Need help adjusting machine, posting SleepyHead data

[DavidSimon]

Hi All!

I posted awhile ago about my newbie struggles, but have been trying to slog through. My nasal pillows no longer hurt me (I use some lanolin). And I have had a few decent nights (out of 60+ now....) . Here is what I need some help with:

1. My System one machine is off by 10 minutes. This is irritating, but I don't think I can fix it (based on searches).
2. I camp a lot, and I don't take my CPAP. Generally, these nights of sleep seem pretty good. I don't wake up freaking out or gasping. BUT...
3. Almost every night I use the CPAP at home, I end up waking up feeling like I can't breathe, usually in some sort of dream panic state. I kept a journal of these incidents and almost all of them correlate to an OA event in SleepyHead. Usually this occurs within the first hour after I fall asleep.
4. I have also noticed a variety of "clear airway" events, usually closer to morning wake up time. I understand these might be CA events? Maybe it's just me removing/messing with the mask? No idea.
5. I want to post some SleepyHead stuff so I can get advice, but I'm not sure what part to post, or if I should just post a screenshot or what.

Any help would be much appreciated! I can post thorough data correlated with my personal logs and journals, if someone is willing to help. I feel like I've overcome the mental/physical pain hurdles and now just need to get things dialed in so that my sleep at night actually feels good with the machine, because right now , my perception is that a night with CPAP is going to be a much worse, less rested, more panic centric night.

[Pugsy]

For how to post images using imgur to host them
https://sleep.tnet.com/reference/tips/imgur

For how to organize those images see this and be sure to read all 3 pages (there are links to the other pages)
https://sleep.tnet.com/resources/sleepyhead/shorganize

For examples of what we like to see look at this thread
viewtopic/t103468/Need-help-with-screen-shots.html

[DavidSimon]

Thanks pugsy.

So , as I stated my machine is off by ~10minutes. Is there any way to fix this? I wrote down that I turned the machine on at 1:17-1:18 am and the data starts at 1:28. This seems consistent over testing many nights, although one night (last night) the data doesn't start for 17 minutes, so... I don't know.

Here is an example night where I woke up freaking out felt like I couldn't breathe etc. It corresponds exactly to an OA in SleepyHead data. I wrote down that it happened at 1:37am and the sleepyhead data says the OA was at 1:47 (which, given the 10m offset seems accurate), and there was a pressure increase right before this.



I have other nights just like this, where I woke up thinking I was basically dying, freaking out, ripping mask off, super confused (like mid dream etc) and there is OA correlated to it. On the other hand, there are also a number of OA events where I didn't wake up, there are CA events where I didn't wake up, and there are a few times where I woke up freaking out and there is no corresponding OA. I am happy to post more data if it is helpful.

[Pugsy]

Those little spikey/sawtooth looking pressure increases are the test pressure probes that the machine does at random to test things out a bit. Those are NOT related to any apnea event precursors are meant as a response to something. It's a small 1.5 cm increase over a period of time and not nearly as rapid as the spike makes it look like. It goes up slowly over a few minutes and back down slowly...you can zoom in and see how gradual the change is.

The clock being off. Nothing you can do about it. The Respironics machines have an internal clock that is preset at the factory to GMT time and a little battery to keep it going when there is no power. Clocks being off has been a common complaint about Respironics machines for years and years.
Now if it was off by an hour we could make adjustments with the time zones to fix it but for just 10 minutes there isn't anything we can do short of altering the computer clock by 10 minutes.

ResMed machines have a similar battery back up system but if the time is off with those machines there's a setting in the setup menu to fix it. Respironics doesn't think it is important enough to add that feature....I guess.

[DavidSimon]

Any thoughts on what I should do? I am still waking up freaking out even on CPAP. I feel like the machine isn't tuned to give me the proper benefit .

[Wulfman...]

Any thoughts on what I should do? I am still waking up freaking out even on CPAP. I feel like the machine isn't tuned to give me the proper benefit .

Try straight pressure.
Maybe a straight 8 cm. (for a starting point). You can either do it by setting your minimum and maximum to the same pressure or switch it to CPAP mode.


Den

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[DavidSimon]

Thanks Wulfman. If I just up the bottom end to 8 instead of 5, and leave the max at 20, what is the downside?

[palerider]

Thanks pugsy.

So , as I stated my machine is off by ~10minutes. Is there any way to fix this? I wrote down that I turned the machine on at 1:17-1:18 am and the data starts at 1:28. This seems consistent over testing many nights, although one night (last night) the data doesn't start for 17 minutes, so... I don't know.

as Pugsy says, there's no way, short of a maintenance depot, to fix the clock, however, sleepyhead has an offset feature to compensate and line up your graphs with the real time.

[Wulfman...]

Thanks Wulfman. If I just up the bottom end to 8 instead of 5, and leave the max at 20, what is the downside?

Depends on your breathing characteristics and how the machine algorithm reacts to all that.
If those ( 1.5 cm. ) pressure "probes" scattered throughout the night are enough to disturb your sleep, that might be one.

"Auto" machines aren't necessarily "the greatest thing since sliced bread". They have their purposes and they work for some people (on a nightly basis), but they don't provide the best therapy for everyone, all the time.
For some people, they can be very disrupting to sleep. A person's breathing can change as they enter deep or REM sleep stages and the machine may detect flow limitations and decide to increase pressures. If that happens, the person may be bumped out of the needed sleep stages.......and left feeling unrested.


Den

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[DavidSimon]

Thanks - this is very interesting. I was kind of assuming the OA events were what cause me to wake up "freaking out" - I REALLY want to understand what is causing that, as it is incredibly stressful. If it is actually the pressure probes, I guess switching to CPAP for a few nights would help me understand that.

Based at the data I posted, the OA is recorded right after this pressure probe, is that normal? Is it normal to have OAs despite CPAP/APAP or should I be shooting to eliminate all of them?

Do other people have specific events in SleepyHead that they correlate to waking up like this (very disorienting, sometimes heart racing, feeling like I was dying or something) ? The thing that makes the most logical sense to me is that it is because I wasn't breathing.

[Wulfman...]

Thanks - this is very interesting. I was kind of assuming the OA events were what cause me to wake up "freaking out" - I REALLY want to understand what is causing that, as it is incredibly stressful. If it is actually the pressure probes, I guess switching to CPAP for a few nights would help me understand that.

Based at the data I posted, the OA is recorded right after this pressure probe, is that normal? Is it normal to have OAs despite CPAP/APAP or should I be shooting to eliminate all of them?

Do other people have specific events in SleepyHead that they correlate to waking up like this (very disorienting, sometimes heart racing, feeling like I was dying or something) ? The thing that makes the most logical sense to me is that it is because I wasn't breathing.

Looking at some of the reports, it's sometimes hard to line up what came first. However, keep in mind that Autos don't attempt to address an Apnea in progress. For one thing, it takes 10 seconds to categorize "lack of breath" as an apnea. So, what the algorithms do is to key pressure increases on Flow Limitations and/or Snores (VS) with the belief that those events precede apneas. Apneas are a complete cessation of air flow, Hypopneas are partial cessations/limitations and Flow Limitations are even smaller air flow changes. Not everyone experiences those preceding events and the apneas can be sudden, abrupt and out-of-nowhere. So, the machine can't/doesn't attempt to head them off with increased pressure. Another thing to consider is that if using a pressure range, the minimum pressure really needs to be high enough to eliminate almost all of the events. If the minimum is too low, it can take too long for it to be bumped to where it needs to be and there may be too many events taking place before it gets there. AND, those pressure increases MAY be sleep-disturbing.

From my use of Autos in ranges of pressures, I found the pressure changes and pressure probes disturbing to my sleep and use all of my machines in single pressure (CPAP) mode. I also found that my breathing characteristics don't agree with the pressure changes......I don't have enough preceding events (Flow Limitations and Snores) and I usually have a higher AHI because of that.
And, I admit that I'm prejudiced toward single pressures, but I've steered lots of APAP (pressure range) users in that direction and they've found the virtues of single pressures beneficial to their sleep quality.

It never hurts to experiment with various modes and settings, but try to remember that the goals ARE "sleep quality" and "good therapy".


Den

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[DavidSimon]

Zooming in deeper into the flow rate for my OA events in this picture ... it looks like my flow rate was 0 for 40 seconds (wow!!!) and then there were 5 pressure pulses during that time. 40 seconds seems like an incredibly long time - was I not breathing that whole time??? This seems incredibly dangerous. Or could it be that I removed the mask? Any ideas what that looks like on the flow rate? I'm assuming negative flow rate is exhale, positive is inhale?

I'll try a CPAP at 8 tonight to see how it goes!

[Wulfman...]

Zooming in deeper into the flow rate for my OA events in this picture ... it looks like my flow rate was 0 for 40 seconds (wow!!!) and then there were 5 pressure pulses during that time. 40 seconds seems like an incredibly long time - was I not breathing that whole time??? This seems incredibly dangerous. Or could it be that I removed the mask? Any ideas what that looks like on the flow rate? I'm assuming negative flow rate is exhale, positive is inhale?

I'll try a CPAP at 8 tonight to see how it goes!

I don't know how accurate they were, but I had some apneas in the 60 - 72 second range early on in my therapy (according to my software reports). Yeah, it can be a little scary, but that's the nature of how the oxygen levels can get as low as they do for some people. I'm not really all that familiar with the categories of flow rates, etc. All of my equipment is about 7 - 10 years old. Fully data-capable, but compared to the new stuff, it's a little "older".


Den

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[Pugsy]

Zooming in deeper into the flow rate for my OA events in this picture ... it looks like my flow rate was 0 for 40 seconds (wow!!!) and then there were 5 pressure pulses during that time. 40 seconds seems like an incredibly long time - was I not breathing that whole time??? This seems incredibly dangerous. Or could it be that I removed the mask? Any ideas what that looks like on the flow rate? I'm assuming negative flow rate is exhale, positive is inhale?

Removing the mask didn't cause the flow rate to go to 0 for 40 seconds and yes negative flow is exhale and positive flow is inhale.
If you remove the mask there is no air flow at all on the flow rate graph....usually a gap will show up and there usually is a big leak show up at the same time on the leak graph and I think in Encore there is a notation that the machine was "on but no breathing detected".

[DavidSimon]

Here is after last night with pressure set at 8. Pretty good night, although I did wake up a little confused/hard to breathe at 1:43, where you see a gap here. I turned the machine off and got up and went to the restroom etc. Turned it back on at 1:47. I don't see any events correlated with that, excpet the big increase in flow rate just prior - not sure what that is about.