help interpreting my sh graphs.

[lliann]

Last night I used Dreamwear again, with a cervical collar and some mouth tape. Trying to stop the mouth breathing and each day it seems to get worse.

My large leaks seem to really take off near the end of my sleep or when I finally remove the mask (I don't always know what makes me take it off. I am half a sleep but I think breathing through my mouth keeps waking me up. I do have a deviated septum, but it mostly feels like I can nose breathe adequately. But I don't know what makes my mouth keep opening even with tricks and restraints?

I am trying to understand the graphs (but a lot is still flying over my head). I wonder if the pressures are ok. The epap seems questionable to me but I don't really know what the question is? I really do want to learn this stuff but to me this is a lot harder than accounting. Sigh.

Here is my last night if anyone would like to explain any of it to me (and why) Thank you

[Julie]

Too small to read even after growing it on Imgur... can you do a slightly larger size? One thing for sure - I'd raise my min. pressure to e.g. 7 as I could tell it wanted to go higher and 4 is the default low... very hard to inhale at.

[Pugsy]

I could enlarge it just fine on imgur.

3 % of the night was in large leak. I am not so sure that all of that is mouth breathing. I suspect some of it is just mask movement.

Your AHI and each event category index added together doesn't jive.

Do you have the Clear Airway/Central Index turned off?

Go down to the lower left corner and see where it says "Flag" click on the arrow to expand the menu and click on Central/CA and make sure it is green and not red.

The obstructive part of your AHI is about half that total AHI. 3 ish which isn't horrible. Remember we can't fix the centrals with this machine and at this point not sure if they need to be fixed anyway.

You can increase the minimum EPAP by 1 cm and see what happens. As long as you don't have problems with more base pressure should hurt anything. Main problem might be aerphagia or belly issues. Rare problem might be centrals but I don't see it so far in your data as being related to pressure. I suspect your centrals are SWJ or post arousal centrals.

[lliann]

I could enlarge it just fine on imgur.

3 % of the night was in large leak. I am not so sure that all of that is mouth breathing. I suspect some of it is just mask movement.

Your AHI and each event category index added together doesn't jive.

Do you have the Clear Airway/Central Index turned off?

Go down to the lower left corner and see where it says "Flag" click on the arrow to expand the menu and click on Central/CA and make sure it is green and not red.

The obstructive part of your AHI is about half that total AHI. 3 ish which isn't horrible. Remember we can't fix the centrals with this machine and at this point not sure if they need to be fixed anyway.

You can increase the minimum EPAP by 1 cm and see what happens. As long as you don't have problems with more base pressure should hurt anything. Main problem might be aerphagia or belly issues. Rare problem might be centrals but I don't see it so far in your data as being related to pressure. I suspect your centrals are SWJ or post arousal centrals.

Last night I tied my hair into 2 ponytails and trapped the straps and then made one ponytail. I had a cervical neck thing plus tape. I am a restless sleeper and my hips hurt on and off and I have to change positions often. The Dreamwear is so comfortable on me (I am using a small) and I check often and don't feel leaks. But thats when I am awake-. Asleep- anything could be happening.

Last night I had fewer problems with aerophagia (thinking the neck thing helped). Other nights, I am pretty gassy. I think I have always tended to swallow air, much less steady pressure air. Do you think by morning I could have such a build up of aerophagia, that that is making my body react?

I did check the flag and all were green except UA which I changed to green.

I did notice the last 2 nights, the leaks went haywire toward the end of my sleep (I believe at that point my mouth won't stay closed. I think whatever mental ability I have to control my mouth is not there at that point. No idea why. I don't know if its the deviated septum or air hunger. I feel like I am getting plenty of air and after I raised it to 16.6 I was able to take a full inhalation finally. I guess there is a line between me getting a full breath and me swallowing too much air?(even through a nasal Mask) Could that make any sense?

Could you explain how the ahi and each event does not jive? I have left clicked, right clicked, left, right , up, down buttoned. I am not sure what I am measuring. (utube said a central is about 10 seconds. How long is an official obstructive?

Am I even close to asking any of the right questions? Thank you Everyone.

[Pugsy]

AHI is the total of each index. CA/Central plus OA plus Hyponea
So the AHI is showing 7.61

And each index
Hyponea is 0.45
Obstructive Apnea 3.67

If you add 3.67 and 0.45....it doesn't add up to 7.61
So it doesn't jive. Something is missing that makes it total 7.61

[Pugsy]

Do you think by morning I could have such a build up of aerophagia, that that is making my body react?

It's entirely possible that belly issues caused enough discomfort to cause a lot of restlessness or tossing and turning stuff.
Of course it's also possible that you were just restless at the end of the night from some unknown reason with a lot of tossing and turning and mask moving stuff.
It's also possible that the leaks from whatever cause...caused some sleep disruptions and arousals.

When I see this kind of restlessness, with some SWJ flags sometimes, mine are usually related to pain issues. The nights my pain is worse are usually uglier in terms of everything...SWJ, mask movement leaks, Etc.

[lliann]

Too small to read even after growing it on Imgur... can you do a slightly larger size? One thing for sure - I'd raise my min. pressure to e.g. 7 as I could tell it wanted to go higher and 4 is the default low... very hard to inhale at.

the min epap is 10 and ps is 4? I should change that to 11?

[palerider]

I am trying to understand the graphs (but a lot is still flying over my head). I wonder if the pressures are ok. The epap seems questionable to me but I don't really know what the question is? I really do want to learn this stuff but to me this is a lot harder than accounting. Sigh.]

I'd lower the PS by 1 and raise the EPAP by 1, if it were my chart. See if that helps both the CAs and OAs.

[Pugsy]

you said CA + OA + hypops but added in none of the CA amount

Because there is no index for CA/Central and that's why I said to check to see if the flag was turned on for CA.
I can't add in a number that isn't there.
I know the pie chart shows about half CA...but there is no CA index.

She's got the CA index turned off somewhere for it to be absent.
I don't have time right now to poke around in SH to figure out where else it might be.

[Guest]

AHI is the total of each index. CA/Central plus OA plus Hyponea
So the AHI is showing 7.61

And each index
Hyponea is 0.45
Obstructive Apnea 3.67

If you add 3.67 and 0.45....it doesn't add up to 7.61
So it doesn't jive. Something is missing that makes it total 7.61

======

the pie chart shows about half are CA
double 3.67 and you get close to the 7.61

you said CA + OA + hypops but added in none of the CA amount

Did you even read the entire thread or LOOK at the graph??? That's the problem. The CA is not showing and thus the confusion! Brilliant engineer my ass.

[Pugsy]

the min epap is 10 and ps is 4? I should change that to 11?

You can but you run the risk of making the aerophagia worse.

I don't know if PR's idea to lower PS to help offset the EPAP increase will keep the aerophagia monster away or not.
Worth trying.

Sometimes we have to make compromises with this stuff....like just how bad are the belly issues compared to how "bad" the Obstructive stuff is.
We can easily reduce those OAs and hyponeas...more pressure but will more pressure create a different problem? Dunno...and you won't know until you try.
It's a learning experience...even if all you learn is "man, that was a stupid idea"... I have had several of those myself.

[Pugsy]

We have zero idea what is going on with the centrals...they are absent from the Event graph and absent from the AHI breakdown. They do show up on the pie chart and roughly half of the 7ish AHI was central per the pie chart but that's all we know.

We don't know when they occurred. We don't know if they are all clustered at the end of the night and are maybe a boat load of SWJ.
We don't know if there was a cluster of them at the beginning of the night and were maybe sleep onset centrals.
All we know is the pie chart says they happened and rough math estimates about half of that AHI is central.

Hey PR...where else do we turn on category flagging besides the lower left Flag area? She says that CA is green but they sure aren't showing up.

I know where PR is going with the idea to reduce PS though...there's a very small percentage of people who get centrals simply from bilevel pressures and his idea is worth trying.
I personally know one person who gets around 15 Centrals per hour with PS of 4 but maybe 1 per hour with PS of 3...go figure that one.
Surprised the heck out of me when I saw it for my own eyes.

[lliann]

the min epap is 10 and ps is 4? I should change that to 11?

You can but you run the risk of making the aerophagia worse.

I don't know if PR's idea to lower PS to help offset the EPAP increase will keep the aerophagia monster away or not.
Worth trying.

Sometimes we have to make compromises with this stuff....like just how bad are the belly issues compared to how "bad" the Obstructive stuff is.
We can easily reduce those OAs and hyponeas...more pressure but will more pressure create a different problem? Dunno...and you won't know until you try.
It's a learning experience...even if all you learn is "man, that was a stupid idea"... I have had several of those myself.

I am reading all kinds of posts but I am still undereducated. Will take time to understand. So centrals are when my body forgets to breathe?I can relate. I am a very shallow breather. It may be because I have learned to compensate for my deviated septum. Every once in a while I have to take a full inhale. Both daytime awake and nighttime awake (and maybe asleep?) I don't know why or where to look to see why my ca's are not recording?

will this help?

[Pugsy]

Centrals can be because the body "forgets" to breathe or because the carbon dioxide levels haven't got high enough to wake up the brain so that the brain sends the command to "breathe".
Centrals can also be awake/semi awake pauses in breathing or irregular breathing. Commonly called Sleep/Wake/Junk SWJ. These aren't real and are of no importance.
Centrals can also be normal in that it's normal to have what is called a sleep onset central. I don't know why they are considered normal though. Just they aren't usually a problem unless present in large numbers and/or they keep a person from progressing into the next normal sleep stage or they are of a duration that can cause desats or so many of them they cause desats.
Centrals can also be a post arousal central meaning you had some sort of arousal for some reason (you may or may not remember the arousal or awakening) and with the arousal comes a bigger gulp of air followed by a pause in breathing which gets a flag. Sometimes obstructive events are the cause of the arousal and if that is the case then reducing the obstructive events could reduce the centrals if the centrals are related to just the arousal.
And of course a large number of centrals could mean some sort of health condition is going on to cause an imbalance in the exchange of gases and cause the brain to not send the command to breathe. Heart issues is one potential and I know you were recently diagnosed with some heart issues but I don't want you to panic and think your heart issues are the problem. Normally when heart issues are the cause of centrals people will have a lot more of them than you are having.
And finally there are pressure triggered centrals. CPAP pressure (commonly people think higher but it can happen at lower pressures) causes the unstable breathing where too much carbon dioxide is blown off too soon and the levels don't get high enough to wake up the brain.

It is possible that your tendancy for shallow breathing could be fooling the machine into thinking the pauses are something they aren't in terms of irregularity.
Remember these machines only measure the air flow and flag it per the criteria they are given. Maybe your air flow which is normal for you sometimes meets the criteria for a flag of some sort.

Your CAs are showing on this recent zoomed in graph. I have no idea why they aren't included in the event category graphs on the left or the first graph you posted and it wasn't in the Events graph either.
Maybe it is just a Sleepyhead bug.

All of these possibles aren't necessarily easy to figure out with the data we have available. We do the best we can with what we have available and go about treating the stuff we can with these pressures or adjustments and while we don't totally ignore the centrals we set them aside for the time being and fix what we can with what we have and then see what is left that might need fixing.

Hence the idea to try maybe a little more EPAP to bring down the obstructive stuff and maybe if the centrals are post arousal they will reduce as the obstructive stuff reduces.
And the idea to reduce PS because sometimes just a little change in PS can make a big difference in the results.
Reducing your PS will reduce your IPAP and even though EPAP goes up a little...IPAP is coming down so the end result isn't that much of an increase in overall average pressure.
If EPAP is 10
and PS is 4
then IPAP is 14

If EPAP is 11
and PS is 3
then IPAP is still 14

I don't know if your centrals are related to PS at all but it hurts nothing to try reducing PS to see if the centrals change in numbers.
A very small percentage of people using bilevel therapy (and that's what PS is doing and also what EPR does) can have this happen. Don't know why but it just happens.

Finally sometimes we can just get centrals for now reason and maybe a bunch of them.
I once had 17 centrals in 17 minutes. They were all brief but made for an ugly 17 minutes. I slept right through it or at least I had no memory of being awake when they were flagged. Sometimes we just have to scratch our heads and shrug our shoulders and move on.
We don't always get clear cut answers.
It only happened once. Now if it was happening often then I would devote more time and energy trying to figure it out but I am not going to go expend a lot of time or energy on fluke data.

[lliann]

Wow. I have a whole folder of your explanations (and RobySue)

Thats a lot to digest. Also last night I was doing some coughing. Allergies were acting up so I had post nail (nasal even)drip in nose and throat.

I am not going to worry about the heart thing. I have a nuclear test scheduled 9/11. I will assume (yes I know what that means<g>) that 5 weeks out, maybe they don't think I will easily stroke out (so no running marathons for me) I am hoping all this extra air is helping my heart not have to work so hard when I stop breathing (apparently my snoring is the stuff of legends Altho when I asked the cardiologist the relationship between heart and apnea he just went meh.

So I am going to put ps at 3. epap at 11. And do everything the same. I think we are just looking for the right combination of air/pressures/ whatever. I don't know how to speak the language but I think I have the concept? (swj is what?)

Sleep well everyone.