone wasn't sufficient.

Now, that isn't to say that a doctor wouldn't require a study before writing a prescription, or that a vendor wouldn't require a prescription before selling a machine. However, I'd question whether this is truly due to a need for a study to get the right settings, vs simply being the way things are done and for legal/financial reasons.

Of course, if it were up to me you'd be able to buy an ASV at Walmart as long as you had the cash, as well as every prescription drug out there other than antibiotics. Insurance companies could require prescriptions for coverage, but I don't see why people shouldn't be willing to buy whatever they want as long as it doesn't hurt anybody else and they're willing to suffer the consequences.

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Re: How to read Sleepyhead data?

Postby archangle on Sun Aug 05, 2012 1:06 pm

You're way too worried way too soon about your numbers. Unless they're a whole lot worse, wait a few weeks before worrying about numbers like that. Your body will take a while to adjust.

Don't obsess over centrals. Worry about how long, how often, and how completely you stop breathing. Look at the detail event data and the airflow waveform. See how long you're holding your breath. Centrals aren't necessarily more harmful than obstructive, just harder to get rid of.

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Re: How to read Sleepyhead data?

Postby avi123 on Sun Aug 05, 2012 1:54 pm

I notice that the OP declines to tell if he/she underwent a sleep study. So all the "advice" is nice but useless. Without EEG and respiration effort sensors no one can tell if it's CA, OA, Hypo -central, Hypo-obstructive, etc.

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Re: How to read Sleepyhead data?

Postby Headintheclouds on Sun Aug 05, 2012 2:02 pm

How long did you sleep for the night?


Robysue you are a fountain of knowledge :D Thank you so much for such an in-depth reply. You might be shocked but I was in bed for about 9 hours where the above data comes from. It sounds a lot but I was repeatedly jolted awake the last few hours I think my body just wants to recover as much sleep as possible even when it's all broken up.

I still don't know what to make of the CAs. All I notice is that shortly before a jolt I seem to stop breathing.

But in some people, apneas during that period can lead to sleep instability and real problems with finally getting into a real sleep. Is this the case with you?


It's the jolts which stops me from getting into sleep. If I don't use sleeping tablets I won't get any sleep. When they first happened they kept me awake for two days. it's like being electrocuted every time you nod off. It's very unpleasant.

Did your diagnostic sleep study mention anything about centrals?


Unfortunately I wasn't issued with a report (I'm in the UK). The neurologist just told me I have OSA without going into any details. Not sure if it mentioned hypnic jerks or PLMD.

Did the jerks start after you startedf CPAP? Did they get worse after you started CPAP?


They started three months before I used CPAP. They didn't get better or worse after started CPAP. Just the same.

Many people find commonly prescribed sleeping pills help with getting to sleep, but do not help keep them asleep all night.


As I said above I can't sleep at all without using the sleeping pills. I really hate myself for using them (been 3 months now) but it's that or melt down. My body is now conditioned to them so I have to ween myself off slowly in time. I really envy people who say they can sleep after using CPAP. These pills (Zopiclone) has a half life of 5/6 hours.On the charts there're relatively fewer events during those hours.

Perhaps you are trying too hard in the morning to squeeze out just a bit more sleep


That's exactly what I'm doing, trying hard to squeeze a little bit more sleep. But when a jolt happens part of me wants to 'try again' hoping that I'll be able to sleep on and the jolts'll magically disappear.

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Re: How to read Sleepyhead data?

Postby mike95490 on Sun Aug 05, 2012 2:19 pm

on a side note, how do ya'll get the pie charts to show in sleepyhead I just get a [ ? ] in the spot everyone shows a pie chart?
(uploaded a pic to the sleepyhead facebook owner, photobucket non-cooperative today)

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