My Sleepyhead report - feedback please

[flyguyjake]

**High res screen. **
May I get your feedback on my report. Does anything specifically stand out to you?

I started off with min pressure 5 but didn't like the results. Last night (this report) I increased to 7 min. Are CA's & Hyp's a problem?
Should I continue to increase the min pressure until I don't have any OSA's?

Untreated AHI 46, Heavy snorer, No titration study, Prescribed pressure 5-20
S9 Auto - APAP mode, EPR 3, Set pressure 7-14, Mirage Quattro FFMask

[The Latinist]

It's kind of hard to read your screencap. Can you expand the graphs so we can see more of them? We don't need any of the graphs below the "leak" one, and you could also hide the AHI and Mask Pressure graphs. Mostly we need the Event Flags, Flow Rate, Pressure and Leaks graphs.

You could also click to the left of the leaks graph to change the scale so we can get a better idea how big your leaks toward the end of the night were.

[flyguyjake]

[Taz]

Hi flyguyjake,

I've noticed you are using the 9.5 version of SleepyHead. Pugsy informed me a couple of days ago it was the wrong version, I needed the 9.6 Version. The 9.5 version is the reason your lines on the grafts look so wonky. PM Pugsy for the 9.6 Version and your grafts will print out much smoother.

Taz

[Pugsy]

Are CA's & Hyp's a problem?
Should I continue to increase the min pressure until I don't have any OSA's?

No. There is no urgent need to increase the minimum pressure at this time. It's an unrealistic expectation to think we can totally eliminate all the hyponeas and OAs. It's nice to get the 0.0 AHI thing...but it's not something that we break our neck trying to get. AHI less than 5.0 is acceptable and looks like 1/3 of your AHI is CA (centrals) anyway so the obstructive components are much less than 5.0 in your situation.
The CAs (centrals) we don't treat with more pressure anyway. It's possible some of those are awake/semi awaking breathing flags anyway. Do you spend any time awake while the machine is on? Like the cluster of CAs at 1:36 to 1:38...were you awake at that time by chance? Even if you were asleep...not enough centrals to be alarmed about though.

The pressure line being fragmented..that's a little bug that affects some S9 reports (it did mine) and there's a new version of SleepyHead coming out shortly that fixes that little bug (among other bugs) that will have an installer.
I have a pre release version of it without the installer that you can have if you want to try it.
https://dl.dropboxusercontent.com/u/978 ... OpenGL.zip
It works just like the 0.9.5 version. No installer yet.

You are new to therapy. Give things a bit of time and see if those OAs and Hyponeas reduce a bit all on their own. They just might do it without your changing anything and if they don't...and you want to try to reduce them a little more then later maybe try a wee bit more minimum pressure. There's no urgent need at this point though.

So one other question besides the "were you maybe awake during those centrals" question..
How is your sleep quality in general? Sleeping fairly soundly or waking up often for whatever reason? And if so...do you know the reason? It's normal to have a few awakenings...not so normal to have a lot of them or have trouble going back to sleep when you do have them.

[flyguyjake]

Pugsy you're good!

I do lay in bed for 20 min or so with the mask/s9 on playing an iphone game to fall alseep. So yes, that what those (4) 1am-ish CA's were.
I've only been on APAP for 5 nights so far and I have not needed to take a 4pm nap since! Like clockwork I used to take daily naps around 4pm and some days another nap around 8pm. Bedtime is typically 1am and up at 9am. I work from home so my schedule is very flexible. I used to snore like a big rig and that would wake me up and now I barely snore according to the graph. I don't wake up from it. I definitely feel more clear thinking and have more energy. The first few nights was somewhat difficult getting used to the mask and convincing myself to relax and not feel suffocated. That was at 5min now that I raised it to 7min I feel much better. Last night was the first night using RemZzzs for drool. It worked flawlessly, held the mask in place a little better (oily skin) and made the mask feel softer on my face. I am a side sleeper and usually switch sides a few times each night. I really don't remember waking up to switch sides last night, even though I did and I did not wake up from drool, pressure spikes or air leaks. So all in all I think last night was the best nights sleep so far on treatment. Headaches are gone too!
The mask feels too tight on my face at either side of my nose so I'm going to order a liberty hybrid and give that a shot. I've been mainly a mouth open sleeper for my entire life so I don't know if I could tolerate a nasal pillow style mask with chin strap.
I think that the mask is making my lower eye lids puffy due to where it's sitting my nasal passages. I've never had lower eye bags and holy cow, I've got them now!

[Pugsy]

I think that the mask is making my lower eye lids puffy due to where it's sitting my nasal passages. I've never had lower eye bags and holy cow, I've got them now!

Yeah, most likely the pressure from the mask is causing a little pooling of body fluids in the eye area. I get that sometimes when I have ended up on my stomach with my face buried in the bed pillow and side straps pressing on the cheek area up around the eyes.

The right mask is the hardest part to all this therapy IMHO.
If your DME has ResMed stuff the Liberty would be a good choice to try or even the original Innomed/Respcare Hybrid as it comes with 3 sizes of oral cushions where the Liberty you have to decide on size ahead of time. Plus the Innomed Hybrid has a little chin cup that comes in handy sometimes.

Sounds like you are adapting well for the most part. You are already much further along in 5 days than I was. Heck, at 2 weeks my AHI was still 10 and I was still having all the pre cpap symptoms and sleep was horrible. Got it all sorted out eventually with some little tweaks to minimum pressure and started seeing improvement then.

Remember the machine doesn't know if you are awake or not so if you see some little clusters of events (most likely centrals but could be the others) during a time frame where you were awake you have to mentally remove those numbers from your AHI evaluation.

I couldn't handle 4 or 5 cm pressure myself...way too stifling but I managed 6 cm okay. Some people need 7 or 8 to feel like they aren't suffocating. Gotta feel comfortable to be able to sleep and that includes not feeling like we are suffocating.
While technically we won't/can't suffocate at those lower pressures it can sure feel like it and keep us from falling asleep and that of course is something that has to be fixed. It hurts nothing to use a little more minimum pressure especially we are using APAP mode anyway.

[flyguyjake]

Could you explain to me how the S9 responds to OA's? If my min pressure is 7 and it takes 13 to open my airway, does the S9 immediately ramp to 13 and then back down to 7? Anthem (PPO plan) would not approve a titration test so I'd like to determine from Sleepyhead my best pressure. Is APAP mode better for folks that have random OA's vs CPAP for continual OA's?

[Pugsy]

Could you explain to me how the S9 responds to OA's? If my min pressure is 7 and it takes 13 to open my airway, does the S9 immediately ramp to 13 and then back down to 7?

Robysue actually does the technical description of how the S9 APAP responds better than I do as she gets much more technical.
Let me see if I can find her explanation but no, the S9 doesn't immediately jump from 7 to 13. It increases the pressure in stages over a few minutes and tests the airway as it increases to see if it can stop the increases. Same thing with reductions...not quick or immediate and takes several minutes to get back down to 7.

You can zoom in on the pressure line and watch the increases..they are gradual and take longer than a person might think when looking at the overall pressure graph.

I will see if I can find Robysue's more technical description of the timing of the S9 APAP response. I know it responds just a little quicker than the PR S1 APAP does but it still is far from "immediate" in the response from 7 to 13.

[Pugsy]

Check out Robysue's detailed response in this thread comparing the S9 and PR S1 machines. Scroll down till you find the algorithm section.
viewtopic/t94287/viewtopic.php?f=1&t=82 ... 5&#p866535
She talks about the S9 AutoSet having a rather "rapid" response but it still isn't a blink of an eye speedy response. I thought she had a time frame involved but I didn't see it for the S9 but saw it for the PR S1.

It can't go from 7 to 13 in 10 seconds though...zoom in on the pressure graph line and watch it increase to see how quickly it increases.
I can't test that feature on my current S9 because I am using the Adapt and its response rate is totally different from the AutoSet. Mine does auto adjust but it does do it very rapidly...like from 9 to 20 in 20 seconds. Totally different machine and algorithm though.