Questions on Data

[Sleepless_in_LM]

I am a long time hosehead, but new to SleepyHead. What an awesome program! Kudos to JediMark, and everyone else that had a hand in its development. I just recently started on my new series 60 Respironics APAP. Thanks to a suggestion from Pugsy on increasing my minimum pressure, the new machine and I are getting along much better.

But there are some questions I am hoping some people here can help me with (I have posted a recent nights graphs below):

1) Is it normal to have large clusters of events within the first 30 minutes of falling asleep. It happens at the beginning of the night and again anytime I awake at night. Some nights, these are the only times I have any OAs. I went back and looked at my Encore reports and found the pattern was similar om my old machine, at least in the past few weeks.

2) Also, every night when I fall asleep, my Resp. Rate takes a dive for a few minutes. Is that normal?

3) How concerned should I be about "RE" events? Encore never showed my this much detail, especially the RE events. Not sure I ever heard of them until I read the SleepyHead wiki.

Thanks for any advice or input you can provide.

[Pugsy]

The clusters of events around the time you go to bed and when you are awake are likely the machine sensing and recording awake breathing irregularities as apnea events. The machine doesn't know if you are awake or asleep.
If you normally take a bit of time to fall asleep after turning the machine on...probably those are awake events and you just have to discard them. When evaluating sleep apnea reports we have to limit it to time asleep and any data from awake times is sort of tossed out. Awake breathing is much more irregular than asleep breathing and the machine can and will flag awake irregularities as some sort of event.

Respiration rate is normally lower while asleep than awake...so yes, it is normal for it to slow down quite a bit when we go to sleep.

RERAs....jury is still out on just how accurate or critical that little piece of data is.. Again most of yours appear to be clustered with likely awake events being flagged. I would discard those also. Even if they were real the number isn't horrible. If we see a lot of them along with a lot of snores...they are treated like snores...a little more pressure usually takes care of them just in case they are low level flow reductions that don't qualify for a hyponea or obstructive apnea.

[archangle]

Do you think you might be still awake at that time?

Look closely at the airflow waveform at the time you have these clusters. Consider how long the events are, how completely you stop breathing, how much time between events you have to catch your breath, etc. Think about how much harm you could be doing to yourself.

[Todzo]

I am a long time hosehead, but new to SleepyHead. What an awesome program! Kudos to JediMark, and everyone else that had a hand in its development. I just recently started on my new series 60 Respironics APAP. Thanks to a suggestion from Pugsy on increasing my minimum pressure, the new machine and I are getting along much better.

But there are some questions I am hoping some people here can help me with (I have posted a recent nights graphs below):

1) Is it normal to have large clusters of events within the first 30 minutes of falling asleep. It happens at the beginning of the night and again anytime I awake at night. Some nights, these are the only times I have any OAs. I went back and looked at my Encore reports and found the pattern was similar om my old machine, at least in the past few weeks.

2) Also, every night when I fall asleep, my Resp. Rate takes a dive for a few minutes. Is that normal?

3) How concerned should I be about "RE" events? Encore never showed my this much detail, especially the RE events. Not sure I ever heard of them until I read the SleepyHead wiki.

Thanks for any advice or input you can provide.

Hi Sleepless_in_LM!

To #1 I say no. It is very hard to tell from your time compressed displayes but it looks like you have some events (probably real events) which raise the pressure up - which - is making your breathing a bit more unstable for a time. You do recover and adapt to the pressure and all seems to go well until you start sleep again.

You might try:

Raise the head of your bed a couple of inches. Cheap and easy and tends to make the need for pressure a bit less so may stave off the events at the beginning of sleep altogether making your night easier.

Eat some anti-inflammatory foods. Again, cheap easy and the part I like best tastey. Less swelling makes for less tendency to have sleep apnea events so no increase in pressure needed we hope.

Try quieting your breathing as you fall asleep. What seems to work for me well is to place a pause between exhale and inhale. I do two counts for every one of the three - try to slow the count over time - and try to use less air as I go. I often use a pulse oximeter to guide me in toward eucapnic breathing with 95% found by my last "minimum heart rate" check and 94% recommended by a PhD Exercise Physiologist I just met. As you do this you will probably notice your feet get warm, your stomach relax, and the rest of you as well. It can be very relaxing.

#2 - I do not know.

#3 - Concerned enough to zoom in on them from time to time as with any event. Sometimes I am able to say to myself - well - there I probably rolled over (I have often analyzed my CPAP data compaired to the nighttime recorded audio - good to do). When you look at things breath by breath a lot of things become obivious.

Have a great weekend!

Todzo

[Sleepless_in_LM]

The clusters of events around the time you go to bed and when you are awake are likely the machine sensing and recording awake breathing irregularities as apnea events. The machine doesn't know if you are awake or asleep.
If you normally take a bit of time to fall asleep after turning the machine on...probably those are awake events and you just have to discard them. When evaluating sleep apnea reports we have to limit it to time asleep and any data from awake times is sort of tossed out. Awake breathing is much more irregular than asleep breathing and the machine can and will flag awake irregularities as some sort of event.

Respiration rate is normally lower while asleep than awake...so yes, it is normal for it to slow down quite a bit when we go to sleep.

RERAs....jury is still out on just how accurate or critical that little piece of data is.. Again most of yours appear to be clustered with likely awake events being flagged. I would discard those also. Even if they were real the number isn't horrible. If we see a lot of them along with a lot of snores...they are treated like snores...a little more pressure usually takes care of them just in case they are low level flow reductions that don't qualify for a hyponea or obstructive apnea.

I believe I am asleep when they happen. I watch TV for about 15-20 minutes before hosing up, but once I put on the mask and turn on the machine, I am out. When I wake up in the night, it is usually only for a few moments because of back pain. I shift slightly and am right back to sleep. So those middle of the night events are also after I fall back to sleep. I don't know how deep of sleep, but I certainly have no memory of the more than a moment or two.

Taking a closer look at the graphs, I did notice that when my respiration rate drops right after falling asleep, that my tidal volume is actually higher then once the rate picks up. So I must be taking slow, but rather deep breaths. Just wondering if that is normal for it to drop significantly and then pick back up after a few minutes.

RERA's do mostly cluster around the other events, but some nights I have them off by themselves. But they are usually the highest number of events, so I was just curious how important they are. I guess it is better that the jury is still out then if it had come back with a death sentence Again, just wondering if this is the norm that most people see, or if I should be concerned.

Thanks for the info!

[Sleepless_in_LM]

Do you think you might be still awake at that time?

Look closely at the airflow waveform at the time you have these clusters. Consider how long the events are, how completely you stop breathing, how much time between events you have to catch your breath, etc. Think about how much harm you could be doing to yourself.

Don't think I am awake (see response to Pugsy) The clusters of OAs are mostly about 15 to 20 seconds. Starts with real small waves and ends with about 5 seconds of nearly nothing before jumping to a big wave or two, and then levels off into a normal breathing pattern again. The "harm I could be doing" is why I am asking these questions. I suppose the better measure would be how my O2 levels do during that time, but I haven't gone the route of an oximeter... yet.

I am trying to avoid a trip to the Sleep doc. I used to have a decent one, but he left the area and the new guy just flips through reports I print for him (faster then he could possibly absorb the data) and then just asks if I have any questions. Doesn't instill a lot of confidence

Thanks!

[Pugsy]

If you are pretty sure you are asleep when these clusters happen...then for some reason something is going on that is totally different for the rest of the night because except for these 2 clusters you night is near perfect.
Something is changing...something is causing a need for more pressure to prevent those events IF you are truly asleep.
The 2 most usual suspects are REM stage sleep and supine sleeping. That first cluster would unlikely be REM stage sleep since REM doesn't normally present until around 90 minutes or so into sleep.
Maybe sleep position???

RERAs that are seen with clusters of events would go along with respiratory arousals that would happen with with these events. If they are real..probably a little more pressure.

What's odd about yours is that the rest of the night is pretty uneventful...so something is happening during those 2 clusters that is different from the rest of the night.
If you see this often the perhaps a little more minimum pressure would be enough to prevent whatever is causing these clusters.

[Sleepless_in_LM]

Hi Sleepless_in_LM!

To #1 I say no. It is very hard to tell from your time compressed displayes but it looks like you have some events (probably real events) which raise the pressure up - which - is making your breathing a bit more unstable for a time. You do recover and adapt to the pressure and all seems to go well until you start sleep again.

You might try:

Raise the head of your bed a couple of inches. Cheap and easy and tends to make the need for pressure a bit less so may stave off the events at the beginning of sleep altogether making your night easier.

Eat some anti-inflammatory foods. Again, cheap easy and the part I like best tastey. Less swelling makes for less tendency to have sleep apnea events so no increase in pressure needed we hope.

Try quieting your breathing as you fall asleep. What seems to work for me well is to place a pause between exhale and inhale. I do two counts for every one of the three - try to slow the count over time - and try to use less air as I go. I often use a pulse oximeter to guide me in toward eucapnic breathing with 95% found by my last "minimum heart rate" check and 94% recommended by a PhD Exercise Physiologist I just met. As you do this you will probably notice your feet get warm, your stomach relax, and the rest of you as well. It can be very relaxing.

#2 - I do not know.

#3 - Concerned enough to zoom in on them from time to time as with any event. Sometimes I am able to say to myself - well - there I probably rolled over (I have often analyzed my CPAP data compaired to the nighttime recorded audio - good to do). When you look at things breath by breath a lot of things become obivious.

Have a great weekend!

Todzo

Thanks Todzo! Now that you mention it, I have a foam wedge in the closet. My dad had bad OSA, but refused to sleep with a mask and machine. He insisted having a wedge under the mattress solved it, so I always kept one on hand for when he came to visit. It did NOT solve his OSA by the way, but it is worth a try to see if it helps.

I'll have to google "anti-inflammatory foods" since I can honestly say I haven't heard of that before. Got any specific ones you recommend?

I can try the breathing excersises, but honestly, most nights, I don't think I take more than a few breaths before I fall asleep. Been that way my entire life. I had expected that might change with treatment, but it hasn't. I think it is a blessing, but it drives my wife nuts since she is somewhat of an insomniac.

Been thinking of trying to video tape the first 30 minutes of sleep, but an audio recording would be simpler, so maybe I'll try that first. I usually wake up in pretty much the same position as I fall asleep so I don't think I am tossing and turning.

Thanks!

[Sleepless_in_LM]

If you are pretty sure you are asleep when these clusters happen...then for some reason something is going on that is totally different for the rest of the night because except for these 2 clusters you night is near perfect.
Something is changing...something is causing a need for more pressure to prevent those events IF you are truly asleep.
The 2 most usual suspects are REM stage sleep and supine sleeping. That first cluster would unlikely be REM stage sleep since REM doesn't normally present until around 90 minutes or so into sleep.
Maybe sleep position???

RERAs that are seen with clusters of events would go along with respiratory arousals that would happen with with these events. If they are real..probably a little more pressure.

What's odd about yours is that the rest of the night is pretty uneventful...so something is happening during those 2 clusters that is different from the rest of the night.
If you see this often the perhaps a little more minimum pressure would be enough to prevent whatever is causing these clusters.

Yeah, I am pretty sure I am asleep. I have read that some people can go very quickly into REM, but that is rare. My sleep test (a number of years back) showed almost no REM, so I doubt that am one of the "special ones." And the middle of the night ones are when I remember waking and looking at the clock. Is it possible that you can wake and then fall back asleep and continue the cycle where you left off? Wake just before REM and fall back asleep and go right into REM? Or does waking kinda reset the cycles?

I would be surprised if I am supine. In the past, if I laid on my back, the machine would go all the way to its max pressure of 18 and pretty much stay there. Plus, with my current back issues, I am sleeping with plenty of pillows that I think would keep me from rolling onto my back. But that is why I was thinking of videoing the first 30 minutes or so of sleep. Maybe something weird is happening.

On your earlier recommendation, I went from 8 to 10 on minimum. That helped a lot. So it might make sense that a little more will help more. I just hate to go too high when my body obviously doesn't need that much pressure once I get past those initial events. My original cpap pressure was 10, but again that was a few years ago. Lots of things have changed since then, including letting the ENT Doc talk me into some extra reconstruction when he took my tonsils out - BAD decision. I blame him for lots of things, Maybe I should blame him for this too!!

So back to my original question, "is it normal..." I gather it is not something seen often. Funny, when I was younger, I used to think it was good to be special...

[Pugsy]

Maybe it is the aliens experimenting on you just twice a night.

It's odd for sure. The fact that you had similar reports on the older machine means it has been going on for a while.
Something is changed but don't know what.
Do you have any nights where you don't have a cluster pretty much immediately after turning the machine on?

[Sleepless_in_LM]

Maybe it is the aliens experimenting on you just twice a night.

It's odd for sure. The fact that you had similar reports on the older machine means it has been going on for a while.
Something is changed but don't know what.
Do you have any nights where you don't have a cluster pretty much immediately after turning the machine on?

Thanks Pugsy,
Great! Tonight will probaly the first night I don't fall asleep right away, while I am watching for aliens.

The best night I had was Monday after the pressure adjustment. Here are the first part of the nights since I started the new machine (th-wed):








Some aren't so bad, but they all have the majority of events right after falling asleep, and again when I wake up in the middle of the night.

[Sleepless_in_LM]

Yikes! Last nights was the worst one yet. It took me a few more minutes to fall asleep since I was looking for those aliens, but once asleep (or at least I think I am asleep), I had 47 minutes with 58 events and an AHI for that time period of over 70.
Today I ordered an oximeter. If my O2 levels are OK, than I am thinking I don't need to worry about this. If there not, well then I guess it means a trip to the sleep doc.... Does my logic seem reasonable?

[Todzo]

Yikes! Last nights was the worst one yet. It took me a few more minutes to fall asleep since I was looking for those aliens, but once asleep (or at least I think I am asleep), I had 47 minutes with 58 events and an AHI for that time period of over 70.
Today I ordered an oximeter. If my O2 levels are OK, than I am thinking I don't need to worry about this. If there not, well then I guess it means a trip to the sleep doc.... Does my logic seem reasonable?

Hi again Sleepless_in_LM!

Pulse oximeters are the bomb - I think every OSA CPAP user should have one. More data has always proved helpful.

In this case we may have the data we need to see what is going on. In the cases of high AHI the machine ramps up pressure at or just prior to the times. So lets take a very close look at what causes the ramp up of pressure.

I would love to see a zoom that includes just a bit of time before the ramp to just a bit of time after the pressure ramp up levels off.

I would love to see a zoom of about 5 minutes before the ramp starts including the first 10% of the ramp.

Some other questions for you:

Do you fall asleep on your back?

If you use a pillow is it under your head when you first fall asleep?

What do you normally do for the hour before bedtime?

When you get the Pulse Oximeter consider the oxygen saturation as follows in terms of CO2 levels:

99% Probably hyperventilation - probably true hypocapnia
98% Some hyperventilation - probably at the edge of hypocapnia
97% Likely over breathing - have moved away from eucapnia toward hypocapnia
96% Possibly over breathing - possibly moved a bit toward hypocapnia
95% Possibly breathing at eucapnic rates - this is likely good.
94% Possibley breathing at eucapnic rates - this is likely good

Have a great weekend!

Todzo

[Sleepless_in_LM]

Hope these are what you were looking to see.





I always fall asleep on my side. That has been a change in the last 6 weeks. I used to be stomach sleeper, but back issues make that very painful. And if I sleep on my back, the apap usually goes to max. That could explain these big clusters, but I always wake up on my side like fell asleep.

I use a cpap pillow, which is always under my head. I have a pillow between my legs, a pillow hugged to my chest, and usually a pillow behind my back to make sure I don't roll.

I spend most of the time in the evenings watching tv...can't do much else with my back in this condition. I usually watch tv in bed for about 20 minutes before I strap on the mask. Once I turrn on the machine, I am usually asleep within 5 minutes.

I just can't figure out these huge clusters right after falling asleep. And then clusters after waking up in the night. It seems my throat closes a lot right after the onset of sleep....??

[Todzo]

I always fall asleep on my side. That has been a change in the last 6 weeks. I used to be stomach sleeper, but back issues make that very painful. And if I sleep on my back, the apap usually goes to max. That could explain these big clusters, but I always wake up on my side like fell asleep.

I use a cpap pillow, which is always under my head. I have a pillow between my legs, a pillow hugged to my chest, and usually a pillow behind my back to make sure I don't roll.

I spend most of the time in the evenings watching tv...can't do much else with my back in this condition. I usually watch tv in bed for about 20 minutes before I strap on the mask. Once I turrn on the machine, I am usually asleep within 5 minutes.

I just can't figure out these huge clusters right after falling asleep. And then clusters after waking up in the night. It seems my throat closes a lot right after the onset of sleep....??

Hi again Sleepless_in_LM!

Your situation kind of reminds me of the time after I was robbed, beaten and stabbed five times. After a day or so in the ICU and acute care, after I walked and did not leak, and finding that I had a daughter to tend the wounds they sent me home.

So I lay awake one night, wondering why I cannot sleep. Then the thought occurred to me, "well, does anything hurt?". As I let myself take inventory - well - everything hurt - actually - quite a bit. I broke down and took one of the 30 oxycontin pills the doctors provided and slept like a baby. I think those 30 pills lasted me about 45 days and I needed no refill. They were nice when I needed them but I have no idea why people do crime to get them. Not even a buzz for me - just sleep.

In your case I kind of wonder if relaxing also brings some pain into the picture. That would ratchet up the central nervous system perhaps pushing breathing to be hypocapnic bringing on inflammation, apneas, and unstable breathing (the events!).

It is probably a time to look at your bed critically. If it is old and has developed a bit of a “U” shape when you sleep in it – well – I used to add a plywood support between mattress and box spring to keep things flat which was much more comfortable for me.

A bed that forms to your shape well may be worth the investment.

Perhaps some form of physical therapy may help.

Perhaps even (this is last resort) a pain medication for a time.

My thoughts for now.

Todzo