What is this breathing pattern and why isn't it scored?

[ilatruman]

I have been using CPAP for about 1.5 weeks now. My AHI is always about 1.5-2/hr. However, looking through my SleepyHead data I'm seeing a whole bunch of breathing patterns like this that aren't scored as anything, but do not look like my normal breathing pattern most of the night. What does this look like and why aren't these being scored? Could my AHI be higher than my machine is reporting?

[ilatruman]

As a reference, here is what my breathing pattern looks like most of the night and an "overall" glance at the night.

[palerider]

wiki/index.php/Sleepyhead:Organize

[ilatruman]

Sorry, I will take new screenshots tomorrow. Didn’t realize I had to fix them. Thanks.

[Pugsy]

The machine does the scoring'flagging. Not SleepyHead.
So if there was no flag then it was because the machine didn't flag something.
There is certain criteria to earn a flag...duration and percent of flow reduction play a major part.
Something was lacking meeting criteria and that's why no flag from the machine.
Duration must be at least 10 seconds... 9.9 seconds of total cessation of breathing won't earn a flag.
Amount of air flow reduction needed to earn a flag is at least a certain minimum percentage and at least 10 seconds.

[ilatruman]

Thanks. I guess that makes sense. Some of them look longer than 10 seconds to me but who knows, I'm probably missing something else that doesn't flag them as an event.

More examples below.

[Pugsy]

Some of them are longer than 10 seconds...that's obvious.
What isn't obvious is the amount of flow reduction that is going on. We can't see that so easy sometimes.
Depending on the brand the criteria is a little different (like one brand uses 40% minimum and another might use 50% minimum) maybe you simply didn't have enough air flow reduction to earn the flag despite it obviously lasting longer than 10 seconds.

Example....suppose the criteria for a hyponea was at least a 40% reduction in air flow up to 79% (80 % and above gets the OA flag)..
suppose the amount of flow reduction was just 38%....won't earn a flag no matter how long it might last. Could last a minute and if it never hits 40 % reduction...no flag.

There's always duration in seconds and % of flow reduction involved in the criteria....must meet both to earn a flag.

Now in real life is there really that much difference between a 38% reduction and a 41% reduction...not really in terms of the effects on the body but there has to be some lines somewhere and that's what everyone decided to use. It is what it is.
If it were me and I was seeing a LOT of this sort of unflagged stuff and I wasn't feeling so great or sleeping so great...I would tend to want to increase the pressure a bit even if the AHI was already low. Just to see if smoothing out the breathing maybe would help how I sleep and feel.

Now I would also make sure I was worried about asleep breathing and not awake breathing irregularities.
Before trying to fix something with more pressure make sure it is fixable with more pressure kind of thing.
Go here and read and watch the videos so you can learn to spot the difference.
http://freecpapadvice.com/sleepyhead-free-software
Quite a bit of what you have shown appears to be SWJ to me and not real asleep breathing. SWJ...sleep/wake/junk
A lot of SWJ means crappy sleep...lots of arousals that we may or may not remember.
Might be related to airway issues and might not. It's not always easy to figure out the cause of a lot of SWJ stuff and then even harder to fix it when it is unrelated to the airway itself.

[ilatruman]

Thanks so much!

I am still feeling tired and needing about 9 to 10 hours of sleep at night. This is my CPAP trial and I have a titration study end of December. I will definitely watch the video and consider raising the pressure a bit if I think it’s sleep related.

[Julie]

Oh, just raise it a bit - you may be surprised at what a difference it makes, and it's very unlikely to do any damage in a few days (to at least prove to you what a diff. it made).

[palerider]

Thanks so much!

I am still feeling tired and needing about 9 to 10 hours of sleep at night. This is my CPAP trial and I have a titration study end of December. I will definitely watch the video and consider raising the pressure a bit if I think it’s sleep related.

If it were me, (yeah, I'm a rebel), I'd switch it to auto, with a minimum pressure of 8, and see if that doesn't help (it should).

[ilatruman]

I’ve switched it to 8 to 14 the last three nights and 95% of my night is spent at 10.5 to 11.5. So tonight I am going to raise my minimum pressure to 9. My mask is leaking quite a bit now that I have higher pressure though. It wasn’t leaking at 8.

[palerider]

95% of my night is spent at 10.5 to 11.5.

If you mean that your 95% number on the machine is somewhere between 10.5 and 11.5, then that means you spent 95% of the night at *or below* that pressure.

The 95% number is commonly misunderstood... it's basically a more reasonable 'max' number, just with any brief peaks lopped off.

[Pugsy]

95% numbers of anything (pressure or leak) really are just numbers that are easily skewed to the high side by a relatively short period of time at higher numbers.
It is NOT where we spend 95% of the night like some people tend to think.

If someone wants to use a number from the reports as a guideline where to put the minimum pressure on an auto adjusting machine then the median average or true average might be a more suitable minimum pressure for most people....or something in that neighborhood.
My own minimum is 7 cm...but my true overall average for the night is about 9.75 and 95% pressure long term 1 year average is around 13 or 14 cm with the AHI running long term average of around 1.0.
I often see much higher pressures only for a small part of the night when I am in REM...those relatively short periods of time elevate that 95% number significantly and might make someone I need higher pressures all night but I don't. I do quite well with the current minimum of 7. I don't need 9 minimum much less anything close to the 13 or 14. And heck, I have seen 18 cm 95% numbers on occasion.

Now some people might be seeing 90/95% numbers close to their true average...but not everyone will.
So we have to be careful how we are using that 95% number for anything. Sometimes it doesn't really tell the true story.

[ilatruman]

Thank you. That makes sense! My average is about 9.5 to 10.5 depending on the night and my 95% is 10.5 to 11.5 depending on the night. So perhaps 8 to 12 is a more suitable pressure. I had it at 9 to 14 last night and for some reason my AHI is higher than it was when my minimum setting was 8. I'm also having so many more mask leaks now that my pressure is higher. At 8 I didn't really have leaks and now there are always periods of "large leaks" during the night.

This was last night.

[palerider]

For future charts, please redo them like this: wiki/index.php/Sleepyhead:Organize

I'd bump your min pressure up to 10.6, maybe 11, based on the way your pressure line is bouncing around.