Newb - Help with My Sleepyhead Reports

[jwjeffrey]

Thank you so much in advance for helping me interpret my data. I am very thankful for this forum and community.

I took a home sleep test fall of 2017 to discover that I had mild OSA, having felt symptoms for over the past decade of morning lightheadedness/headache (feeling like I was holding my breath when I wake up), heart banging, and daytime fatigue, regardless of how much I'd sleep. I was excited to try out CPAP therapy and have been on therapy for about 6 weeks. However, despite getting AHI scores of ~2.0 on average and scoring 98-100% on Resmed's "myAir" app (I dont have major leakage issues I dont think?), I realized that my sleep problems have not gotten any better over the past 6 weeks. In fact, I think I may be feeling even more tired during the day. A good friend of mine who is also on CPAP mentioned a 50% energy boost in his 1st month, something I've surely not felt.

A few of my learnings and observations so far that may provide helpful context:
1. My sleep test noted I sleep on my back ~60% of the time (I have no preference for back or side-sleeping, I do both). Do any back-sleepers have advice on transitioning to side-sleeping effectively?
2. My jaw drops when I sleep (I know this because of morning drool). To combat this, I purchased a chin strip (CareFusion Puresom Ruby Chinstrap), which is somewhat effective. Any advice on how to solve for jaw drops?
3. I have experimented with different masks and have most enjoyed the Resmed Airfit P10 (pillows). However, because of my jaw drop problems, I have been using the Respironics Amara view full-face mask + chin-strap. Any recs on other masks to try?
4. I normally sleep straight through the night, but ever since I started CPAP, I wake up once a night (usually its because of mask leak causes air to blow on my face). This has gotten better over time and now I can more often sleep straight through
5. I left out "Snore" in my sleepyhead data since its pretty much blank
6. When I look at my sleepyhead data, I dont see any consistent pattern among event types. i.e. one day CA causes the majority of the events, the next day its OA, and the next could be RERA. I know every night of sleep is different, but there should be a predictable pattern right?
7. Do I have a minimum/maximum pressure problem? After looking at other folks' sleepyhead charts, I notice I have pressure spikes that are pretty wacky. Ideally, the pressure chart is supposed to be somewhat "flat-line"?
8. After several months of effort dealing with my sleep specialist/DME, finally getting the device, and experimenting for 6 weeks, I am feeling a bit discouraged..Despite getting low AHIs which are supposed to be in the normal range, why do I feel no better? even when I get about 8 hrs of sleep a night
9. Has anyone tried an elevated pillow? or a sleep apnea pillow? Do those work/help?

I'd really appreciate any feedback on my observations/questions, any insights as to what's going on with my sleep per Sleepyhead, and any advice on how to improve my therapy. Thank you again for your time and help; I'm very grateful for all of your collective wisdom.

These Sleepyhead images below (past 3 nights) are with my using: Resmed Airsense 10 Autoset with heated humidifier, pressure range 7-12, Respironics Amara View mask (full-face) + CareFusion Puresom chin-strap https://www.cpap.com/productpage/respir ... -mask.html. Happy to add additional images if helpful.

Last night (1/5/18)


Thurs 1/4/18


Wed 1/3/18


Summary Stats

[Julie]

Things look pretty good (on paper) but if you don't feel better then you need to look other places. Btw, My Air is next to useless, so don't pay it much attention.

I would try a soft cervical collar to keep your head up, with or without the strap. And try to stay off your back if at all possible overnight - there are various tricks to use to help train you to not flip.

I also wonder if you've had other labs, etc. recently to see what else might be going on aside from OSA (if anything) to explain how you feel... maybe talk to your GP. You could try raising the min. pressure 1-2 cms for a couple of nights to see if it helps as well, 7 is still not that high as things go.

[USMCVet]

Try bumping your max up to 15. I see your maxing it out a few times.

I'm new to this as well and if it weren't my one night of not using it because of rain out I wouldn't of know how much it helps. Have you tried a night without it to see how that makes you feel in morning?

[ajack]

You are getting too many leaks with that mask, I would look at mask fit videos on youtube and find the mask fit function on your machine, where it will blow a higher pressure for a while, as you fit it.
you actually have a very tight pressure range, it is just that it looks large on the chart. you could keep the pressures where they are for now. Or raise the min to 8 to be closer to the Med/median number and lift the max to 15, in case you have a bad night and need it.

[jwjeffrey]

Thank you, below is the image from last night with leaks somewhat all over the place. Im very surprised at the leaks since last night, I purposely switched to the Airfit P10 (nasal pillows) which I find most comfortable and dont have any issues with. I did NOT use a chin strap though. Looks like the leak-rate is somewhat correlated with the pressure changes. Is that evidence of my jaw dropping? I dont think the mask came loose, since this mask fits very snug.

I will try a few more nights with a tightened chin strap + increase my pressure range to 9-15, and post some more images. Thanks for any feedback

Last night 1/6/18

[Oltremare]

Just a small detail.
You say you use a full face mask but in your last report your APAP is set for nasal pillows.
I suggest you check.
Maybe I would raise a little the maximum pressure but, I'm not an expert.

Hello,
Oltremare

[TedVPAP]

You are getting too many leaks with that mask, I would look at mask fit videos on youtube and find the mask fit function on your machine, where it will blow a higher pressure for a while, as you fit it.
you actually have a very tight pressure range, it is just that it looks large on the chart. you could keep the pressures where they are for now. Or raise the min to 8 to be closer to the Med/median number and lift the max to 15, in case you have a bad night and need it.

Agree. I would set the min to 8 and the max to 15 and report back after a week.

[Pugsy]

Looks like the leak-rate is somewhat correlated with the pressure changes. Is that evidence of my jaw dropping? I dont think the mask came loose, since this mask fits very snug.

Did you wake often with any of the leaks you are seeing? Event the ones that don't hit Large Leak territory?

My leak graphs aren't always real pretty but as long as I sleep through the ugly part and the ugly part isn't deeply and prolonged in large leak territory I don't really care if they aren't real pretty.

Mask movement leaks can happen and look just like mouth breathing/jaw dropping leaks. I know this for a fact because I had occasion to tape my mouth one night last summer when I was seeing some really big ugly leaks and wanted to know for sure if it was mouth opening or mask movement leaks.
With lips totally sealed the leaks were still ugly and the only remaining culprit was mask movement.

[jwjeffrey]

Looks like the leak-rate is somewhat correlated with the pressure changes. Is that evidence of my jaw dropping? I dont think the mask came loose, since this mask fits very snug.

Did you wake often with any of the leaks you are seeing? Even the ones that don't hit Large Leak territory?

Yes, I wake up almost every night because the leak wakes me up. Maybe I'm getting bad sleep because I wake up every night? My jaw is still dropping despite my wearing the chin-strap, which is frustrating (I can tell because I wake up with drool). Are there any chin-straps that have been particularly effective for folks?

I have been alternating between Amaraview full-face mask and the Airfit P10 pillows, so some of my sleepyhead reports will show one or the other.

I called my doc to change the pressure range to 9-15 to try out.

[Pugsy]

Maybe I'm getting bad sleep because I wake up every night?

Some wake ups are just a normal part of sleeping...but normally we don't remember them because they are so short lived.
When we can remember a number of wake ups then we can usually assume a few wake ups that we don't remember most likely occurred and the wake ups themselves obviously impact overall sleep quality and sleep architecture in general. The body needs the nice normal progression of all those sleep cycles in the needed percentages for the magic of restorative powers of sleep to work.

It's normal to wake after a REM sleep stage and sometimes we vaguely remember it and sometimes we don't.

Now when we can remember a lot of wake ups because of something...like leaks...even teeny tiny leaks then we know that the leaks are most likely causing the wake ups and thus unwanted (no matter how big or little they might be).
If you told me that leaks never woke you up then I don't know that I would worry about what little large leak is shown on your report.

But you mention it so we know it is a problem because leaks are disturbing sleep and anything that disturbs sleep is unwanted.

Chin straps...for mouth breathing reduction and to lessen the chance of loss of therapy are an option but as with any option they come with their own baggage and they don't always work so great for keeping that mouth closed anyway. They are supposed to be gentle reminders for the jaw to stay closed but they shouldn't be so tight (actually they can't be that tight) to act as a vise grip to clamp the jaw shut. I can clamp my jaws shut right now but part my lips and mouth breathe just fine.

Some folks have tried various chin straps and found them to be reasonably effective in preventing major mouth opening but it won't/can't necessarily prevent mouth breathing. Remember I can clamp my teeth together and still mouth breathe just fine.
So chin straps can work well for some people but not necessarily all people. You are going to find that pretty much everything related to cpap therapy comes with a big YMMV sticker. What works well for one person doesn't always work so well for the next person.

Early on in my therapy I saw evidence of some mouth breathing but my nose was fine...so it was out of habit probably and not a physical need to mouth breathe because of nasal congestion. I tried various ways to keep my mouth shut but found that most of those ways (like chin strap) caused more sleep disruptions or wake ups than the leak was causing a problem. I opted to tape my lips shut for a while because it was the least annoying or sleep disrupting of the various things I tried.

Please note if you are mouth breathing out of a physical need because the nose is clogged up and you can't unclog it...use a full face mask.

It doesn't sound like whatever chin strap you are using is preventing the mouth from opening and that mouth opening is disrupting your sleep.
I don't know if a different chin strap would yield different results...people do have varying degrees of success with the various different chin straps available.
I think you might benefit from an experiment with a Scunci because it kind of does two things..helps with the jaw drop but also helps keep those lips closed and it doesn't have to be so god awful tight you feel like your head is in a vise....and it's a cheap experiment.

See this thread about Jay's Scunci results. His post with pictures is down towards the bottom of the page.
viewtopic.php?f=1&t=112758#p1086296
As with anything cpap related...big YMMV sticker.

For myself I found that after about 3 months of taping my mouth that for the most part my mouth stayed shut on those nights where I would "forget" to tape and eventually I just abandoned taping and allowed a less than pretty leak graph to happen as long as I was sleeping through whatever leaks I was seeing. Your large leak times...aren't horrible and if you weren't complaining of any leaking waking you up I would say just let your sleep quality be the deciding factor.

[crtrun]

WIll the SleepyHead Software work with Windows 10.

Thanks

[Pugsy]

WIll the SleepyHead Software work with Windows 10.

Yes but only on cpap machines that use a SD card (Respironics, ResMed, F & P and Devilbiss)...so if you have an older machine that uses a smart card it won't work because SleepyHead only works with SD card machines..

I use a Windows 10 computer and SleepyHead works fine with it.