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General Discussion on any topic relating to CPAP and/or Sleep Apnea.
palmer1121
 
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Data analysis

Postby palmer1121 on Sat Dec 21, 2013 6:47 am

hi everyone
I have been on c-pap for 3 moths now and haven't missed a day..yeah!.
I am definitely getting better sleep. but still feeling tired..not like I used too though..I hear it gets better with time.
I am attaching my sleepy head export as I have some questions. ( I tried the photo bucket but not sure how to get the image into the body of this post. If I need guidance, please provide

I have reviewed and I think it looks much better than pre c-pap. in REM I was having 65 episodes an hour. My overall average is 15/hour. this last analysis shows .88. Yeah!
here are my questions and would appreciate input
on this day, I used my full quattros for her mask with a pad a cheek liner. I find a liner so much better in decreasing leaks.. Also with an overall AHI of .88 , should I be concerned with the leaks? I also use the swift fx for her nasal pillows.I am going to use that next week and compare the difference in data from the full mask.
1. leaks: not bad : Min: 0, med: 2.4 but 95% is 43.95. this seems to correlate to when I experience AHI episodes. Also with an overall AHI of .88 , should I be concerned with the leaks? why is the 95% so high, should correlate and be lower relative to the other findings regarding leaks
2. why am I snoring? if i am having less obstruction, shouldn't snoring decrease?
3. finally the last 2 weeks I have been having crazy dreams..i mean crazy..all over the place..nothing really to do with people i know but weird scenarios (ex: i was middle school child and we had to have an exterminator to come and remove snake skins from around my house..no one was hurt but there were hundreds of them..weird...Also I just seem very busy when I am sleeping..i can't remember all my dreams but i know a lot is going on. pre c-pap, very few dreams..let a lot crazy ones like now. I have heard that dreaming is good as part the the sleep cycles but when do they start to start to come at a regular pace and i finish 'catching up on them"
4.If you have any other analysis of my data or comments it is appreciated. thank you

A daily snapshot

Image

And here is the summary:

Image

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robysue
 
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Re: Data analysis

Postby robysue on Sat Dec 21, 2013 10:20 am

palmer1121,

First just some feedback on what data to provide. The Flow Rate and Event tables are missing here and they would have been quite useful to include. The mask pressure graph gives us no meaningful data, so turn it off. If the Flow Rate graph and the Event table are included, then the AHI graph is also unneeded. So turn off those graphs and include at least the Flow Rate graph in the future.

palmer1121 wrote:1. leaks: not bad : Min: 0, med: 2.4 but 95% is 43.95. this seems to correlate to when I experience AHI episodes. Also with an overall AHI of .88 , should I be concerned with the leaks? why is the 95% so high, should correlate and be lower relative to the other findings regarding leaks
Prior to about 7:00, the leaks are manageable---they're below 24 L/min and you are using a Resmed and that's where Resmed draws the line for Large Leaks. But that last hour of data is one very long, large leak. The leak is both large enough and long enough to potentially affect both the quality of your therapy and the accuracy of the data. Sine the AHI graph shows an increase during this time frame, it looks like three of the five events that were recorded were during the large leak and the other two events were recorded just as the leak was starting to get bad.

The 95% leak rate is so high because you were leaking at a rate of 43.94 L/min for at least FIVE percent of the night. The 95% of a set of data is the number for which 95 percent of the data lies AT or BELOW this number. And hence FIVE percent of the data lies AT or ABOVE this number. If you want a more detailed explanation of what a 95% number means, please see my blog post Average, Median, 95% numbers: A guide to those who don't remember their introductory stats

In your case, it's easy to see that the leaks were (well) above 40 L/min for at least 30-40 minutes out of the night. And the machine was run for 5:40, or about 5.67 hours. Hence your leak rate was above 40 L/min for at least 0.5 hours out of 5.67 hours, which is about 8.8% of the night. My guess is that your 90% leak rate would be much, much lower than 40 L/min. And it's also clear from looking at the leak graph that Mr. Green Smiley Face showed up this morning because Mr. Red Frowny Face shows up only when your leak rate is 24 L/min or more for at least 30% of the night. (In statistical language, Mr. Red Frowny Face shows up when your 70% leak rate is AT or ABOVE 24 L/min.

So technically, Resmed's engineers would say your big leak is bad, but not bad enough to trigger a "poor mask fit" warning.

My advice on the leaks? If this night is typical, then you don't need to be excessively worried about leaks, but it may be worth trying to do a bit of troubleshooting to see if you can keep the huge leak at the end of the night from getting quite so much out of control. If that large leak woke you up or if you felt like you tossed and turned during that time period, then it's worth putting more effort into troubleshooting the leak.


2. why am I snoring? if i am having less obstruction, shouldn't snoring decrease?
In general snoring does decrease with CPAP, and for some people it's eliminated entirely.

But snoring is often the last thing (rather than the first thing) eliminated by increasing the pressure. Think of it this way: As the pressure is increased during the titration study, the OAs typically turn into Hs and the Hs turn into RERAs, FLs, and snoring. So the OAs are often the first event to disappear during a titration study. They increase the pressure some more and the original OAs that are now Hs turn into RERAs, FL and snoring and the original Hs that are now RERAs, FL, and snoring are eliminated. They increase the pressure some more and the original OA that had been turned into Hs now turn into RERAs and snoring. The AHI is now officially a 0.0 at this pressure and unless they're titrating to eliminate all signs of RERAs, FLs, and snoring, the increases in pressure may stop at this point---particularly if the last pressure increase was very late into the titration study.

Or you simply had a "good" night without much snoring on your titration and they didn't pick up that you might still snore at 11cm of pressure. Or this is a particularly bad night for snoring.

Adding to the considerations is that you are also using EPR and it looks like you have EPR = 3. And in that case, the pressure is only at 8cm when you are exhaling. And it is the pressure on exhalation that is critically important for controlling or eliminating the snoring.

What to do about the snoring? That depends. If this is a typical night for the snore graph AND the snoring is waking you up or waking your bed partner up, decreasing EPR to 1 or 2 might fix the problem entirely. But that may also make it harder for you to exhale against the pressure. And so if you don't want to decrease EPR, then a modest 0.5 or 1.0 increase in pressure might help reduce or eliminate the snoring.

3. finally the last 2 weeks I have been having crazy dreams..i mean crazy..all over the place..nothing really to do with people i know but weird scenarios (ex: i was middle school child and we had to have an exterminator to come and remove snake skins from around my house..no one was hurt but there were hundreds of them..weird...Also I just seem very busy when I am sleeping..i can't remember all my dreams but i know a lot is going on. pre c-pap, very few dreams..let a lot crazy ones like now. I have heard that dreaming is good as part the the sleep cycles but when do they start to start to come at a regular pace and i finish 'catching up on them"
This seems like you may be experiencing a bit of REM-rebound. You're dreaming more than normal right now because it's been so long since your body was able to get into REM and stay there. (You did say your REM AHI = 65 on the diagnostic sleep study.) As your body acclimates to PAP, the amount of dreaming should return to normal---not your personal pre-CPAP normal, but normal for high quality sleep. And as you acclimate to CPAP, you'll also probably quit remembering all the dreams in great detail.

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palmer1121
 
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Re: Data analysis

Postby palmer1121 on Sat Dec 21, 2013 2:51 pm

thanks so much for taking the time to explain. that was very comprehensive. I will go to read your guide that you suggest as I do need to understand better
I updated my graphs as you suggested and include the graphs that were missing.

Image

Am I do ok or any concerns that I should further be managing
thanks again everyone. this community is so helpful!

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Pugsy
 
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Re: Data analysis

Postby Pugsy on Sat Dec 21, 2013 2:59 pm

You might take a look at my SH tutorial when you have time
understanding your data viewtopic/t88983/Pugsys-PointersSleepyHead-Tutorialdata-understanding.html
Most of the basics are covered in layman's terms.

Leaks...a war we never totally win...sometimes we win and sometimes the mask wins.
If leaks are waking you up...they need to be fixed even if they aren't big enough to impact therapy all that much.
Anything that wakes us up is unwanted.

I suspect that big leak probably woke you up but for the bulk of the night...especially the first part of the night...they were within acceptable limits.
Overall for new to therapy...quite acceptable.

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palmer1121
 
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Re: Data analysis

Postby palmer1121 on Tue Jan 07, 2014 4:52 am

thanks to those who provided input. Appreciated.
Wishing all a very happy new year and rest filled nights of sleep :)

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penuel
 
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Re: Data analysis

Postby penuel on Tue Jan 07, 2014 10:03 am

IMO, there is not enough sleep data to make decisions. Is the SH graph a nap and the given event data relates to it? In the SH Stats, also nothing is standing out of the ordinary. The main question is if to switch to APAP mode and raise the top pressure somewhat (to 12cm -13cm) to treat the Snoring. No Centrals are showing, so it should be OK to switch to APAP.

The S9 is robust to deal with the leak here at 09:15:

Image

palmer, because you're using a Resmed machine, any chances that you would try to use ResScan software to analyze your data? I find Sleepyhead to be full of bugs. See in my Stats below, in the upper table the 95% Leaks of above 32.40 Liter/Min during the last 30 days which is incorrect! Resmed's ResScan shows none of it. If the 95% leak was so hi then the S9 would not be able to diagnose, during the last 30 days, most of the events and would show them as unknown (in yellow color). This is NOT as happened.

Image

The leak of 40.2 in the following graphs is Mouth Breathing. To eliminate it you should consider either a chinstrap or a full face mask:
Image

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