help interpreting first set of data?

[forgetcolor]

It's been 30 days so I finally took a look at the data using sleepyhead. My last 30 day numbers are:

AHI: 5.14
Hours/night: 7:10
Pressure: 5
Average Leaks: 0.7
95% leaks: 3.6

And here's some graphs and more data (make browser really wide to see it all):





From the graph I can see the peak AHI is still getting up pretty high sometimes. Should I be worried about this? Since my avg AHI is just a slightly above 5 I guess it's more than it should be, but my last 7 days AHI is 3.98 so perhaps it's getting better. I was diagnosed with a 15.4 avg from my sleep study.

Also does the leaks look good? There were a couple nights when I took it off without knowing it and those are easy to spot. I know sometimes I wake up and adjust it. But most of the time it's seeming like it's staying on and sealed.

I have tried incredibly hard to adjust to the mask and am sleeping with it all night, but am not yet feeling much of a positive effect.

Thanks for any insight!!

[Pugsy]

Looks like your AHI is trending downward....this is great.
Don't be alarmed if you have an occasional bad night..they will get fewer and fewer till they are rare.
Your overall leak numbers look quite decent. Leaks are a battle we will always wage. Some nights we win and some nights the leaks win but again with time you will find that you win more.

The 95 % leak number means that for 95% of the time you were AT OR BELOW that number. Yours is well below the 24 L/min line where ResMed says therapy and data scoring might be impacted. For 5 % of the time it was higher and you would need to look at the leak line to see when and why. Usually those are really easy to spot.

Give things some time. Your AHI is trending downward. Things look pretty good on paper. How are you feeling? Having frequent awakenings? Feeling decent enough? Are you okay with the 5 cm pressure?
The AHI that you are seeing....how much of that index is central? I know it won't be high because the AHI is not high but I mention it only in case you are tempted to do some tweaking with your pressure.
Remove the central index to see the obstructive components before evaluating need for perhaps a wee bit more pressure. If half of that AHI of 2 is centrals...there is no need for more pressure at all. Remember we don't treat centrals with increase in pressure on these machines. If an AHI of 4 has a central index of 2.5...there is no need to increase pressure.

[robysue]

Agreeing with pugsy:

The leaks look really good based on the numbers. With a 95% leak rate as low as yours, you don't have serious large long leaks. So you can cross that off the "worry" list.

I also agree with Pugsy that before just assuming you need a pressure increase that you need to look at the number of CAs. In the AHI graph, the daily CAI is graphically shown by the purple chunk of the bar. And there are lots of days where purple makes up the biggest chunk of the bar. The average CAI = 2.55 from the AHI graph. I'd be reluctant to increase pressure with these CAI numbers.

Usage hours look pretty good: It appears that you are using the machine all or most of the time. (What happened on March 26?).

The data presented in the "sessions" graph indicates that your bedtime is somewhat erratic and often very late (as in 4:00 AM). Are you a shift worker perhaps? The "sessions" data also indicates that on a fair number of days you are waking up enough to turn the machine off and back on during the night. That's a sign that you've still got some fragmented sleep issues. But there are also some nights where you've got a nice long chunk of uninterrupted mask time. My guess is that those are the nights you feel like you sleep all night with the machine on without waking up.

The critical question of course is: How are you feeling?

If you're not yet beginning to feel at least marginally better, it's likely because of a combination of a slightly too high AHI (overall) and somewhat fragmented sleep (overall). Some days that AHI is really too high (but it is trending down) and some days the sessions data indicate that you were waking up fairly often during the night. So if you're not feeling much different that you were before CPAP, you might want to keep a log that includes the following info:

• Bedtime
  Wake up time
  # of wakes (estimate)
  amount of sleep (estimate)
  Overnight AHI broken down by types
  Rating of "How you feel on wake" (and notes if you want)
  Rating of "How did you feel during the day" (and notes if you want)

That's the only way you will figure out if your remaining problems are more due to the AHI being a bit higher than we'd like to see or if your remaining problems are more tied to fragmented sleep

[avi123]

See my post below

[robysue]

IMO, you should add a chinstrap and see if it cuts down the leaks.

Avi, the OP's 95% leak rate is already very, very low---as in 3.6 L/min.

That means his leak line is already better than your leak line with the chinstrap. You need the chin strap to get a good leak line (and the one you posted IS a good leak line). The OP is already getting a great leak line without a chinstrap.

[avi123]

Leak rates are good, I agree. But I am wondering about the OP's pressure of 5 cm on CPAP. In my first sleep study, a year ago, I was told by the Technologist that for pressures below 6 cm I would be OK without CPAP. This was when she prescribed for me an optimal pressure of 5 cm to 6 cm on CPAP. After a year I found out, in a repeat sleep study, that she goofed and the real pressure should have been 13 cm on CPAP. I doubt it that over one year my optimal pressure could have changed that much. But thanks to the S9 Autoset in APAP mode, I did find this higher pressure after a couple of months from beginning of XPAPing, as soon as I got the APAP. Overall, I find my treatment much better while on APAP than CPAP with same pressure of 13 cm. See it here that the pressure graph almost never touches the top line of 13 cm:



Notice that I get the Stats with the evening date and the graphs from the next day date.
I tried to fix it but don't know how.

[jab1972]

I'm also looking at my first set of data on sleepyhead -- but only for my first week. Is there someplace online with a glossary and what numbers are important or what the numbers should look like?

[Zboatman]

Jab1972 said "I'm also looking at my first set of data on sleepyhead -- but only for my first week. Is there someplace online with a glossary and what numbers are important or what the numbers should look like?"

I just started googling things like sleep apnea terms and came up with a couple of terms sheets, there is one on this forum (CPAP Definitions). Here is another one - http://www.sleepapneahelpcenter.com/glo ... leep-terms. I am a month into my new life. I have bought a very technical medical clinical study on sleep apena to try to get a grasp on what all this data means. I am also a sleepyhead user and found the data retrieval process from my machine excellent, had no clue what it was telling me. I have yet to find a real good breakdown of all that the data that sleepyhead gives us. I will say while hopping around to multiple forums, the folks who have responded to this specific thread seem to have a pretty good grasp on things, communicate really well and are consistently jumping in with what appears to be excellent knowledge. I have appreciated their involvement here.

Good luck on your hunt!

[robysue]

I'm also looking at my first set of data on sleepyhead -- but only for my first week. Is there someplace online with a glossary and what numbers are important or what the numbers should look like?

Pugsy has links to a SH glossary and a SH tutorial in her signature. These things are under construction, but they may still be useful to you.

Short story on the numbers:

AHI: You want the AHI < 5 on a daily basis. You may feel better if it's below 2.5. Or not.

Leak rate: The number you want for your leak rate numbers depends on the machine you are using, and if the machine reports the total leak rate, the desired numbers depend on the mask you are using and the pressure you are using. And after you know the expected leak rate number, then it's important to look at the leak rate graph as well as the just the numbers.

Pressure levels: If you are not using an Auto adjusting machine, the pressure setting will be constant and there's not anything to watch. If you are using an Auto adjusting machine in Auto mode, it's worth comparing the 90% (or 95%) pressure level to both the min and max pressure settings. Ideally you want that min pressure to not be too far below the 95% or 90% pressure level. And if the 90% or 95% pressure setting is equal to the max pressure setting, that may mean a small increase in the max pressure could be needed if the AHI is also high.

Usage: Ideally you want the mask on whenever you are in bed trying to sleep. In other words, the usage time should reflect your total time in bed. For compliance purposes, most insurance companies want to see Usage > 4 hours for at least 70% or 75% of the nights during the first 1-3 months of use. (How long the compliance period lasts depends on the insurance company.)

[jab1972]

Thanks robysue for the overview and Pugsy for the great links. It's good to know that the leak data varies with the equipment. My AHI has been <2 all week, but my leaks are sky-high compared to forgetcolor's (Average Total Leaks 42.21, 95% Leaks 57.00). Any user's of the PR System One & Mirage FX know how normal those leak numbers are?

[Pugsy]

s. It's good to know that the leak data varies with the equipment. My AHI has been <2 all week, but my leaks are sky-high compared to forgetcolor's (Average Total Leaks 42.21, 95% Leaks 57.00). Any user's of the PR System One & Mirage FX know how normal those leak numbers are?

Forgetcolor's leak numbers can't be compared to your leak numbers.
ResMed machines subtract the intentional leak/vent rate prior to reporting the leak. So theirs is excess leak.
Respironics machines don't subtract anything...instead they lump the intentional vent/leak rate in with the excess leak rate to give is Total Leak. You won't ever get a 0.0 leak because there is always the vent rate.
When you are comparing leak numbers make sure you are comparing like definitions.

Respironics does not give us a set Large Leak number but from past experience I don't get a Large Leak flag till I get somewhere between 85 and 90 L/min... Unless you use a 4 or 6 cm pressure I suspect that your leak numbers are quite acceptable. Watch the leak line on the graph if it stays fairly steady and well below the 90 L/min area...you are probably doing fine. Short excursions into Large Leak territory aren't the end of the world as long as they are short lived...they will mess with that 90/95% number though.

Mirage FX intentional vent rate will vary depending on the pressure used. The higher the pressure the higher the vent rate.
Here is a graph that shows various ResMed masks with various pressures...just compare your average pressure to the chart and see what your vent rate is.
http://www.resmed.com/us/assets/documen ... sa_eng.pdf

[jab1972]

Pugsy, at the risk of gushing, you're a treasure. At my pressure of 15, my leak is right around what's expected.

[forgetcolor]

Looks like your AHI is trending downward....this is great.
Give things some time. Your AHI is trending downward. Things look pretty good on paper. How are you feeling? Having frequent awakenings? Feeling decent enough? Are you okay with the 5 cm pressure?
The AHI that you are seeing....how much of that index is central? I know it won't be high because the AHI is not high but I mention it only in case you are tempted to do some tweaking with your pressure.
Remove the central index to see the obstructive components before evaluating need for perhaps a wee bit more pressure. If half of that AHI of 2 is centrals...there is no need for more pressure at all. Remember we don't treat centrals with increase in pressure on these machines. If an AHI of 4 has a central index of 2.5...there is no need to increase pressure.

Are 'centrals' indicated in sleepyhead as 'clear airway apneas', or CAs? (as opposed to hypopneas and obstructive apneas) I can't find any way to remove it from the calculation, but the overview does calc some averages:

AHI: 5.14
CA: 2.55
OA: 2.09
UA: 0.01
H: 0.56

So is this what you're referring to...that the CAs are about half the AHI, so a pressure tweak is not needed? Is this because the pressure mitigates obstructive apneas but not central apneas? Still trying to understand all this.

Also, what about the 'peak AHI' graph? There are some days that read 26 peak AHI (Mar 15). The daily report for that day says I had 53 CA, 11 Hypopneas, and 41 OA. This seems extreme to me, but maybe I'm not understanding it? However, as you note, this all appears to be trending downward too. I never had another day that bad in the next 15 days.

thanks for the help!

[forgetcolor]

Agreeing with pugsy:

The leaks look really good based on the numbers. With a 95% leak rate as low as yours, you don't have serious large long leaks. So you can cross that off the "worry" list.

I also agree with Pugsy that before just assuming you need a pressure increase that you need to look at the number of CAs. In the AHI graph, the daily CAI is graphically shown by the purple chunk of the bar. And there are lots of days where purple makes up the biggest chunk of the bar. The average CAI = 2.55 from the AHI graph. I'd be reluctant to increase pressure with these CAI numbers.

Usage hours look pretty good: It appears that you are using the machine all or most of the time. (What happened on March 26?).

The data presented in the "sessions" graph indicates that your bedtime is somewhat erratic and often very late (as in 4:00 AM). Are you a shift worker perhaps? The "sessions" data also indicates that on a fair number of days you are waking up enough to turn the machine off and back on during the night. That's a sign that you've still got some fragmented sleep issues. But there are also some nights where you've got a nice long chunk of uninterrupted mask time. My guess is that those are the nights you feel like you sleep all night with the machine on without waking up.

The critical question of course is: How are you feeling?

If you're not yet beginning to feel at least marginally better, it's likely because of a combination of a slightly too high AHI (overall) and somewhat fragmented sleep (overall). Some days that AHI is really too high (but it is trending down) and some days the sessions data indicate that you were waking up fairly often during the night. So if you're not feeling much different that you were before CPAP, you might want to keep a log that includes the following info:

That's the only way you will figure out if your remaining problems are more due to the AHI being a bit higher than we'd like to see or if your remaining problems are more tied to fragmented sleep

really glad the leak numbers are good. i feel pretty well adjusted to the mask but it's nice to see it confirmed.

i am trying to use the machine all the time (only in the first couple days was I only trying to get 4 hours in). On Mar 26 I took an Ambien and woke up 8 hours later and found I'd take the mask off in hour 1.

As for my bedtime, I have delayed sleep phase. 4am is my typical bedtime. Sometimes I have to force it earlier when the world demands I'm up earlier. I'm luck enough to have been able to organize my life in a such a way that it's not that often.

I turn the machine off whenever I need to get up to urinate or want to take the mask off for a second. Should I do something different? I am indeed waking up *a lot*.

I'm still feeling really sluggish and tired, but it does seem to be getting very slowly better. At first it was even worse than pre-CPAP, but it's not that bad now.

[Pugsy]

Are 'centrals' indicated in sleepyhead as 'clear airway apneas', or CAs? (as opposed to hypopneas and obstructive apneas) I can't find any way to remove it from the calculation, but the overview does calc some averages:

Yes....centrals are clear airway cessation of breathing..so we use the terms interchangeably.
Remember that the machine has only one dimension to evaluate whether the event is an open airway or a closed airway. So within the limitations of the machine (sometimes it will score awake or semi awake events that a tech in a sleep lab would discard) we call them either.

There is no way to remove the Central Index from the AHI in the software. You just need to mentally remove it.

So is this what you're referring to...that the CAs are about half the AHI, so a pressure tweak is not needed? Is this because the pressure mitigates obstructive apneas but not central apneas? Still trying to understand all this.

This is correct. We don't try to treat the central component of an AHI with pressure. It won't help and could make things worse.

Also, what about the 'peak AHI' graph?

Ignore it for now. It is mainly a way of looking to see how many events occurred within that hour.
The one really bad hour that you mentioned...could have been "awake" events being scored in error during one of your frequent wake ups. To give you an example..if we turn over in bed many of us will hold our breath. It is common and we simply don't realize that we do it. The machine doesn't know that when you hold your breath that is it on purpose so it may flag that episode as a central. Have a whole bunch of tossing and turning and likely the report will be pretty ugly but it is a false ugly. I really don't care for this particular feature in the reports as it is often misunderstood and causes panic.
I turned mine off. I don't even care to see that graph.

Now regarding how you feel. Better but not ready for a marathon yet?
If you are "waking up" a lot can you pin point the reason? Is it cpap related or just something that you do anyway and have for a long time? Fragmented sleep will wreck havoc on sleep architecture and if you don't get the normal cycles of sleep it makes things pretty difficult to have optimal feelings.
So try to evaluate why the frequent awakenings. Pain? Meds? Bed comfort? Mask comfort? Anything?
I myself had great numbers after some initial tweaking with some improvement but not "great". My main issue with fragmented sleep was due to pain in my back and pelvis. Every little movement caused pain bad enough to wake me up so I was having 20 to 30 awakenings a night. Once I got some meds to help with the pain and sleep...I felt noticeably better. Not the miracle but noticeably better.

So take a hard look at any reason for waking up. Sleep Hygiene...habit...cpap related...external things...anything and then work on those things. The cpap machine does a good job with the sleep apnea thing but doesn't work so great when the reason for fragmented sleep is unrelated to the actual sleep apnea events. CPAP doesn't fix bad sleep unless the bad sleep was related solely to the apneas.