Last night's sleepy head data- # CA's okay?

[Pugsy]

If most of my night's looked like last night then I would start probably with 1 cm more minimum.
If last night's results were more of a fluke and I didn't see that sort of results except rarely then I might wait a few more nights (since you admit to recent new changes) to see if this sort of result was going to be a trend or not.

I don't know if more pressure will help with the Flow limitations or not. Sometimes it does and sometimes it doesn't and FLs don't always need to be reduced. I do think it is worth at least trying.

If the AHI was a lot higher I would be more aggressive with the pressure changing but that's just me. I tend to be rather cautious unless there's a clear cut indication where the therapy is grossly sub optimal and this report from last night doesn't meet that criteria at least for me.

If you didn't sleep well last night then the fact you didn't sleep well could be responsible for maybe not feeling so great today. Doesn't mean that this AHI is responsible for not sleeping well though. Not sleeping well could be from a new mask or comfort or leaks or whatever.

In other words I look at more than just numbers before I do anything unless the numbers are grossly bad and yours aren't IMHO.

[Wonderbrah]

Okay, thank you guys for all the input. I raised the minimum to 12.0 last night. Here's the data for that:

http://imgur.com/a/o8HZl

Should I go even higher? Still a lot of hypopneas.

[Pugsy]

I don't like to change pressures nightly based on last night's results unless the results were horrible.
Your Hyponea index last night was 1.65...and that's not a horrible number.

I would suggest you give it at least 2 or 3 more nights and see what happens.

[Wonderbrah]

Okay, hopefully you guys can figure out what the hell went wrong here.

https://imgur.com/a/mLqwS

Took a few hour nap and woke up with a 9.22 AHI. The event flag section actually looks kind of clean so I was surprised at such a high AHI number but that's what it says. I raised the pressure to 14-20 for this.

It seems like I'm having obstructive's and hypoponea's even at the max pressure...

[palerider]

Okay, hopefully you guys can figure out what the hell went wrong here.

https://imgur.com/a/mLqwS

Took a few hour nap and woke up with a 9.22 AHI. The event flag section actually looks kind of clean so I was surprised at such a high AHI number but that's what it says. I raised the pressure to 14-20 for this.

It seems like I'm having obstructive's and hypoponea's even at the max pressure...

too short a time period to bother thinking about.

[Guest]

Let's say you slept for 80 min and had 12 events during that time
divide 12 by 80 times 60 to get the avg/hr (12/80)*60 should be close to what is shown in your graph
The longer you sleep the better (lower) the avg normally works out

[Wonderbrah]

Okay so what happened here.

https://imgur.com/a/ey56U

pressure 15-20

[Pugsy]

Looks like you had a horrible night's sleep last night with a lot of wake ups and I am betting arousals that you may or may not remember that aren't shown because you didn't turn the machine off with every one of them.
Is that true?
Now why it happened....that's a good question that there's not likely to be an answer to unless you have a known reason for simply not sleeping well..like pain or something like that..or cat fights outside your window...or loud neighbors.

[Wonderbrah]

Looks like you had a horrible night's sleep last night with a lot of wake ups and I am betting arousals that you may or may not remember that aren't shown because you didn't turn the machine off with every one of them.
Is that true?
Now why it happened....that's a good question that there's not likely to be an answer to unless you have a known reason for simply not sleeping well..like pain or something like that..or cat fights outside your window...or loud neighbors.

I actually thought I slept quite well last night to be honest. So 15-20 pressure is "a-okay" in your book? I should just give it a few more nights and see how the data turns out?

[robysue]

Okay so what happened here.

https://imgur.com/a/ey56U

pressure 15-20

You had a bad sleep night. But you knew that already

But more seriously, what I mean by bad sleep goes beyond the elevated AHI. You woke up enough to turn the machine off and back on four times and one of those wakes was over 30 minutes long. And it looks to me like you spent a significant amount of time tossing and turning during this night. My guess is that you were bouncing back and forth between SLEEP and WAKE. And my guess is that much of the sleep was Stage 1 or Stage 2. In other words, it's possible that a lot of these events are sleep-wake-junk events that may or may not be "real" in the sense of whether they'd be scored on a PSG. The large number of CAs could be explained by difficulty getting through the WAKE-to-Stage1-to-Stage2 transition if you were doing a lot of tossing and turning. It's also possible that since you are still pretty new at PAPing, that you are still in the stage of learning how to sleep well with your equipment.

A couple of questions:

1) You started out using a pressure of min pressure setting of 9cm and the one night of data that you posted with those settings (at http://i.imgur.com/WnVZbDC.png) had an AHI = 2.4, which is actually quite good. Since increasing the pressure, has your AHI ever been as good as that night that you posted with min pressure = 9cm and an AHI = 2.4?

2) Since increasing the pressure how would you rate the subjective quality of your sleep? Is it taking longer to get to sleep? Are you waking up more frequently than before you increased the pressure? Are you having a harder time getting back to sleep when you do wake up?

In other words, I would question why you increased the pressure in the first place. And if your subjective quality of sleep has gone down since you increased the min pressure from 9cm to 15cm, I would recommend that you back off on the pressure increases. In addition if you've been changing the settings every couple of days, I'd recommend picking the setting that gave you the best sleep in terms of subjective quality (i.e. how you actually feel rather than what the AHI is) and I'd stick with those settings---regardless of how good/bad the AHI is. And then I'd use those settings for at least a full week or two before evaluating whether a min pressure increase is warranted are not.

In other words, at this stage your goal should be getting a good night's sleep in terms of as few wakes as possible during the night.

[robysue]

Looks like you had a horrible night's sleep last night with a lot of wake ups and I am betting arousals that you may or may not remember that aren't shown because you didn't turn the machine off with every one of them.
Is that true?
Now why it happened....that's a good question that there's not likely to be an answer to unless you have a known reason for simply not sleeping well..like pain or something like that..or cat fights outside your window...or loud neighbors.

I actually thought I slept quite well last night to be honest.

How many of the wakes where you turned the machine off and back on do you actually remember?

So 15-20 pressure is "a-okay" in your book? I should just give it a few more nights and see how the data turns out?

Has the overall subjective quality of your sleep gone UP or DOWN since you increased the pressure from 9-20 to 15-20?

[Pugsy]

You may have thought you slept well last night but why the at least 4 breaks in therapy when you obviously turned the machine off and most people have to be awake to turn it off and back on again.
Those alone would make me classify the sleep quality as being in the toilet for the night.
Something is waking you up...what is it?

RobySue makes some good points. I have actually forgotten why the increases....were you chasing a lower AHI or better sleep? I don't have time to go back and read all the past pages to refresh my memory...sorry.

[Wonderbrah]

I remember the fourth break (the longest one) but not the others. I don't remember why I woke up, just that I took my mask off, whipped out my laptop and fell asleep without putting it back on. Luckily it was only for a short time because I woke up I think 30 minutes later and put my mask back on. The pressure increases were to chase lower OA's, H's and AHI but the opposite has happened since I've started the increases. I'll go back to 9-20 for a time and reevaluate I guess.

[Pugsy]

I will let RobySue explain why bringing out the laptop in bed after a wake up is a bad habit.
Aside from the obvious danger of falling back to sleep without the mask being on.

It would also be helpful if you could answer each of her questions. We don't ask questions without a good reason and the reason is that it enables us to know more history so that we can hopefully offer better ideas to help.
I don't know about her but it really frustrates me when I ask specific questions and I don't get answers to each of them.

[Wonderbrah]

Okay so what happened here.

https://imgur.com/a/ey56U

pressure 15-20

You had a bad sleep night. But you knew that already

But more seriously, what I mean by bad sleep goes beyond the elevated AHI. You woke up enough to turn the machine off and back on four times and one of those wakes was over 30 minutes long. And it looks to me like you spent a significant amount of time tossing and turning during this night. My guess is that you were bouncing back and forth between SLEEP and WAKE. And my guess is that much of the sleep was Stage 1 or Stage 2. In other words, it's possible that a lot of these events are sleep-wake-junk events that may or may not be "real" in the sense of whether they'd be scored on a PSG. The large number of CAs could be explained by difficulty getting through the WAKE-to-Stage1-to-Stage2 transition if you were doing a lot of tossing and turning. It's also possible that since you are still pretty new at PAPing, that you are still in the stage of learning how to sleep well with your equipment.

A couple of questions:

1) You started out using a pressure of min pressure setting of 9cm and the one night of data that you posted with those settings (at http://i.imgur.com/WnVZbDC.png) had an AHI = 2.4, which is actually quite good. Since increasing the pressure, has your AHI ever been as good as that night that you posted with min pressure = 9cm and an AHI = 2.4?

2) Since increasing the pressure how would you rate the subjective quality of your sleep? Is it taking longer to get to sleep? Are you waking up more frequently than before you increased the pressure? Are you having a harder time getting back to sleep when you do wake up?

In other words, I would question why you increased the pressure in the first place. And if your subjective quality of sleep has gone down since you increased the min pressure from 9cm to 15cm, I would recommend that you back off on the pressure increases. In addition if you've been changing the settings every couple of days, I'd recommend picking the setting that gave you the best sleep in terms of subjective quality (i.e. how you actually feel rather than what the AHI is) and I'd stick with those settings---regardless of how good/bad the AHI is. And then I'd use those settings for at least a full week or two before evaluating whether a min pressure increase is warranted are not.

In other words, at this stage your goal should be getting a good night's sleep in terms of as few wakes as possible during the night.

1.) The best AHI I've had is with pressure set to 9-20

2.) To be honest, sleep quality feels the same to me between 9-20, 15-20 or anywhere in-between. I can't specifically peg a different between pressure settings. In terms of comfort 15 is no less comfortable than 9, starting out. I don't remember any awakening in regards to last night except the fourth one. I wouldn't say it's unusual for me to wake up in the middle of the night, regardless of pressure. When I take melatonin I think I'm more likely to sleep throughout the night but last night I did not. I'm trying to cut that habit because it makes me drowsy in the AM. I don't have a hard time getting back to sleep regardless of pressure either.

So subjective quality of sleep has not changed regardless of pressure but I think the objective sleep considering the data has.