Sleepy head data Screenshots. Please decipher

Hy, i need some knowledgeable members to help me decipher my sleepy head data, and if i need to make any changes to my therapy. i still feel head fog. some days worse then others, some days fine, i don't feel i get deep sleep especially in the late half of the night with frequent awakenings.
This example was last night. when there was i period i did not use the machine for about an hour or so.
IS there any changes i need to do why so many CA (clear airway apneas?) what should i do to better my therapy.
using a bipap Ipap is 8 to 12 and epap ix 6-8 (auto, low pressures because i have UARS (maybe)

i don't know what the respiratory rate means or tidal volumes ect...please help with any input,any advice. here are the pictures.
Thank you in advance

Your numbers look good. You do not have an excessive number of central apneas. The one thing you might want to do is click on the "Events" tab in the left side panel to see how long your CA's are -- if they are minute-long events even a few could be excessive -- but otherwise your numbers look really good.

In my opinion, your fogginess could be entirely explained by the fact that you removed your mask for a significant period of time. While your mask was off we have no idea what sort of sleep you were getting -- you may have spent significant amounts of time in desaturation, which would definitely affect you the next day, no matter how good your sleep was the rest of the night. The most essential thing you can do for your sleep health is never to sleep without your mask.

Ruinednose,

The biggest problem with the data that you posted is the hour long period where you did not use your machine. If this common pattern---i.e. taking the mask off in the morning and going back to sleep for an hour or so, then the untreated apnea for that one hour of sleep may be the main reason you are still dealing with brain fog issues: The number of apneas and hypopnea in that one hour of untreated sleep is likely far greater than the total number of events scored by your machine during the rest of the night.

why so many CA (clear airway apneas?)

The total number of CAs (5 for the ENTIRE night) is actually rather low and is of no concern by itself. There's also a chance that one or more of the CAs is NOT a real CA in terms of what would be scored on a PSG: They may be post-arousal "centrals" that occur as you are falling back asleep and the control of your respiration is being handed back to your autonomic nervous system. That kind of CA is NOT scored on a sleep test because it doesn't start in sleep.

i don't feel i get deep sleep especially in the late half of the night with frequent awakenings.

Once PAP is well optimized in terms of controlling the obstructive events, it doesn't do much to fix other sleep problems. Your obstructive events are well controlled at your current settings. So the question then becomes: Why is your sleep still fragmented? The answer to that question is NOT "undertreated OSA", and so tweaking the settings on your BiPAP is not likely to fix this problem. You need to tackle whatever the underlying problem actually is.

So what's triggering those wakes? And how do you react to them? And how many times a week are they a serious problem?

Fixing sleep maintenance insomnia is not particularly easy: Many sleeping medications do a good job in helping you get to sleep, but they don't keep you asleep, particularly in the second half of the night; still they can take the edge of the problem for some people. Sometimes CBT for Insomnia can help; the CBT for Insomnia usually focuses on reducing the disruption of the middle of the night wakes so they don't start a bad positive-feedback loop that keeps you more awake once you first wake up. A rigorous, fixed wake up time where you force yourself to get up at the same time seven days a week regardless of how little you slept and how tired you are can also help force the body to learn how to NOT wake up excessively during the second half of the night.

what should i do to better my therapy.

Don't sleep for an hour without the mask on your face. And start working on the sleep maintenance insomnia as its own separate issue rather than expecting tweaking PAP settings to fix that problem.

i don't know what the respiratory rate means or tidal volumes ect

Respiratory Rate = number of breaths per minute that you take.

Tidal volume = the amount of air you inhale in one inhalation (measured in mL)

Minute Ventilation = the total amount of air you inhale over the course of one minute. (measured in L/min). In general,

• Minute Ventilation = (Tidal Volume * Respiratory Rate)/1000 [The /1000 coverts mL/min into L/min]

Insp. Time = length of one inhalation measured in seconds

Exp. Time = length of one exhalation measured in seconds

Since each breath consists of one inhalation and one exhalation, in general,

• Respiratory Rate = 60/(Insp Time + Exp Time)

There is a fair amount of variability in all these numbers in normal people. Tidal Volume and Minute Ventilation depend on both the size of the person and whether there are existing lung issues such as asthma or COPD.

In quality sleep the Respriatory Rate is usually pretty stable; but some variation (spikes in the RR graph) is pretty common in REM sleep. Waking Respiratory Rate is more variable than Sleep Respiratory Rate. So sometimes a ragged RR graph can indicate a lot of plain old "restlessness" during the night.

I am in a similar situation. As UARS patients, we are more sensitive and react faster to airway obstructions, so you cannot reply on the AHI numbers to tune the xPAP treatment.
Note your pressure increases multiple times during the night. I guess fixed IPAP=10 EPAP=8 might provide more effective treatment.

Ruinednose wrote:Hy, i need some knowledgeable members to help me decipher my sleepy head data, and if i need to make any changes to my therapy. i still feel head fog. some days worse then others, some days fine, i don't feel i get deep sleep especially in the late half of the night with frequent awakenings.
This example was last night. when there was i period i did not use the machine for about an hour or so.
IS there any changes i need to do why so many CA (clear airway apneas?) what should i do to better my therapy.
using a bipap Ipap is 8 to 12 and epap ix 6-8 (auto, low pressures because i have UARS (maybe)

i don't know what the respiratory rate means or tidal volumes ect...please help with any input,any advice. here are the pictures.
Thank you in advance

musculus wrote:I am in a similar situation. As UARS patients, we are more sensitive and react faster to airway obstructions, so you cannot reply on the AHI numbers to tune the xPAP treatment.
Note your pressure increases multiple times during the night. I guess fixed IPAP=10 EPAP=8 might provide more effective treatment.

What pressure increases are you talking about?

Here's Ruinednose's data that shows the pressure graphs for the night:


Note that the EPAP is flat all night long. No increases at all.

And those bumps on the IPAP graph? They are nothing more than the PR's "Search algorithm" testing what a 2cm increase in IPAP might do. And since no improvement in the shape of the inhalations is found during the "Search", at the end of the 2cm test increase, the machine lowers the IPAP pressure back down to baseline = min IPAP pressure.

In other words, the machine is finding NO reason to increase either the IPAP or EPAP pressure AT ALL on this night: Every "test search pressure increase" doesn't improve things AND nothing else is being scored that would ordinarily trigger a pressure increase in either the IPAP or EPAP or both.

The PR System One BiPAP scored NO Flow Limitations, NO RERAs, and NO VS1 snoring at all. If the problem were untreated or undertreated UARS, we would expect to see some Flow Limitations and/or RERAs scored by the machine. Indeed, we'd expect to see a fair number of FLs and/or RERAs if untreated or undertreated UARS was the problem.

The handful of OAs and Hs that are scored are "isolated" in the sense that they occur far enough apart to prevent the machine from increasing either the IPAP or EPAP in response to them: On a PR BiPAP Auto, it takes scoring two or more Hs (or RERAs + Hs) within about 2 minutes of each other to trigger a 1 cm increase in IPAP; it takes scoring two or more OAs or (OAs + Hs) within about 2 minutes of each other to trigger a 1cm increase in EPAP.

I guess fixed IPAP=10 EPAP=8 might provide more effective treatment.

Ruinednose is currently using:

• Min EPAP = 6
  Max IPAP = 12
  Min PS = 2
  Max PS = 6

And with these settings, the machine wants to run at IPAP = 8 and EPAP = 6.

Changing from the current Auto BIPAP range to your proposed fixed pressure settings is a HUGE change, and will probably not do much except cause additional sleep disruption for Ruinednose.

If Ruinednose is determined to increase the pressure settings, I would suggest going very, very slowly. Perhaps a 1cm increase in min EPAP might do something without causing additional problems. But a two cm jump in both EPAP and IPAP is way too much at one time.

1. the airway obstruction was not effectively treated based on the symptom and the vastly variable airflow chart.

2. people with UARS react faster to airway resistance than machine increase pressure, so it's not very useful to use auto. I didn't mean to suggest pressure change overnight.

robysue wrote:

musculus wrote:I am in a similar situation. As UARS patients, we are more sensitive and react faster to airway obstructions, so you cannot reply on the AHI numbers to tune the xPAP treatment.
Note your pressure increases multiple times during the night. I guess fixed IPAP=10 EPAP=8 might provide more effective treatment.

What pressure increases are you talking about?

Here's Ruinednose's data that shows the pressure graphs for the night:


Note that the EPAP is flat all night long. No increases at all.

And those bumps on the IPAP graph? They are nothing more than the PR's "Search algorithm" testing what a 2cm increase in IPAP might do. And since no improvement in the shape of the inhalations is found during the "Search", at the end of the 2cm test increase, the machine lowers the IPAP pressure back down to baseline = min IPAP pressure.

In other words, the machine is finding NO reason to increase either the IPAP or EPAP pressure AT ALL on this night: Every "test search pressure increase" doesn't improve things AND nothing else is being scored that would ordinarily trigger a pressure increase in either the IPAP or EPAP or both.

The PR System One BiPAP scored NO Flow Limitations, NO RERAs, and NO VS1 snoring at all. If the problem were untreated or undertreated UARS, we would expect to see some Flow Limitations and/or RERAs scored by the machine. Indeed, we'd expect to see a fair number of FLs and/or RERAs if untreated or undertreated UARS was the problem.

The handful of OAs and Hs that are scored are "isolated" in the sense that they occur far enough apart to prevent the machine from increasing either the IPAP or EPAP in response to them: On a PR BiPAP Auto, it takes scoring two or more Hs (or RERAs + Hs) within about 2 minutes of each other to trigger a 1 cm increase in IPAP; it takes scoring two or more OAs or (OAs + Hs) within about 2 minutes of each other to trigger a 1cm increase in EPAP.

I guess fixed IPAP=10 EPAP=8 might provide more effective treatment.

Ruinednose is currently using:

• Min EPAP = 6
  Max IPAP = 12
  Min PS = 2
  Max PS = 6

And with these settings, the machine wants to run at IPAP = 8 and EPAP = 6.

Changing from the current Auto BIPAP range to your proposed fixed pressure settings is a HUGE change, and will probably not do much except cause additional sleep disruption for Ruinednose.

If Ruinednose is determined to increase the pressure settings, I would suggest going very, very slowly. Perhaps a 1cm increase in min EPAP might do something without causing additional problems. But a two cm jump in both EPAP and IPAP is way too much at one time.