Is This Sleep-Wake-Junk?

This has happened three times in the last couple weeks. I have a pretty good night up until about 5am and then from 5 to 6:30 I have a buttload of events.

Not often I get AHI less than 5, I'm usually happy with less than 10.


So most of the night I was below 6.


And the last hour and a half I'm at 26


Looks like textbook OA waves.

Do you remember being awake and tossing and turning a lot during that time frame?

If yes...might be SWJ but that's a long time period to be having it.
If no...might be REM related events that simply need a little more pressure to prevent them from materializing. That time frame is also where we have the most REM stage sleep.

Robysue or others could you please discuss this swj phenomenon?

photonic wrote:Robysue or others could you please discuss this swj phenomenon?

Pugsy pretty much said it all: If sc0ttt remembers being restless during this time frame, it's most likely SWJ.

If sc0ttt thinks he was sound asleep, there's a good chance that the OAs might be REM related: The longest REM cycle of the night often occurs shortly before we wake up for good in the morning.

robysue wrote:

photonic wrote:Robysue or others could you please discuss this swj phenomenon?

If sc0ttt thinks he was sound asleep, there's a good chance that the OAs might be REM related: The longest REM cycle of the night often occurs shortly before we wake up for good in the morning.

I don't remember being restless, but maybe. I thought it might be REM sleep thing too, except it didn't happen the first four months of therapy... or maybe I had clusters that weren't all at the end of the night and so they looked more normal. Last night wasn't bad.

So if I do think it's a REM sleep thing, and it keeps happening, I just go up a cm on the pressure and get an AUTO next time?

Supine sleeping might also be a factor unless you never go onto your back. Might even be a combination of supine sleep and REM.

Normally from my own past experience with SWJ that is more than a minute or so.....I pretty much remember being awake and tossing and turning.

Yes, most likely another cm of pressure would prevent it and yes, having auto available for a little more pressure being available for those times (whatever the reason) would be something to consider.

You have a 60 series machine don't you? You have some limited APAP capabilities already if you have the 460 model.
Have you thought about trying apap mode for a week or so just to see what the pressure wants to do? Doesn't have to be a big range....maybe 10 min and 12 max just to see if the machine senses real obstructive events or flow limitations and wants to try to fix them.
A disadvantage to using the cpap mode is that the machine doesn't bother to flag flow limitations which might give you another data point that might help in evaluating the therapy and help in determining if what you see is related to the airway itself or just SWJ.

Pugsy wrote:Supine sleeping might also be a factor unless you never go onto your back. Might even be a combination of supine sleep and REM.

You have a 60 series machine don't you? You have some limited APAP capabilities already if you have the 460 model.

I'm almost always on my back.

Oh yeah thanks... I've never tried out the trial auto mode, that's a good idea.

Hi again. Still wondering about this term SWJ. I don't really know what this term means. I surmise that the reading on SH that you get while you are tossing and turning and not falling asleep are artificial data points and thus can't be relied upon diagnostically. Is this what the term means? And I take it that since we don't have EEG on our machines that we have to make this judgment based on our memory of being awake during those periods? Do I have this correct? Is SWJ considered a big problem in evaluating our data.

Thanks for bringing junior (me) along......

photonic wrote:Hi again. Still wondering about this term SWJ. I don't really know what this term means. I surmise that the reading on SH that you get while you are tossing and turning and not falling asleep are artificial data points and thus can't be relied upon diagnostically. Is this what the term means? And I take it that since we don't have EEG on our machines that we have to make this judgment based on our memory of being awake during those periods? Do I have this correct? Is SWJ considered a big problem in evaluating our data.

Yeah, that's pretty much what sleep/wake/junk is. Erratic/irregular breathing that is normal part of awake or semi awake state confuses the machine. Remember the machine just records the breathing and can't tell if you are awake or not.
It's not always easy to spot SWJ on the flow rate graphs. Sometimes it's real obvious but sometimes not so much.

Normally not a big problem though if a person is aware that they didn't sleep so great in the first place.
This is why when we see ugly reports we usually ask....were you soundly asleep or was the sleep fitful and restless.
Like your report the other night where you had 3 sleep sessions. First 2 were ugly but the 3rd was quite decent. There's a good chance the first 2 segments were ugly because of poor sleep.
Most of the time SWJ is short lived anyway. For newbies like yourself we accept SWJ as pretty much coming with the newbie to cpap territory. It isn't exactly normal to have all this stuff attached to us in the first place. Sleep that is already easily disrupted due to sleep apnea gets disturbed just from sleeping with the mask and machine. Comes with the territory.

Beginning to make so much sense. Thanks for that. Yes, I am seeing those nights where I am rolling around that the data just looks wacko like last night. But the previous night I slept straight through 8 hours with an AHI of 0.7. I was SHOCKED! It felt like normal sleep. Of course that did not last and last night I pitched and rolled and swore I would NOT look at the clock. Also there was that fantastic sensation of the machine blasting me and literally blowing out my nose plugs into the bed - THAT was fun. Never did have to take a sleep hygiene break though which is progress!

So it sounds like this up and down and all around experience is par for the course getting use to the ASV and xPAP in general. I will hang in there and choose to be "amused" by the roller coaster of results. At least all of this is intellectually interesting - one saving grace....

photonic wrote:Beginning to make so much sense. Thanks for that.:

also, when you see a term on the forum you don't understand, like swj, you can use the search that's up at the top to search for that, and you'll usually find enough info on it very quickly, (since it's usually be explained many times before

I'm not familiar with your mask nor its expected leak rates, but it seems your leak rate is high for a pressure of 10 cm. Do you notice the mask leaking? I would think a fit adjustment is needed from the data you posted.

SleepyHead now reports large leaks and while his leaks are sometimes getting a little bit close to large leak territory he really doesn't spend much time there.
It's the LL on the events graph and only 1 of the nights has a tiny little bar for large leak. Looks like around 1:40 AM
It was brief .

If leaks aren't waking a person up then these technically fall withing the range where the machine can compensate and aren't a big impact to therapy effectiveness itself.

The red line is the default red line at 24 L/min and that's a ResMed line. It needs to be turned off or raised to Respironics leak number to avoid which is probably up around 80 L/min or so.

Pugsy wrote:SleepyHead now reports large leaks and while his leaks are sometimes getting a little bit close to large leak territory he really doesn't spend much time there.
It's the LL on the events graph and only 1 of the nights has a tiny little bar for large leak. Looks like around 1:40 AM
It was brief .

If leaks aren't waking a person up then these technically fall withing the range where the machine can compensate and aren't a big impact to therapy effectiveness itself.

The red line is the default red line at 24 L/min and that's a ResMed line. It needs to be turned off or raised to Respironics leak number to avoid which is probably up around 80 L/min or so.

Oh, I see... that makes more sense.



Actually 84 l/m matches the bar even better.

Large leak territory isn't a one size fits all number with the PR S1. It varies between which PR S1 machine is use and the mask used and the pressures used. Some people may have it at 75 L/min and others at around 90 L/min (that's where mine is)....and others might have it anywhere in between. I haven't ever seen a LL reported at 70 L/min (total leak) but that doesn't mean it couldn't happen if someone was using say a nasal pillow mask and a very low pressure.

I do know that leaks that get into the 100 L/min and above range will greatly impact how the machine reports events and how it responds if in APAP mode. I have seen leak reports showing 120 L/min and the machine in APAP mode but function is like a cpap mode. In that case the user thought the machine was broken. The machine wasn't broken but the large leak at 120 L/min which was pretty much all night long was seriously impacting the machine's ability to do anything.