Interpreting Sleepyhead results

[hbeardave]

Hi all,
I've been using my Resmed S9 for quite a while, and I thought I had been getting pretty decent results (Machine reported AHI usually 2 or below).
I just recently installed SleepyHead and imported data.

I'm assuming SleepyHead must calculate AHI very differently from the machine.
The the older night's data has no detail stats, but Sept 6, I had AHI of 0.89, while Sept 7 and beyond (with the detail data) shows AHI around 14. (Aaack!)
Same settings.
Without details: low AHI. With details: high AHI.

I've bumped up the low end pressure over a couple weeks from 7.4 up to 9.4. Last night's AHI was about 9. I'm hoping I can get it lower.

Not sure if I should try bumping the low end even higher, or am I having a lot of central apnea?
3 graphs below.
Thanks!

[Pugsy]

SleepyHead needs the files that are missing and the reason you don't have the detailed graphs and that's why the AHI might not match what is on the machine LCD screen.
SleepyHead needs the missing files to do an accurate calculation for AHI reporting. On the nights where there are no detailed graphs the AHI isn't going to match the machine.

Your SD card MUST be in your machine each night and all night or you won't get the detailed graphs.
If you don't get the detailed graphs the AHI shown in SleepyHead probably won't match what is shown on the machines LCD screen.

You have a S9 machine and you MUST download at least once a week or the old detailed data files get written over and probably explains why you have missing detailed graphs nights.

Do you have copies of your sleep study results?
The diagnostic sleep test???? If not, get it.
Did you have an in lab sleep study with cpap for them to find an accurate pressure? If so, get a copy of that sleep study result also.

Do you take any medications that might suppress respiration particularly pain meds?

Are you sleeping soundly for the most part or are you spending prolonged periods of time awake with mask and machine on?

How long have you been on cpap therapy?

[hbeardave]

SleepyHead needs the files that are missing and the reason you don't have the detailed graphs and that's why the AHI might not match what is on the machine LCD screen.
SleepyHead needs the missing files to do an accurate calculation for AHI reporting. On the nights where there are no detailed graphs the AHI isn't going to match the machine.

Your SD card MUST be in your machine each night and all night or you won't get the detailed graphs.
If you don't get the detailed graphs the AHI shown in SleepyHead probably won't match what is shown on the machines LCD screen.

You have a S9 machine and you MUST download at least once a week or the old detailed data files get written over and probably explains why you have missing detailed graphs nights.

Do you have copies of your sleep study results?
The diagnostic sleep test???? If not, get it.
Did you have an in lab sleep study with cpap for them to find an accurate pressure? If so, get a copy of that sleep study result also.

Do you take any medications that might suppress respiration particularly pain meds?

Are you sleeping soundly for the most part or are you spending prolonged periods of time awake with mask and machine on?

How long have you been on cpap therapy?

Thanks Pugsy,
Yes, I know that the S9 doesn't keep the details beyond a week. This was the first time I had imported data from the machine. I only have details from Sept 7 forward.
Looking more closely, I do see that the values in SleepyHead do match (at least for last night, and last month). I guess I thought that SleepyHead would be able to pull the AHI from the older data without the details. I don't know what it's using to calculate.

My initial sleep study was... I think... about 20 years ago, and I went on normal CPAP at 7.5.

I had another lousy study about 10 years ago where they just wired me up and had me go to sleep... they didn't do anything with a CPAP to find a pressure.
They just documented that I had some OSA. Surprised me that they didn't titrate to find a pressure, but at that point, I just needed an updated prescription to be able to buy a new machine to replace a dead one and have insurance help with cost.
I do not have access to details of either study.

I'm kind of on my own with the settings. S9 purchased from CPAP dot com. I have thought I've been doing pretty well on the system (my wife has been happy with no snoring), but the recent data shows high AHI.

You mentioned pain meds... and yes... I do have a relatively low dose with a continuous delivery patch. So, I suppose that could be causing central apnias.
I've been on that for about 6 months for chronic migraine while they try to find another treatment that might lessen the constant headache pain.

Perhaps I need to track down a reputable place for a new sleep study. I'm not sure I can convince my insurance carrier to cover it.

hbear

[Pugsy]

The machine stores the summary data on the machine so SleepyHead is picking up the summary data but it's not 100% going to match the machine LCD if those other files aren't also available.

It would have been really interesting to see the detail data for that night with the AHI of 0.89.
You were using EPR of 2 which would be the same as Pressure Support of 2.

Since you are pretty much on your own how about trying Pressure Support of 2 and let's see if the centrals reduce with less pressure support. The people who have centrals just because of Pressure support are in a very small minority but you might be one of those and it wouldn't hurt a thing to try PS of 2 instead of 4.
Like minimum EPAP of 8 and PS of 2 and see what happens. You can leave the max IPAP where it is now.

If you really do have complex sleep apnea brought on by cpap pressure and/or your pain meds then you should be talking with your doctor about the centrals.

I would try reducing PS first...won't hurt anything to try and it might just work a miracle. I have seen it happen so I know it can happen.

[hbeardave]

Thanks so much.
The weird thing about the AHI 0.89 is that ALL of the nights that only have summary data have AHI around 1 or less, while all of the nights WITH details have the significantly higher AHI numbers without any change in the treatment settings. I slowly started ramping up pressure to 8.4 then to 9 then to 9.4 to see if that would reduce AHI.

If I'm understanding you correctly, when you say "Pressure Support", you're referring to the EPR setting?
That has already been at 2 this entire time. I don't see where you see info that it went to 4.
In SleepyHead, Sept 6 Pressure/EPAP were 7.4 & 5.4
Sept 7 was the same
Last night's Pressure/EPAP were 9.4/7.4 (EPR still set to 2).

Perhaps I should try EPR of 1?

Really appreciate your assistance. Yes, if things don't improve dramatically, I'll find a competent sleep Dr.

[Pugsy]

Sorry. Brain fart. I swore I saw a difference of 4 cm between EPAP and IPAP somewhere.

Do you have a Windows computer? If so let's get you ResScan so you can see for sure what the AHI is on those nights with no detailed graphs.
You can go here and read how to request it via email.
http://www.apneaboard.com/adjust-cpap-p ... tup-manual
Just scroll down till you see the list of ResMed manuals available and there is a line with instructions on how to get ResScan.
ResScan won't have a problem with the summary only numbers that SleepyHead does.

When did the centrals start? Was it about the time you put the pain meds patch on?

[TedVPAP]

Hi all,
I've been using my Resmed S9 for quite a while, and I thought I had been getting pretty decent results (Machine reported AHI usually 2 or below).
I just recently installed SleepyHead and imported data.

I'm assuming SleepyHead must calculate AHI very differently from the machine.
The the older night's data has no detail stats, but Sept 6, I had AHI of 0.89, while Sept 7 and beyond (with the detail data) shows AHI around 14. (Aaack!)
Same settings.
Without details: low AHI. With details: high AHI.

I've bumped up the low end pressure over a couple weeks from 7.4 up to 9.4. Last night's AHI was about 9. I'm hoping I can get it lower.

Not sure if I should try bumping the low end even higher, or am I having a lot of central apnea?
3 graphs below.
Thanks!

I am still confused.
I am not familiar with your machine. To get detailed data instead of just summary, is there a setting that controls this?
When looking at the detailed data with SH, do the high AHI numbers reported by SH match what the machine LCD screen says?
If they match then it means that the machine and SH calculations are consistent. This means that your therapy either degraded since you started increasing pressure or the Resmed machine calculates AHI differently when in detail mode.

[Pugsy]

To get detailed data instead of just summary, is there a setting that controls this?

No. Unfortunately not.

I have a S9 machine and it overwrites data fairly quickly. 7 days for the high def data (the graphs) and 30 days for some other data.
So if someone just gets SleepyHead now and they have months of data they won't have anything in terms of graphs over 7 days from now.
Sleepyhead isn't 100% accurate without the detailed data files (ResScan is which is why I suggested ResScan) but I don't think it is this far off in terms of accuracy but let's look to see what ResScan says for those old nights where graphs aren't available (they won't be available in ResScan either.

When looking at the detailed data with SH, do the high AHI numbers reported by SH match what the machine LCD screen says?

There's no way to go back on the S9 LCD screen to see what the machine reports on the LCD screen for those nights where the AHI is low and no detailed data available.
The current data with the detailed graphs available is going to match what the LCD screen shows.

The problem is SleepyHead needs some files that aren't available when the file gets written over.
The newer AirSense machines don't write over the files for a year so that issue has been corrected with the new models.
We have noticed in the past that when the detailed graphs aren't available that the AHI reported by SleepyHead doesn't always match what is on the screen (by people seeing it the same day so they know what the AHI breakdown is from the LCD screen) .
It was never this far off though...maybe 1 or 2 difference...like the machine might show 2.2 and SH might show 3.2.

[TedVPAP]

To get detailed data instead of just summary, is there a setting that controls this?

No. Unfortunately not.

I have a S9 machine and it overwrites data fairly quickly. 7 days for the high def data (the graphs) and 30 days for some other data.
So if someone just gets SleepyHead now and they have months of data they won't have anything in terms of graphs over 7 days from now.
Sleepyhead isn't 100% accurate without the detailed data files (ResScan is which is why I suggested ResScan) but I don't think it is this far off in terms of accuracy but let's look to see what ResScan says for those old nights where graphs aren't available (they won't be available in ResScan either.

When looking at the detailed data with SH, do the high AHI numbers reported by SH match what the machine LCD screen says?

There's no way to go back on the S9 LCD screen to see what the machine reports on the LCD screen for those nights where the AHI is low and no detailed data available.
The current data with the detailed graphs available is going to match what the LCD screen shows.

The problem is SleepyHead needs some files that aren't available when the file gets written over.
The newer AirSense machines don't write over the files for a year so that issue has been corrected with the new models.
We have noticed in the past that when the detailed graphs aren't available that the AHI reported by SleepyHead doesn't always match what is on the screen (by people seeing it the same day so they know what the AHI breakdown is from the LCD screen) .
It was never this far off though...maybe 1 or 2 difference...like the machine might show 2.2 and SH might show 3.2.

Thanks for the clarification. It seems like the OP's SA got bad quickly (he did mention increasing pressure) or something is wrong with the report. Either way - interesting.

[hbeardave]

I don't think the SA changed that significantly. Looking at day-after-day AHI for nights where no detail is available is where SH shows the low AHI.
Day-after-day starting on the first day of detail data, the AHI jumps way up.
I think it must be in the way the SH calculates AHI when the detail data is not there.

I wish I had been collecting data long ago now... I had no idea things were going this poorly in my sleep.

Just downloaded ResScan software .. It will take a bit to figure out what's going on.
The older data (without the details) shows AHI values 3-6 (where SleepyHead showed less than 1).
Something crazy went on in August with AHI values shooting up into high teens and sometimes 20s.
Back down to 8-11 right now, but mostly tagged as Central Apneas... so I'm going to try reducing EPR to 1.

hbear

[Pugsy]

Let's see if changing EPR helps anything or not.
Increasing the pressure won't help because more pressure can't fix centrals and might be making things worse if there is a line of pressure where more pressure triggers the unstable breathing resulting in the centrals.

Odd that things were going along decently and then just up and went all to hell fairly recently.

I can't help but wonder if the pain patch isn't playing a part in things even though you say you have had it 6 months and the problems seemed to start in Aug with your sleep apnea high number of centrals.

There's some things we can try to sort it out though. Don't know if we will be successful but there's a couple of things we can do.

[hbeardave]

I was hoping for a better night last night with new settings, but power went out at 11pm and is still out today.
I do have a marine battery and inverter to run the S9 through power outages, but I realized that it was not fully charged, and it gave out around 4am (after several blinks of electricity on/off, causing all sorts of beeps in the house).

So today will be a groggy day.
Not sure if they will get things fixed by tonight.
We've got crazy fires going on here in the Napa Valley.

dbell

[Pugsy]

Stay safe.

I was thinking about you today and come up with a couple more ideas to try if reducing EPR doesn't help.

[SleepyFinger]

hbeardave,

Just a quick fyi...I've been using Sleepyhead for some time. I have a lot of Centrals, like you appear to have. When I look at my history, any time I only have summary data available, the Centrals are drastically lower on those days in SH. If I look at the same days on ResScan the reported AHI is much higher. So it must be the way SH is calculating the AHI.

Best thing I did was to get the wireless Toshiba card so I don't have to pop out the SD card anymore. I can just download directly to my pc when I'm down there.

Stay safe among the fires!!

[hbeardave]

Thanks, SleepyFinger. I'm sure you're right about SleepyHead missing the centrals on the non-detail days.

I dropped pressure to 8, and dropped EPR from 2 to 1.
First night, inconclusive, since power was going off & on (ending on Off) due to the windstorms that caused the fires in Northern CA.
Last night I ran on battery. Results somewhat better than average, but still encouraging. Mostly the Central value going down.

Will stick with this for a week or two and see what we get.