Couple of Weeks in, have questions about data

[AnnePandora]

Hello, all!

I've spent two weeks on the machine now, and last night from my point of view I slept through the night, for the first time in years. Decades, maybe -- I'm unclear on when this all started.

But my machine doesn't see it that way.

I was diagnosed with obstructive apnea -- no mention of central events that I was told. AHI at that time was 50. I've got the machine on a 15 min ramp, and it's set at 6-20 pressure, as per my prescription.

I had some trouble figuring out how to keep the mask from leaking, but that got sorted out.

So, again, from my point of view, last night the mask wasn't leaking; I woke up once (obvious break in the graph) when there was some excitement about a skunk outside; went right back to sleep; don't remember any dreams but know that I had them (you, know that knowledge when you wake up that you've been some place else).

But the machine says my AHi was over 20, and indeed, it's never been below 15 this whole two weeks, and a few times was around 30. Since I was having trouble with mask leaks I put it down to that; obviously something else is going on.

Can you take a look, please, if you've got time?

Thanks, Anne

[Julie]

What happened to the graphs?

[Pugsy]

SleepyHead may be having some trouble with your data from your AirCurve machine. While I doubt it is making up centrals perhaps we need a ResScan report which is for sure compatible with the new AirCurve machines.
The latest SleepyHead version 0.9.8-1 was released in August of last year and the AirCurve machines were released later in December so we have been seeing some odd stuff.

I don't think that SleepyHead is making up the centrals though and if you are for sure that you were asleep during all that ugliness then you need to be getting with your doctor.
Your doctor or DME will be using ResScan though...so we need to see what ResScan shows.

Is your computer a Mac or Windows?

Oh...one other question....did you have a sleep test where you were hooked up to the mask and machine so that they could find suitable pressures?

[palerider]

What happened to the graphs?

there's a very brief session early on, then lots of nothing, clicking that session off in the session list would make things look normal.

[robysue]

Anne,

The leaks are fine for now. They're well below the 24 L/min line that Resmed uses to define a Large Leak.

The Central Apneas, however, are NOT fine. Like Pugsy, I don't think the CAs are a SleepyHead bug. I think they're present in your machine's data. And so I believe they need to be investigated. You only posted one night of data. Are you seeing this kind of Central Apnea activity every night? Or was last night an outlier? Now, if this is just an exceptionally bad night for CAs, that's one thing. But if you are seeing CAs like this on most mights, you definitely need to be getting in touch with your doctor.

It would be useful to zoom in on the hour of data between (roughly) 22:00 and 23:15. If you were for sure fast asleep during that time, something is amiss. On this scale, it looks as though the CAs start to kick in really badly when the pressure hits about 12cm.

Also: You are using a Resmed AirCurve 10 VPAP-Auto, and SleepyHead is obviously having a bit of trouble with some of the summary data in the left side bar. (Probably a SH bug) But one thing that I'm not seeing that I would expect to see is the PS setting on your machine. Also, you say that your prescription is:

I've got the machine on a 15 min ramp, and it's set at 6-20 pressure, as per my prescription.

This is not usually how VPAP-Auto prescriptions are described. Usually there is a PS setting, a min EPAP setting, and either a max IPAP or max EPAP setting. Your data also clearly shows that the min pressure (IPAP? EPAP?) is 10cm in the graph shown and in the summary data, not 6cm. And it indicates you are ramping up from 10cm to about 12 cm in about a 15 minute time. Can you check the settings manually on your machine and let us know exactly how the machine is set up since SH is garbling the settings information in the left sidebar?

[AnnePandora]

Thank you all, so much!

I will check the settings on the machine later -- for now (I'm not near it):

1) I would love to use ResScan but I've been unable to find the links for it.

2) Yep, I had a titration study.

3) Using Windows.

4) Alas, I am having CA's every night; after the first week, American Home Patient called me up and told me to call my doctor and say I'm having a high number of them every night. I did that, and left a message for the doctor. Have not heard anything, but then this is the same place that didn't get my prescription in for two months after the titration study. Tomorrow instead of calling the satellite hospital where I saw my sleep doctor and had my studies, I'll call the main hospital, and try to light some useful fires.

cheers, Anne

[Pugsy]

Okay...you have Windows so that means easy to install ResScan. There is no Mac version available so if you had a Mac we would be doing something differently.

Get a written copy of your titration sleep study. If those centrals are a response to cpap pressure they should have shown up on the titration study. Might be why you were given the AirCurve 10 VAuto....as sometimes that is the first thing they try.
It's also not impossible that you were given the wrong machine...I dunno that happened here but if it did you wouldn't be the first.
Normally for a high central count there is a different AirCurve machine that is used.

Do verify the settings like RobySue asked...I don't know if SleepyHead is whacko or your settings are set up in a manner that doesn't make much sense.
Using ResScan will at least clarify that part. Check your private message box as I sent you a PM with some information on obtaining ResScan.

Come hell or high water.....get written copies of your sleep studies...both the diagnostic (without cpap) and titration (with cpap) and lets see what was documented on those studies and what was recommended.
I say come hell or high water because from what you say about the service you have had so far at the doctor's office....I bet they will drag their feet or put up road blocks.

That's too many centrals to pooh pooh off.

[AnnePandora]

Thank you, Pugsy.

I will download the ResScan.

I'm not looking forward to trying to wrest the prescription from this office, but I will get on it.

anne

[AnnePandora]

Trying again, with data from last night.

My experience is that I slept 8 hours (unheard of! awesome!) and maybe woke up once to adjust the mask. Alas, still having AHI of around 15.

Oh, settings: min EPAP 6.0; max IPAP 20.0; Pressure support 6.0; Ramp time 15.

[Pugsy]

Can you include the Events graph and maybe omit the tidal volume and inspiratory time graphs (they aren't particularly useful)?

I assume mostly Centrals in that AHI of 15?

[Pugsy]

Hey Robysue...what are your thoughts on PS of 6 possibly causing the unstable breathing turning into centrals?
I have seen it with people using 8 to 10 PS but not 6 PS.
If EPR at 3 will do it in a small subset of people then it's definitely possible that PS of 6 could do it but I just haven't seen that many instances of bilevel (or EPR) actually causing centrals. I think I can count them on one hand.

We really need those sleep study results and need to know why they jumped to the AirCurve right off the starting line.

[AnnePandora]

Here's a screen shot with the different information, oh, kind kind human.

and update: the doctor left the information (this info wasn't sent to me; I had to call to get it) that if I'm sleeping well, having energy, and not waking up -- and these things are all true -- then the central events aren't a worry.

The prescription can be got if I go over to the sleep clinic in person and sign up for the "patient portal." So I'll do that when I can.

[Pugsy]

I forgot..one more graph...the pressure graph so we can see the pressure status relative to the Events graph.
The AHI graph (right under the Events graph) isn't useful so it can be omitted. That's just an hourly visual and we already know it is ugly.

Interesting that there is some significant clustering at times and times where not much is going on.
Would be useful to see what the pressure was doing during those times.

Do you sleep on your back at all?

[AnnePandora]

Ok. I post another screen shot!

I swear, I am going to get this right.

anne

[AnnePandora]

Oh, sorry, and there was another question --

I hate to sleep on my back, but I apparently do it sometimes.

anne