Another New User- Need help understanding data- Sleepy Head

[zbuquet]

So I am going to VA tomorrow to hopefully have them look over my data, but wanted to learn more myself and found the sleepy head software.

Any help understanding what this means would be helpful.

Have been using for about 30 days, but feel more tired than before I started using CPAP. Most days I cant ever seem to feel awake, or it may take hours to finally feel half alive.

here is data from Last Tue which seems to have alot of events... Is this normal? 33 year old Male

Not sure how to add images on this site.

Here are the numbers


Philips Respironics
System One 450P
RemStar Pro with C-Flex+
Date Sleep Wake Hours
11/23/2011 00:20 09:26 09:05:4

AHI 10.6
Hypopnea 5.61
Obstructive 1.21
Clear Airway 3.85


Events

Clear Airway Apnea 35
Hypopnea 51
Obstructive Apnea 11
Pressure Pulse 98
Chyene Stokes Resp 3 events

[Pugsy]

Easiest way to add image is a screen shot of the report, saved it as jpeg file and upload to photo hosting site.

Here is how I do it.

Open the image to full size so it is easily read.
I use Vista snipping tool to create a screen shot and crop the image at the same time.
Prt/scr key will also take a screen shot if using XP. If laptop is used sometimes the Fn key has to be pushed at the same time as the prt/scr key
I think windows 7 Home Premium has the snipping tool, Basic may not.
Once the screen shot is created save it in jpg format.
Upload the image to a host site. I use Photobucket it is free, there are others.
Once the image is uploaded then copy the ENTIRE IMG address. Be sure to include the opening and closing IMG in brackets. Paste that copied address into a post here.
Use the preview button. If you can't see the image try again because if you can't see it we can't.

[robysue]

Comments about your data are listed in RED.

So I am going to VA tomorrow to hopefully have them look over my data, but wanted to learn more myself and found the sleepy head software.

Any help understanding what this means would be helpful.

Have been using for about 30 days, but feel more tired than before I started using CPAP. Most days I cant ever seem to feel awake, or it may take hours to finally feel half alive.

here is data from Last Tue which seems to have alot of events... Is this normal? So the data below is just for Tuesday night?
33 year old Male

Not sure how to add images on this site.

Here are the numbers


Philips Respironics
System One 450P
RemStar Pro with C-Flex+
Date Sleep Wake Hours
11/23/2011 00:20 09:26 09:05:4
For the night that started on 11/23 (and ended on 11/24) you went to bed at 12:20AM, woke up at 9:26AM, and used the machine for a grand total of 9 hours, 5 minutes, and 4 seconds

AHI 10.6
During the 9:05:04 hours of usage, the machine detected an average of about 10.6 apneas and hypopneas per hour of run time. Note that AHI = (number of events detected)/(usage time in hours).

Hypopnea 5.61
During the the 9:05:04 hours of usage the machine detected an average of about 5.61 hypopneas per hour of run time. Note that the hypopnea index is computed as HI = (number of hypopneas detected)/(usage time in hours)

Obstructive 1.21
During the the 9:05:04 hours of usage the machine detected an average of about 1.21 obstructive apneas per hour of run time. Note that the hypopnea index is computed as OAI = (number of obstructive apneas detected)/(usage time in hours)

Clear Airway 3.85
During the the 9:05:04 hours of usage the machine detected an average of about 3.85 obstructive apneas per hour of run time. Note that the hypopnea index is computed as CAI = (number of clear airway apneas detected)/(usage time in hours). Also note that clear airway apneas are typically assumed to be central apneas---i.e. the problem is that you were making no effort to breathe, not that a collapsed airway was preventing air from getting down to your lungs in spite of an effort to breathe.



Events

Clear Airway Apnea 35
During the the 9:05:04 hours of usage the machine detected a total of 35 CAs. Note that 9:05:04 of run time is equal to 9.083 hours of run time. And note that 35/9.083 = 3.85

Hypopnea 51
During the the 9:05:04 hours of usage the machine detected a total of 51 hypopneas. Note that 9:05:04 of run time is equal to 9.083 hours of run time. And note that 51/9.083 = 5.61

Obstructive Apnea 11
During the the 9:05:04 hours of usage the machine detected a total of 11 OAs. Note that 9:05:04 of run time is equal to 9.083 hours of run time. And note that 11/9.083 = 1.21

Pressure Pulse 98
During the the 9:05:04 hours of usage the machine detected a total of 98 Pressure Pulses. A pressure pulse is a rather short burst of higher pressure that the System One uses to determine the patency of the upper airway. Typically any time the machine has detected no or almost no airflow in/out of the lungs for about 6 seconds or so, it will send out a PP in order to determine whether the airway is open or closed. So it's possible to have PP's without an apnea being flagged if you stopped breathing for 6-9 seconds and the pause in breathing is too short for the machine to mark it as an apnea. The machine will also send out multiple PP during long apneas to continue to measure the patency of the airway. So if you have a particularly long apnea, there will be numerous PPs. You can also see multiple PPs right before something my DME insists on calling a "patient disconnect"--- a place where the machine simply looses the flow wave data for some reason other than the machine being turned off. Supposedly a very large leak can lead to a "patient disconnect". Obviously taking the mask off without turning the machine off can lead to a patient disconnect. Likewise, if the mask gets jarred out of position, that can lead to a patient disconnect.


Chyene Stokes Resp 3 eventsDuring the the 9:05:04 hours of usage the machine detected 3 episodes of breathing patterns that look suspiciously like Chenye Stokes (Periodic Breathing). This is a breathing pattern where the the volume of the inhalations repeatedly wax and wane. Often times in the middle of lowest volume breathing there is a central apnea. The pattern is often thought of as an overshoot/undershoot cycle for the CO2 levels in the blood. First, as the breaths are increasing in size, you're blowing off too much CO2 (the overshoot). Once the brain senses this, it reduces the effort to breath in an attempt to correct the CO2 level, but it over compensates and at during the period of lowest volume breathing, you're not exhaling enough CO2 in each breath (the undershoot) and so the CO2 levels build up higher than they are supposed to be and the cycle starts over with breaths of increasing volume. A bit of periodic breathing now an then is not uncommon. But significant chunks of periodic breathing night after night is a problem. Congetstive heart failure is one known cause of periodic breathing.

[robysue]

Now for your real question:

Have been using for about 30 days, but feel more tired than before I started using CPAP. Most days I cant ever seem to feel awake, or it may take hours to finally feel half alive.

here is data from Last Tue which seems to have alot of events... Is this normal?

If the numbers posted in your data are very typical for you night after night, then I'd say, the numbers are still high: The goal of PAP therapy is to get that AHI under 5 and many of us don't really feel at our best unless the AHI is usually below 2.5. That said, many of us also have the random "bad night" where our numbers look far worse than they normally do. Sometimes we feel it; sometimes we don't if it's only one bad night in a string of decent to good nights.

But the more important observation here is that you are about a month into therapy and you "feel more tired than before" you started CPAP and that you are having real problems with excessive daytime sleepiness (EDS) as well. Is this normal? Well, the docs and techs all seem to expect that we'll all start feeling better within a couple of weeks of starting therapy and some people do feel better that soon. But judging from the comments on this forum plus others that I read, it takes many of us much longer to start feeling genuinely better.* And that's after our therapy really is optimized in the sense of consistently getting AHI's less than 5. In my opinion you really should talk to the doc about just how tired and sleepy you are still feeling during the daytime. He probably won't offer much help, but I still think its worth bringing to his attention. And you definitely need to bring that AHI number to his attention. It could be he'll recommend a slight pressure increase. Or possibly a week or two of auto titration to see if you need a bit more pressure to take care of the hypopneas. But given the high number of clear airway apneas being recorded, an increase in pressure might wind up making the situation worse not better.

* NOTE: In my own case, I experienced a huge three month crash and burn in terms of how I felt and how I functioned (or rather did not function) after starting therapy. The only way to describe it is I felt like I'd died and gone to some kind of purgatory. Things slowly started to turn around during my 5th month of xPAP therapy: In my sleep journal I was noting that the hand and foot pain I'd woken up with each morning for a number of years was no longer there. And I was waking up without a headache occasionally. But it took several more months before I was feeling as well as I felt before CPAP on a consistent day-to-day basis. Finally by the time I was on therapy for about 8-10 months I started noticing that I was indeed waking up feeling more rested and more refreshed most of the time than I had felt before CPAP. Now? On the average day I can tell the BiPAP is doing me some good and I feel at least as good as I did before PAP in terms of daytime sleepiness and fatigue and much better in terms of joint pain and headaches. On my best days I feel much, much better than I did before starting CPAP: On those days I wake up feeling genuinely rested and refreshed in a way that makes me feel some 20 years younger. I just wish I had more of these "best" days. And I still have hope that with continued work on my part the percentage of those "best" days will continue to increase.