Sleepyhead Question about Snoring

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birdwatcher
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Sleepyhead Question about Snoring

Post by birdwatcher » Fri Nov 08, 2013 3:13 pm

I've read alot about Sleepyhead in this forum and elsewhere but I haven't seen how to interpret the Snoring graphs. There are actually 2 - Vibratory Snore and Vibratory Snore 2. I don't think I snore but Sleepyhead usually reports anywhere from 2 to 20 snoring events of both types up to 1.0 on the graph with durations of 2-6 minutes. What is the measurement that is being used and what is the difference between Vibratory Snore and Vibratory Snore #2. Even more important, how does this impact quality of sleep? I thought cpap Tx was supposed to stop snoring. Why am I still snoring? During the sleep study I demonstrated only "soft snoring" so I should have almost none at this point.

Otherwise I'm doing well. I started cpap in July '13 with 2 wks off in August due to a trip. I'm diagnosed with mild to moderate sleep apnea. I tried out 4 different masks and am currently using a Wisp nasal mask. It seems to be working fairly well with only occassional leaks that don't wake me up. My AHI is between 3 and 4. I would like it to be lower but for now I think this is the best I can do and I feel pretty good. I'm just trying to understand more of the data and tweak my Tx if possible because I feel REALLY good when my AHI is 1-2 but that has happened only a few times.

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Re: Sleepyhead Question about Snoring

Post by robysue » Fri Nov 08, 2013 4:06 pm

birdwatcher wrote:I've read alot about Sleepyhead in this forum and elsewhere but I haven't seen how to interpret the Snoring graphs.
There's no official guide to how to interpret the Snoring information from SleepyHead. JediMark had to back engineer the snoring data from the PR machines and the information on why Encore presents the snoring data the way it chooses to present it is pretty scarce ....

And when you start analyzing the raw snoring data the decisions that Encore makes on how to present the snoring data just seem plain bizarre from a statistical point of view.
There are actually 2 - Vibratory Snore and Vibratory Snore 2. I don't think I snore but Sleepyhead usually reports anywhere from 2 to 20 snoring events of both types up to 1.0 on the graph with durations of 2-6 minutes. What is the measurement that is being used and what is the difference between Vibratory Snore and Vibratory Snore #2. Even more important, how does this impact quality of sleep?
Yes, once JediMark started back engineering the snoring data, he discovered that the PR machines were keeping track of two kinds of snoring data. Those of us who had access to Encore Pro and had data from both straight pressure mode and auto mode were able to help JediMark figure out just what the significance of those two kinds of snores are in the Encore/PR world are. Here's the run down as we now understand things:


VS snores
VS snores are recorded ONLY when a PR machine is running in Auto mode. If the machine is set to straight CPAP (or straight BiPAP), the machine will NOT record VS snores. If the machine is a model number 450/460 (System One PRO) or 650/660 (System One BiPAP PRO), the machine will NOT record VS snores.

VS snores have time stamps attached to them, but they do not have a "magnitude" number. In the Sleepy Head "events" list, when you look at the detailed information for each VS snore event, the number in parenthesis will always be a 0. But VS snores are the snores that cause the Auto algorithm to respond by increasing the pressure. (On a BiPAP Auto, it's the EPAP that is increased.) For each VS scored, the machine typically increases the pressure by 1 cm. Hence if there's a cluster of VS's, the machine will keep increasing the pressure until either the snoring stops or the max pressure setting is reached.

In Encore, the VS's do NOT seem to show up as tick marks in the Events table. But it's hard to say for sure. Where they do show up is on the wave form when you look at it in Encore Pro (or Encore Basic). Of course, Encore only downloads the wave form for the last night (or sometimes the last two nights) when you down load the data. Encore Pro at least stores all the previously downloaded wave forms in the patient's database, but Encore Basic only stores the last wave form. SleepyHead also puts tick marks for VS snores on the wave form data when a PR machine is running in Auto and the VS data is being recorded.

So---as near as anybody I know who follows such things can tell: The VS snores make up the part of the snoring data that is used by the Auto algorithm when it determines that the snoring is significant enough to warrant an pressure increase.


VS 2 snores
VS 2 snores are recorded by all PR machines. They have both a time stamp and a "magnitude" number attached to them. In the Sleepy Head list, when you look at the detailed information for each VS snore event, there will be a NON-zero number in the in parenthesis for that event. Whether that number represents the length the snoring went on or some kind of measure of the loudness of the snoring is anybody's guess. We really do not know the significance of that number.

JediMark's SleepyHead VS 2 graph uses the "magnitude" numbers for the vertical-coordinates in the Snore graph. In other words, JediMark has set the SH VS2 graph up with the assumption that the "magnitude" numbers are somehow related to how bad the snoring is. That's not a totally unreasonable assumption since you can have VS 2 events closely space together with some rather large "magnitude" numbers. But it is an assumption and there's no real way to verify whether this assumption is valid. That's why the units on the Snore graphs are labeled as "Unknown" when you hover the mouse over the vertical scale of the Snore graph.

The VS 2 snores show up in Encore (all versions) as tick marks in the Events table based on the time stamp of the VS 2 event. But the calculation of the VSI index in Encore is not as straightforward as you would expect.


The Snore Indices in Sleepy Head and Encore
SleepyHead calculates the VSnore Index shown in the left sidebar of the Daily Details data as follows:
  • SleepyHead VSnore Index = (# of VS scored during the night)/(run time for the night)
And so the SleepyHead VSnore Index is nothing more than the average number of VS snores detected in an hour of sleep (or more technically run time).

IMPORTANT NOTE: The VS 2 events are not used to compute this index. This is important because:
  • If you are using a PR System One PRO or BiPAP PRO, your SleepyHead VSnore index will always be 0.0 even if you are snoring like a freight train because these machines record only the VS 2 snores; they do not record VS snores.
  • If you are using a PR System One AUTO or BiPAP AUTO in FIXED pressure mode, your SleepyHead VSnore index will always be 0.0 even if you are snoring like a freight train because these machines record only the VS 2 snores when run in FIXED pressure mode; they do not record VS snores.
Encore calculates the VSI shown on the right sidebar of the Daily Detailed data in a really bizarre way. I can illustrate this with data from my own data. On July 31, 2013, I had 3 VS 2 snores scored for the entire night. In SleepyHead, the data looks like this:

Code: Select all

Vibratory Snore #2 3 events
   #001:  06:43:58 (2)
   #002:  06:54:13 (3)
   #003:  08:27:51 (1)
Vibratory Snore  1 event
   #001:  06:53:41 (0)
Total run time for the night was 5:31:47, which is 5.53 hours. In Encore, the VSI on the right side of the Daily Detailed Data panel is reported as VSI = 1.1. Now Encore only shows three snore tick marks in the Events table on the daily data---one for each of the VS 2 snores. And the Encore Pro wave form shows only one snore tick mark---the one for the VS snore. So the total number of (relevant) snores is either 3 or 4 depending on whether the VSI is computed using just the VS 2's in the Event table or both the VS 2's and the VS snores shown only in the wave form.

But it's obvious that 3/5.53 is NOT equal to 1.1 and 4/5.53 is NOT equal to 1.1. Hence Encore is not computing its VSI by simply dividing the number of VS2 snores recorded during the night by the time the machine was running. Nor is it dividing the total number of snores recorded during the night by the time the machine was running.

Instead, with a bit of mathematical backwards engineering, we can figure out that Encore computes the VSI for the night as follows:
  • Encore VSI = 1.1 = 6/5.53 - (2 + 3 + 1)/5.53 = (Sum of the "magnitude" numbers of the VS #2)/(run time)
And I've checked this "formula" out on many other nights---some with rather large numbers of snores and some with small numbers. And it always seems to be the case that:
  • Encore VSI = (Sum of the "magnitude" numbers for the VS 2's as shown in SleepyHead)/(run time for the night)
Why would Encore define the VSI (Vibratory Snore Index) in this way? I have no idea. Mathematically it makes no sense. If the snores are being scored as "discrete" events (the same way the Flow Limitations are scored as "discrete events") then the intuitive meaning of VSI would be the average number of events per hour, and VSI ought to be (number of snores)/(run time)

So that then leads to the following speculation: Is it possible that the "magnitude" number on the VS2 snores represents something other than loudness (severity) of the snoring? Perhaps the "magnitude number represents the length of time measured in (seconds? minutes? number of breaths?) that snoring was being detected? In that case, the Encore VSI would then represent the average amount of "snoring time" in each hour of sleep measured in (seconds? minutes? number of breaths?)


How does the machine detect snoring anyway??
The PR System One does not have a microphone attached to it. So it's not listening to the sound of your snoring. So how does it actually detect snoring?

It analyzes the wave form. When a person is snoring (at least when they're snoring loudly or persistently) there are some characteristic changes to the wave form, and the PR's analysis algorithms can pick that up. Exactly what the difference between the changes needed to score a VS and the changes needed to score a VS 2 are is anybody's guess. But some of the machines can be pretty sensitive to picking up vibrations that are coming from sources other than the patient's own airflow. If I recall, Pugsy says that her VS 2 numbers are strongly correlated to whether or not her snoring dog is sleeping in the bed with her. Other folks have noticed that they can make the machine score VS2's by causing the hose to rub against a sharp edge of the nightstand or the headboard. And so on and so forth. But that said, real snoring is picked up by the PR System One as well as false snoring. You basically have to look at patterns in your own data and learn to interpret based on what you know is going on at night and what you think might be going on at night.

I'm aware that my post has likely provided you with both far more (technical) information than you wanted and far fewer answers than you hoped for.

But hopefully this will give you some things to think about when looking at your own snore numbers.

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Last edited by robysue on Fri Nov 08, 2013 4:10 pm, edited 1 time in total.

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Re: Sleepyhead Question about Snoring

Post by robysue » Fri Nov 08, 2013 4:08 pm

birdwatcher wrote:I thought cpap Tx was supposed to stop snoring. Why am I still snoring? During the sleep study I demonstrated only "soft snoring" so I should have almost none at this point.
Like many other things with sleep disordered breathing, the machine will minimize the chances of snoring happening (once the pressure is right) but a bit of snoring is likely to get through now and then.

What kind of snoring numbers are we talking about?

And keep in mind that not all snoring comes from OSA related stuff. As I mentioned at the tail end of my post, sometimes these machines will pick up external vibrations and misinterpret those as "snoring." But sometimes the snoring is triggered by something other than OSA. For example, serious nasal congestion can trigger some snoring in a lot of people. It may only be a few snores here or there or it may be all night long. In my own data for example, one of the first signs of "spring" is a serious uptick in the snoring that is related to the start of Tree Pollen season and my spring allergies kicking in before I'm aware that trees are pollinating and the congestion is starting. It's happened all three springs that I've been on PAP. The snoring settles back down to "normal" as soon as I realize the trees are pollinating and I start treating the allergies with flonase and/or zyrtec to keep the nasal passages and the sinuses happy.

Otherwise I'm doing well. I started cpap in July '13 with 2 wks off in August due to a trip. I tried out 4 different masks and am currently using a Wisp nasal mask. It seems to be working fairly well with only occassional leaks that don't wake me up. My AHI is between 3 and 4. I would like it to be lower but for now I think this is the best I can do and I feel pretty good. I'm just trying to understand more of the data and tweak my Tx if possible because I feel REALLY good when my AHI is 1-2 but that has happened only a few times.
Sounds like you're doing pretty well at this stage of the game. That AHI may start to come down all by itself without any further tweaks once your body starts to heal and any residual inflammation dies down.

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Re: Sleepyhead Question about Snoring

Post by drifterdon » Fri Nov 08, 2013 4:55 pm

I have found that if I try to clear my sinuses that it interprets that as a snore. So does Encore.

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birdwatcher
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Re: Sleepyhead Question about Snoring

Post by birdwatcher » Sat Nov 09, 2013 2:27 pm

Robysue's post WAS a very technical answer but I think I found a possible reason for the recent INCREASE in snoring. I bought a white noise machine last month (to drown out the "breathing sound" on my machine now the AC season is over) and it sits on a shelf right below the cpap machine. I bet it's picking up some of the vibration from that! That would make sense because my AHI has been improving lately with the Wisp nasal mask and I couldn't figure out why the snoring was increasing. I do have both on rubber mats but maybe that's not enough. I'm actually not going to worry about it any further. Actually "worry" is too strong a word...be concerned about it is better. Thanks for the reply (on both forums!).

PS If a PUG can cause the machine to record snoring I'm sure a lot of things can!

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Re: Sleepyhead Question about Snoring

Post by Pugsy » Sat Nov 09, 2013 5:59 pm

birdwatcher wrote: PS If a PUG can cause the machine to record snoring I'm sure a lot of things can!



Here's what Sarge's snores looked like on my Encore report. He sometimes would sleep up by my head with his little chin on my shoulder right next to my neck.
Since he didn't always sleep up there I would have night's with no snores to speak of.
I only put 2 and 2 together one day when he was on the couch and had his chin on my thigh and was snoring up a storm (pugs snore a LOT) and I felt the vibration as well as heard it.
Here he started off the night with his chin on my shoulder. I think they are pretty easy to see.
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birdwatcher
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Re: Sleepyhead Question about Snoring

Post by birdwatcher » Sun Nov 10, 2013 3:06 pm

Your pug snoring is REALLY funny. Now that I see your results I'm not sure mine are from the white noise machine...they're not so OBVIOUS!

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Re: Sleepyhead Question about Snoring

Post by khauser » Mon Nov 11, 2013 12:28 pm

robysue wrote:I'm aware that my post has likely provided you with both far more (technical) information than you wanted and far fewer answers than you hoped for.

But hopefully this will give you some things to think about when looking at your own snore numbers.
But I'm glad you wrote it! I found it very interesting!!

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Re: Sleepyhead Question about Snoring

Post by Sleepy Pete » Sun Mar 01, 2015 10:01 am

robysue wrote:Why would Encore define the VSI (Vibratory Snore Index) in this way? I have no idea. Mathematically it makes no sense. If the snores are being scored as "discrete" events (the same way the Flow Limitations are scored as "discrete events") then the intuitive meaning of VSI would be the average number of events per hour, and VSI ought to be (number of snores)/(run time)
I'm pretty sure the number in brackets is the number of snores in the preceding two minutes and that a snore according to Philips is a breath with snoring.
Also, it looks like a VS2 flag in SH only shows if there was any snoring in the previous two minutes and if there was no snoring in that period then there's no flag.

That would mean there's a problem with how sleepyhead shows this data because one event flag can indicate either one snore or multiple snores.
For example on one night in my sleepyhead data the number in brackets varied between 1 and 38 and sleepyhead shows each of them as 1 event. Adding up all the numbers in brackets gave me 601 snores for the night and sleepyhead showed number of VS2 events as 76.
Also on the details pane sleepyhead shows VS2 as 11.19, a meaningless number as the VSi = 601/7 = 85 (these are approximate numbers)

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Re: Sleepyhead Question about Snoring

Post by palerider » Sun Mar 01, 2015 12:38 pm

Sleepy Pete wrote:
robysue wrote:Why would Encore define the VSI (Vibratory Snore Index) in this way? I have no idea. Mathematically it makes no sense. If the snores are being scored as "discrete" events (the same way the Flow Limitations are scored as "discrete events") then the intuitive meaning of VSI would be the average number of events per hour, and VSI ought to be (number of snores)/(run time)
I'm pretty sure the number in brackets is the number of snores in the preceding two minutes and that a snore according to Philips is a breath with snoring.
what are you basing this belief on? I'm not arguing, just inquiring as to whether there's any evidence, or if it's just purely conjecture.

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Re: Sleepyhead Question about Snoring

Post by Sleepy Pete » Mon Mar 02, 2015 2:51 am

palerider wrote:what are you basing this belief on? I'm not arguing, just inquiring as to whether there's any evidence, or if it's just purely conjecture.
Looking at my own data, I noticed...

1. The VS2 event flags never get closer than 2 minutes apart.
Image
Image

2. The VS2 event flag seconds are always the same and always the same as the start time seconds. (occasionally that's out by one second)
Image

3. The VS2 event flag minutes are always a multiple of 2 from the start time.
So if the session start time is an even number of minutes, the VS2 flags will always be on an even number of minutes.
Image

If the session start time is an odd number of minutes, the VS2 flags will always be on an odd number of minutes.
Image

That makes me think the events are triggered by a timer rather than an event.
(It seems unlikely that I snored exactly on 04:44:02, 04:46:02, 04:48:02, 04:50:02 etc. doesn't it?)
Image

Also robysue did the hard work and said...
robysue wrote:And I've checked this "formula" out on many other nights---some with rather large numbers of snores and some with small numbers. And it always seems to be the case that:

Encore VSI = (Sum of the "magnitude" numbers for the VS 2's as shown in SleepyHead)/(run time for the night)
So if the numbers in brackets always add up to the total number of snores in a night then I think they must be a count of the number of snores for a period of time within that night.

Put that together with the two minute timer and it looks like it's a count for each two minutes. The number is always non-zero so there's no flags created for the zeroes.

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Re: Sleepyhead Question about Snoring

Post by Guest1 » Mon Mar 02, 2015 10:00 am

If we assume that
1) the number in Brackets is no. Of snores in a 2 minute period.
2) And you can only snore once every breath.

you show an event with 32 snores in your SH list.

Is this consistent with your respiratory rate in that period ? Are you taking 16+ breaths a minute during that 2 minute time?

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Re: Sleepyhead Question about Snoring

Post by palerider » Mon Mar 02, 2015 12:07 pm

very interesting observations

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Re: Sleepyhead Question about Snoring

Post by Sleepy Pete » Mon Mar 02, 2015 4:29 pm

Guest1 wrote:If we assume that
1) the number in Brackets is no. Of snores in a 2 minute period.
2) And you can only snore once every breath.

you show an event with 32 snores in your SH list.

Is this consistent with your respiratory rate in that period ? Are you taking 16+ breaths a minute during that 2 minute time?
Yes it is, I count 37 breaths between those VS2 marks. The second is the one that showed 32.
Image

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Re: Sleepyhead Question about Snoring

Post by Guest1 » Mon Mar 02, 2015 4:55 pm

You may have finally cracked the VS numbers' puzzle. I will analyze my own data and report back. Hopefully some other members here can evaluate their own data and report.

If this works out, then Jedimark can use this information in the next release of SH.