5 months later..

[huydts]

Hello ,

So my 2nd night with 9 - 11.5.
Im not sure if i had a good nights sleep... dont think so tbh.
I woke up pretty crappy. And Sleepyhead said for the 1st time there where periods with excessive leaks.
I also remember waking up cause of air escaping.
And i remember waking up cause of a very dry mouth ( but i had turned down the heater and humidifier a litle bit )

When i tighten the p10 it will hurt my nose, even now my nose is red and irritated ... switch to dreamwear under the nose? ( less prone to leak, but slightly less comfy )or stick with this one.

Alright here are the stats:




Lets we what you can say about this Pugsy ... i have faith in you.

[Pugsy]

Leaks...or lack of large leaks in this case.
SleepyHead's statistic for percent of time over the red line is in error. I don't see any large leak flags over on the Events graph. See the LL line on the Events graph? If you had any large leaks reported by the machine itself they would show up on that LL line in gray color flags and you would see it on the leak line graph as well.

SleepyHead (and OSCAR for now) default to a red line leak threshold for a ResMed machine in terms of L/min and Respironics machines don't use the same number. So let's fix the threshold so it won't be in error any more and confuse you.
Either ignore that statistic or change the default threshold to something more in line with your machine.
Preferences/CPAP tab and on the right side you can change the default 24 L/min to something more in line with your machine. There's not a fix threshold though to use because the red line varies with pressures used and the masks uses but something up around 70 L/min would be a nice conservative red line threshold. What I suggest though is even if you change the red line number...just eyeball the graphs for large leak flagging. That's the true leak reporting in terms of large leak.
But even if you had spent 1 % of the time in large leak I wouldn't bat an eyelash at 1 %....heck I don't even give it a second look until I hit 10%.

What does bother me is you say you woke up several times with some small leaks. I know they were small because there are no large leak flags. Any leak no matter the size that wakes us up is a problem because it is disturbing sleep. Anything that disturbs our sleep is unwanted but because of the disturbing sleep factor and not necessarily anything else.
Remember....sound sleep as best we can with minimal disturbances is the goal. Without sleep the rest of the stuff doesn't really matter all that much.

The P10 can be a bit tough of the nose when first using it especially if someone tightens it too much. Heck, when I first started using the P10 I felt like I had run into someone's fist with my nose for a week. And I had years of nasal pillow mask experience behind me.
I also didn't wear it tight at all. It doesn't have to be tight to keep the pillows in place.
Minor tenderness is expected and that's the limit as far as I am concerned...no breaking of the skin or blistering or extreme pain or redness is allowed. If any of that occurs then either the fitting is incorrect or the wrong size nasal pillow is being used.

There is a product in the US call Lansinoh lanolin cream/ointment. Breastfeeding mom's use it on their nipples. I am betting there's something similar in your country. Totally safe for babies and cpap masks. Use it liberally during the day and a tiny dab at night to help promote healing. It works well. One tube will last forever. I found mine the other day that I got over 10 years ago. Half used up.
After a period of time the nostrils won't need the added help as you get better with the fitting and the nostrils get used to having something touching them all night. They get sore easily because they really haven't ever had much touching them. Part of the reason they get sore so easily when we have a cold and have to wipe our nose a lot. Virgin territory.

Now about your results last night. You admit a crappy night's sleep last night...minor leaks didn't help. Might be some false positive flagging going on but I am fairly certain enough real flagging going on to confirm the need for more maximum pressure but again I am being extra cautious because I don't want to open the door for the aerophagia monster.

Interesting that your machine maxes out in a cycle/pattern that looks very suspicious for REM stage sleep activity. I am betting that your OSA is worse in REM. It's really common so not unusual at all. I have it myself. My OSA is 5 times worse in REM and I often need a lot more pressure in REM. We can't do anything about REM nor would we want to if we could. We need REM as part of the normal cycling of the sleep stages. Google "sleep stages" and look at the normal hypnograms and you can see when REM normally happens.
Whatever the cause though (either REM or supine sleeping) the fix is more pressure and in your case for right now more maximum.

Let's try 12 max tonight and see what happens .....crossing my fingers that the aerophagia monster visits someone else tonight and doesn't come to your house.

Stick with the P10 for now if you can. I hate to add in a different mask unless no choice. Get some of that lanolin cream and use it.
Maybe change size of pillows...don't try to get it too tight. The pressure inflating the mask is what actually does the majority of the holding the pillow in place. The straps are for guides.

[huydts]

Leaks...or lack of large leaks in this case.
SleepyHead's statistic for percent of time over the red line is in error. I don't see any large leak flags over on the Events graph. See the LL line on the Events graph? If you had any large leaks reported by the machine itself they would show up on that LL line in gray color flags and you would see it on the leak line graph as well.

SleepyHead (and OSCAR for now) default to a red line leak threshold for a ResMed machine in terms of L/min and Respironics machines don't use the same number. So let's fix the threshold so it won't be in error any more and confuse you.
Either ignore that statistic or change the default threshold to something more in line with your machine.
Preferences/CPAP tab and on the right side you can change the default 24 L/min to something more in line with your machine. There's not a fix threshold though to use because the red line varies with pressures used and the masks uses but something up around 70 L/min would be a nice conservative red line threshold. What I suggest though is even if you change the red line number...just eyeball the graphs for large leak flagging. That's the true leak reporting in terms of large leak.
But even if you had spent 1 % of the time in large leak I wouldn't bat an eyelash at 1 %....heck I don't even give it a second look until I hit 10%.

What does bother me is you say you woke up several times with some small leaks. I know they were small because there are no large leak flags. Any leak no matter the size that wakes us up is a problem because it is disturbing sleep. Anything that disturbs our sleep is unwanted but because of the disturbing sleep factor and not necessarily anything else.
Remember....sound sleep as best we can with minimal disturbances is the goal. Without sleep the rest of the stuff doesn't really matter all that much.

The P10 can be a bit tough of the nose when first using it especially if someone tightens it too much. Heck, when I first started using the P10 I felt like I had run into someone's fist with my nose for a week. And I had years of nasal pillow mask experience behind me.
I also didn't wear it tight at all. It doesn't have to be tight to keep the pillows in place.
Minor tenderness is expected and that's the limit as far as I am concerned...no breaking of the skin or blistering or extreme pain or redness is allowed. If any of that occurs then either the fitting is incorrect or the wrong size nasal pillow is being used.

There is a product in the US call Lansinoh lanolin cream/ointment. Breastfeeding mom's use it on their nipples. I am betting there's something similar in your country. Totally safe for babies and cpap masks. Use it liberally during the day and a tiny dab at night to help promote healing. It works well. One tube will last forever. I found mine the other day that I got over 10 years ago. Half used up.
After a period of time the nostrils won't need the added help as you get better with the fitting and the nostrils get used to having something touching them all night. They get sore easily because they really haven't ever had much touching them. Part of the reason they get sore so easily when we have a cold and have to wipe our nose a lot. Virgin territory.

Now about your results last night. You admit a crappy night's sleep last night...minor leaks didn't help. Might be some false positive flagging going on but I am fairly certain enough real flagging going on to confirm the need for more maximum pressure but again I am being extra cautious because I don't want to open the door for the aerophagia monster.

Interesting that your machine maxes out in a cycle/pattern that looks very suspicious for REM stage sleep activity. I am betting that your OSA is worse in REM. It's really common so not unusual at all. I have it myself. My OSA is 5 times worse in REM and I often need a lot more pressure in REM. We can't do anything about REM nor would we want to if we could. We need REM as part of the normal cycling of the sleep stages. Google "sleep stages" and look at the normal hypnograms and you can see when REM normally happens.
Whatever the cause though (either REM or supine sleeping) the fix is more pressure and in your case for right now more maximum.

Let's try 12 max tonight and see what happens .....crossing my fingers that the aerophagia monster visits someone else tonight and doesn't come to your house.

Stick with the P10 for now if you can. I hate to add in a different mask unless no choice. Get some of that lanolin cream and use it.
Maybe change size of pillows...don't try to get it too tight. The pressure inflating the mask is what actually does the majority of the holding the pillow in place. The straps are for guides.

Good day Pugsy!


Thanks again for your detailed analysis, appreciate that.
You are right about the shallow wake ups caused by the air leak squishing sound is disturbing my sleep.
And we all know what disturbed sleep does ...

If that happens lets say 5 times a night that's 5 disturbances of my sleep cycles...

At this moment i'm at work ( late shift ) and I feel okay scale 1 tot 10 = 6.0

Tonight I will increase pressure to 12. And I ask my wife to go buy lanolin as we speak.

Do you recommend a chinstrap? or don't you think I breath trough my mouth..

I will follow your advice and try the cream. Its probably better to stick with p10 and get used to them. However your mask looks pretty comfy aswell.
The nose pillows should be OVER the nostrils right? Not IN them

Much thanks again! and enjoy your day

[Pugsy]

Yes...nasal pillows rest gently on the outside of the nostrils...none of the base or rim of the pillow should ever be inside the nostril.
I had to move up from the XSmall P10 nasal pillow to the Small because the XS kept trying to crawl up inside the nostril. Too small for my nostril opening. When it did crawl up then it would constrict the air flow and I would wake up from lack of air movement...stifling.
Now the tiny tip of the inner cone will be inside the nose but it should never actually be touching anything inside the nose. Should never actually be noticed or felt.

We all have wake ups during the night that we don't remember. Very brief and we aren't awake long enough to form a memory of the awakening. Like it's normal to awaken briefly after a REM cycle. Not normally a problem in terms of the sleep cycle progression either but when we remember a wake up then it means we were awake long enough to form a memory and that potentially will mess with the sleep cycle progression along with the normal needed percentages of each sleep stage and we all know that the restorative powers of sleep depend on us getting the normal amount in each sleep stage.

I see no reason on the leak graphs to add a chin strap into the mix at this time based on need to reduce any potential mouth leaking unless you think that the mouth leaking (even if it's a small amount) is contributing to the wake ups from small leaks.
I have done the chin strap thing. It's another thing to add to the comfort overall that can sometimes cause its own sleep disruptions.
Also the leaks you are seeing might simply be mask movement leaks and not related to mouth breathing.
Now if you feel your mouth is opening just a little and letting a little air out and it's contributing to the wake ups...you can try a chin strap but all it does is provide a gentle reminder to not open the mouth. It won't necessarily stop the mouth from opening a little. It simply cannot be tight enough to prevent the mouth from totally opening. It's really just supposed to prevent massive jaw dropping mouth opening. Clench your teeth together...keep them clenched together....open your lips and breathe...easy to do.
Now if you really want to make sure the lips stay closed...tape the lips together.
Everything we do comes with its own baggage...pros and cons.
So I personally like to limit the baggage potential unless I just absolutely have no choice.

Now here's another look at your wake ups...you are still having enough OAs and hyponeas that could also be causing wake ups.
It is entirely possible that the OA caused the wake up and you just happen to notice a small leak that you previously had been sleeping through.
Maybe if we can better prevent the OA potential wake ups causes you could sleep through minor leaks....Your OAs and hyponeas need to be reduced anyway....that's a known for sure thing we need to do. I would much rather target that known problem right now and then once those are hopefully reduced to an acceptable level then we look at what is left to deal with in potential wake up causes.
Fix the known problem first if at all possible and then deal with any leftovers later.

So your choice if you want to add a chin strap or not but from the reports themselves....I don't see a need and wearing a chin strap comes with its own baggage which can also impact sleep quality.
Nothing is ever simple.

[huydts]

Yes...nasal pillows rest gently on the outside of the nostrils...none of the base or rim of the pillow should ever be inside the nostril.
I had to move up from the XSmall P10 nasal pillow to the Small because the XS kept trying to crawl up inside the nostril. Too small for my nostril opening. When it did crawl up then it would constrict the air flow and I would wake up from lack of air movement...stifling.
Now the tiny tip of the inner cone will be inside the nose but it should never actually be touching anything inside the nose. Should never actually be noticed or felt.

We all have wake ups during the night that we don't remember. Very brief and we aren't awake long enough to form a memory of the awakening. Like it's normal to awaken briefly after a REM cycle. Not normally a problem in terms of the sleep cycle progression either but when we remember a wake up then it means we were awake long enough to form a memory and that potentially will mess with the sleep cycle progression along with the normal needed percentages of each sleep stage and we all know that the restorative powers of sleep depend on us getting the normal amount in each sleep stage.

I see no reason on the leak graphs to add a chin strap into the mix at this time based on need to reduce any potential mouth leaking unless you think that the mouth leaking (even if it's a small amount) is contributing to the wake ups from small leaks.
I have done the chin strap thing. It's another thing to add to the comfort overall that can sometimes cause its own sleep disruptions.
Also the leaks you are seeing might simply be mask movement leaks and not related to mouth breathing.
Now if you feel your mouth is opening just a little and letting a little air out and it's contributing to the wake ups...you can try a chin strap but all it does is provide a gentle reminder to not open the mouth. It won't necessarily stop the mouth from opening a little. It simply cannot be tight enough to prevent the mouth from totally opening. It's really just supposed to prevent massive jaw dropping mouth opening. Clench your teeth together...keep them clenched together....open your lips and breathe...easy to do.
Now if you really want to make sure the lips stay closed...tape the lips together.
Everything we do comes with its own baggage...pros and cons.
So I personally like to limit the baggage potential unless I just absolutely have no choice.

Now here's another look at your wake ups...you are still having enough OAs and hyponeas that could also be causing wake ups.
It is entirely possible that the OA caused the wake up and you just happen to notice a small leak that you previously had been sleeping through.
Maybe if we can better prevent the OA potential wake ups causes you could sleep through minor leaks....Your OAs and hyponeas need to be reduced anyway....that's a known for sure thing we need to do. I would much rather target that known problem right now and then once those are hopefully reduced to an acceptable level then we look at what is left to deal with in potential wake up causes.
Fix the known problem first if at all possible and then deal with any leftovers later.

So your choice if you want to add a chin strap or not but from the reports themselves....I don't see a need and wearing a chin strap comes with its own baggage which can also impact sleep quality.
Nothing is ever simple.

hey!

back from my late night shift..

i wont use the chinstrap, it indeed is extra discomfort.
it would be great if we could just decrease the apnea's especially if they are waking me up!
I'm a litle pessimistic about that, but then again you seem to know what you are talking about.

That alone is very motivating, and when being motivated sleeping goes better then when being hopeless

anyway, today working went allright, pretty tired during the day, but hey i had days much worse!

im gona apply the lanoline creme and increase the pressure to 12, lets see how it goes.

I think you still have a whole evening to enjoy, so enjoy it!

Im off to bed, ill be posting again tomorrow.

NN

[huydts]

Hello there! its me again.

Tonight was a special night.

Let me explain.

I slept pretty good and deep, but woke up approx 3 times cause of my child crying.
After i woke up i fell back to sleep instantly cause my wife went to take care of our daughter.

Next to those 3 times i woke up enough to realise air was coming out of my mouth. I then shut my mouth and fell back to sleep.
This might have happened 2 times, not sure.

BUT my AHI is pretty nice, only 2.9x,

I woke up very tired, took a 30 min shower and went to work..

Surprisingly the day @ work went very well! I had enough energy for the whole day!
It even felt sometimes like i was having ADHD or something, felt pretty good though ^^

Even now ( dinnertime ) i came back to house, started cooking and i am now waiting for my wife an kid to come home.

The creme you advised pugsy did a very good job aswell.. It acted like a sealing and a moisturer at the same time, very good tip!

Ofcourse now i am affraid previous night and this day are an exception ( had them before but theyre very rare! )

If not, this is a very very good trend!

Would you wanna look at my stats again pugsy and think about the air coming out of my mouth?
Is it a thing i shouldnt worry about? lets shine your light on it again since we now know 4 sure i sometimes open my mouth ( or is it blown open? ) ( dunno for how long )
would you also wanna do a reccomendation about the pressure seetings? keep or slightly adjust?

Thanks in advance!

Nick

[Pugsy]

If you did much mouth breathing it sure wasn't much because the leak line is fine and what we would expect.
If it continues to wake you up much let's talk about things to maybe reduce it later. I don't want to make major changes based off one night and I don't see an urgent need to anyway.

Primary goal right now....get you actually sleeping with the mask that you prefer to use with minimal issues.
Always remember....without sleep none of the numbers matter.

I wouldn't be surprised to see that a few of those flagged events were related to either the baby causing the wake up or maybe the mouth opening ....either can cause arousal related flagged events. At this point I wouldn't worry too much about the cause though.

It's one night...and a good night...followed by a good day. Don't worry so much about not waking and feeling immediately refreshed.
I am still waiting for that myself. I have never in my life been a morning person and I really can't expect cpap to make me into something I never was.
There is a thing called sleep inertia when we wake in the middle of a sleep stage instead of at the end and it's known that we can feel rather groggy when that happens.
https://valleysleepcenter.com/12-facts- ... p-inertia/
I don't know that this is what you might be experiencing but it is possible.

I see no reason to increase the max based on last night's report...you never hit 12 anyway...got close and even if you had hit 12 as long as it wasn't prolonged at 12 I don't know I would do anything about it. Ever mindful of that aerophagia monster lurking in the shadows.

I still am on the fence about the minimum because there is a possibility that some of your AHI is still SWJ due to the wake ups.
Let's not change anything and see if we can establish a trend (and a good one) and then see if we can get a night without very many wake ups to potentially muddy up the AHI evaluation.
Maybe if this becomes a trend we then put the flow rate under the microscope to see if the events are real asleep events or SWJ.
I don't really have the time to do all that extra work right now anyway....what with Turkey day looming on the horizon and all the extra work I have to do here. Gotta clean before I even start cooking.
Besides we might get lucky and get an answer without having to go digging around for one.

[Pugsy]

About this mouth breathing thing...not all mouth breathing will show up as massive leaks on the leak graph because not all mouth breathing equals a massive exodus of the therapy pressure out the mouth.
A while back I happened to wake up mouth breathing.....very gentle mouth breathing with no blast or tornado of air out the mouth.
It was at my normal wake up time so I didn't wake up because of the mouth breathing. I had a bit of time so I decided to just lay there and continue mouth breathing so that I could actually see what mouth breathing can look like on the leak graph.
I did about 10 or 15 minutes of the mouth breathing until I got bored and decided I needed to get up to pee anyway.

Below is the leak graph for that night. The known mouth breathing time is circled in red. It's barely noticeable. It's a ResMed machine so the graph looks a little different than yours will look but I think you can get the idea well enough.
The other parts of the leak graph where the leak was much larger...dunno what was going on because I slept through it. Might have been simply mask movement and that's kinda where I am leaning. I used to assume mouth breathing but ever since I began using the Bleep mask which never moves or leaks I really don't see that kind of large leak anymore. What I do see now with the Bleep sometimes is little leaks very similar to the known mouth breathing leaks at the end of the night. I am thinking that my P10 was moving around a lot more than I was thinking it was. This report is with a P10 nasal pillow mask. One of the drawbacks for me with that mask was the back strap would sometimes slide up the back of my head a bit and the pillows would dislodge a little.

[huydts]

heya,

step by step im learning more and more.
So not everybody wakes up super refreshed in the morning.
I have never done that myself indeed... even when i didnt have apnea i wasnt a morning person.

On most pages on the net you read that you need to wake up refreshed in order to have had a good nights rest.
Especially when on cpap... so thats not for everybody the case.. good to know... It might be sue to sleep inertia aswel... but who cares if the day after is generally okay?

can you explain what a ''flagged event'' is? i think you mean a flagged event is either a hypo, obstructive or central right?
Does the machine record all events? or do they have to be at least 10 seconds or something?

Lets say i wake up cause of the baby, how can that cause a apnea? im not gona hold my breath cause of that, or am i thinking wrong.
I can imagin a slightly opened mouth can cause an event due to pressure drop...

sorry if i ask to much, but im eager to understand how all is working, and im even more eager on regaining my energie on the long run.

thanks again, en sleep well for tonight!

BTW .. had to laugh XD ''I did about 10 or 15 minutes of the mouth breathing until I got bored and decided I needed to get up to pee anyway. ''

[Pugsy]

Flagged events like OA, hyponea or central/CA apnea have to be at least 10 seconds long in duration to earn a flag.

The machine only measures air flow....it doesn't have a clue if you are awake or asleep. It only measures the air flow.

Here's the deal with awake/semi awake breathing....it's very irregular when compared to asleep breathing so when we are awake sometimes that irregular breathing will cause the machine to flag some sort of event but we are awake. If we are awake it's not a real event. We have to be asleep for it to be a real event.

Watch all the videos here
http://freecpapadvice.com/sleepyhead-free-software
While he is mainly talking about central apneas it can really be any category of apnea event that gets flagged by mistake or while we are awake.
The more awake time we have....the greater the chance of some false positive flagging happening.

A while back I had a night where my AHI was 3.6....a nice mix of all 3 categories. Now this is unusually high for me so I decided to take the time to actually look at my breathing to see if I was really asleep or not when the flagging happened.
It also happened to be a night that I just had a really crappy night of sleep with a gazillion wake ups because of back an pelvic pain.
I knew that I did a LOT of tossing and turning trying to get comfortable.
So I zoomed in on each event to see how many of them I was actually asleep when they were flagged. Asleep breathing is fairly easy to spot when compared to awake breathing. Prior to every single flagged event that night I saw huge indications of being awake and a lot of the time the flag was right in the middle of obvious awake breathing. Every single flagged event was so obviously awake/arousal related it was easy to spot. Sometimes they aren't so easy to spot.

So on the face of it without knowing that I already knew that I had a crappy night of sleep someone might think I needed more pressure and the higher than usual AHI was the cause of the poor sleep but the pain was the culprit in my case.

The machine doesn't know if I was awake or asleep though...and it responded to the OAs that were really false positives with an increase in pressure. The machine will do it's job based on what it thinks is happening.
The machine is easily fooled...it's not perfect. It simply cannot tell the difference between awake breathing irregularities and asleep breathing. It just measures the air flow or lack of and calls it like it sees it.

So with your history of wake ups...from the baby or leaks or whatever...I can safely assume that there is a substantial chance of some false positives being flagged...how many I don't really know and can't know unless I take the time to examine each flagged event along with the flow rate/breathing that happened just prior to the flag.

This is why I have been harping on improving your sleep quality so much....I want to reduce the chance of the false positives muddying up the waters making it hard to know just how close we are or aren't in getting your OSA pressure treatments optimized.

I have some major issues with arthritis and pain and thus crappy sleep. My AHI is almost always about 90% false positive SWJ. It's just the way it is because I don't sleep so soundly because of the pain. I do a lot of tossing and turning and I remember a lot of wake ups.
It's extremely rare for me to have a night where I don't remember a large number of wake ups from turning over in bed trying to alleviate the pain.

Here below is an example of a false positive hyponea flag. The asleep breathing is circled in red.
Everything after the circled area the breathing pattern indicates I was likely awake (may or may not always remember it though).




Now these two flagged OAs below...probably real. Notice how the breathing before and after is nice and rhythmic and even and I was probably asleep.

[huydts]

very very clear explanation.

That could be the cause in my case aswell since a toss and turn pretty much aswell...

So when i turn around sami awake and hold my breath for just 2 seconds, will it then flag it as an obstructie apnea??
And when tossing or turning, that mostly takes max 3 to 4 seconds right? how can that cause an event of lets say 9 -> 18 seconds?

And you say the machine only flags events of 10 seconds and longer, but sleepyhead also shows events with duration of 6/7/8 etc seconds?


Tonight i do remember waking up a few times, most of them where due to the irritating leaking sounds ( will tighten it next night a litle bit ) and 1 time to take a pee.
Despite waking up few times a have the idea a slept pretty good. I didnt wake up as tired as yesterday strange enough.. but my AHI is pretty high... I Also slept a litle bit too long i guess? 9.5 to 10 hours.

so, heres my graph again..



i have many many more questions, but im alrdy late for work so.. appologys for my short and maybe unclear post.

Cya, and enjoy your day!

[Pugsy]

And you say the machine only flags events of 10 seconds and longer, but sleepyhead also shows events with duration of 6/7/8 etc seconds?

Respironics machines don't actually flag duration...what you see in the parentheses are some sort of marker system that we don't know just what it does. It's a close indicator to duration in most situations but it really isn't duration. ResMed machines are the only machines that actually measure duration of the OAs or central apneas and even they don't measure hyponea duration.
SleepyHead/OSCAR can only report what the machine reports. Here in the states we would say that this is close enough for government work...meaning less than perfect but close enough. If you were to actually zoom in on those events with 6 to 9 in parentheses you would likely see that if you count the seconds manually where the air flow is restricted it probably barely meets the 10 second minimum criteria.
Future versions of OSCAR won't take the liberty of assuming duration because it isn't...software should report the facts only...whatever the machine deems as facts and not make assumptions.

So when i turn around semi awake and hold my breath for just 2 seconds, will it then flag it as an obstructie apnea??
And when tossing or turning, that mostly takes max 3 to 4 seconds right? how can that cause an event of lets say 9 -> 18 seconds?

It might or might not flag anything and if it does flag something it might be OA or central/CA or hyponea.
And don't assume that your irregular breathing when tossing and turning stops immediately once you stop moving...it might and it might not.

Now...about last night....your machine hit 12 for brief periods some of which correspond to OA clusters and I see at least one time with an OA cluster and no real pressure change around the 1:30 mark.
The minimum isn't doing a good job and the machine isn't increasing the pressure as much as I would expect in this situation.
The machine responds to more than just OAs...flow limitations and snores are also a factor and maybe you just weren't having much in the way of FLs or snores when the machine didn't do much. Like at that 1:30 time frame. Maybe those OAs aren't real asleep OAs.

Nocturia...common symptom of sleep apnea and while I know there are other causes for nocturia...the fact that you still have to pee in the middle of the night lends me to believe the sleep apnea side of things still isn't well treated. My nocturia going away was the first sign that my cpap therapy was working....it went totally away. It's rare that I have to get up and pee in the middle of the night now.

So while I do think some of your flagged events are SWJ stuff...I still think you are having more real asleep events than we want to have...unless you have prostate issues complication the nocturia situation and unless you are an old dude with a new baby (it does happen) it's not very likely.

How do you feel about increasing the minimum either 0.5 cm or 1.0 cm? I think that is less likely to invite the aerophagia monster than increasing the max and the machine doesn't seem to be doing all that much increasing anyway.

After my Thanksgiving holiday stuff is over with and I have some time I think I need to get a copy of your SD card so that I can look through the flow rate zoomed in and see just how many SWJ vs real flagged events you are having.
Do you know how to compress and entire SD card contents in one step?

[huydts]

Hey Pugsy Good evening, or day for you right?

Thanks for your good explenation.
I Didnt knew the numbers didnt represent duration. Pretty useless to show them if they arent acurate though.
I agree we need facts. Will count it manually like you said.

So, during the day i sometimes hold my breath for like 1 to 3 seconds . i do it in my subconsciousness.
I might be doing it in my sleep aswell. So if i hold my breat for 1 sec in my sleep, that counts as an obstructive apnea?

Kinda weird if theres a OA cluster happening without snore or FLs the machine isnt responding?! The machine doesnt know if im awake or not after all.
So what i mean is, if i hold my breath cause of tossing, the machine should be increasing pressure anyway right? Or i'm still not getting it ^^

Today i got my results of the blood tests to exclude other underlying ilnesses.
Outcome was positive , so no underlying ilnnes like a slow working thyroid, diabetes or lack of vitamins or someting else.

Sometimes i have to pee twice a night, and thats even while i pee'd right before going to sleep.
But i remember before apnea was being treated it even was worse, sometimes 3 times a night.

I do drink a tiny bit before bedtime, just 1 glass of water or whatever. I am always a litle thirsty when going to bed. Should i rlly stop doing that?

I still dont know if my sweaty lower legs have anything to do with my apnea, but i have them during parts of the night thats for sure.

I am okay with increasing the minimum pressure ( i love ramp feature )
I dont care if its 0,5 or 1.0 what do you think is best, 1.0? then ill increase it to 10.0. So the machines settings will be 10 to 12 right?
Ill be doing that this night.

I do know how to compress the SD files i think. You mean so i can send it by email or something right?

So Pugsy why are you helping me out every day? Dont you have anything better to do? No serious i really apreciate! When my fam, friends or collegues ask me how things are going with the apnea,
I tell them i have met some one on the internet from the states who has lots of experience with cpap and related things. He is giving me instructions everyday and it is really promesing!

Strange to say about someone i dont even know.

Anyway, thanks again and i would greatly appreciate if you are willing to look at my soomed in flow rates!

If there is anything i can do for you, just saiy it. Im handy with photoshop for example. I also have decent knowledge about engine technology.
Next to that im working as a ''recovery coach'' for people with mental illness, hopefully you dont have that

Byebye

[Pugsy]

So if i hold my breat for 1 sec in my sleep, that counts as an obstructive apnea?

No...won't count as anything. You are trying to overthink things.
The machine might think it was central or OA or hyponea but ONLY if you did it for at least 10 seconds.
Anything less than 10 seconds won't earn any flag at all.

The number in parentheses...is a very close number to duration in seconds. It's close enough. I once took the time to actually manually count over 100 flagged events from a Respironics machine and it was never off by more than 3 seconds. That's really nothing to get concerned with. Most people won't have any serious issues with oxygen until the duration gets up around 45 seconds or you get a truckload of something right on top of each other. There's no reason for you to manually count anything...it's not going to make any difference in the long run anyway. I would like for you to take the time to start learning how to distinguish awake breathing from asleep breathing though.

Kinda weird if theres a OA cluster happening without snore or FLs the machine isnt responding?! The machine doesnt know if im awake or not after all.
So what i mean is, if i hold my breath cause of tossing, the machine should be increasing pressure anyway right? Or i'm still not getting it ^^

Still not getting it. There's a complicated algorithm that drives these machines in auto mode to do anything. I don't know the exact details so please don't ask. Flow limitations and snores are part of the driving force because they normally are the early warning signs that the airway is trying to close. The machine wants to prevent that from happening but it must have something to drive it or cause it to want to change.
When you hold your breath...that's essentially a central/Clear Airway apnea. There's no air flowing but it's because you aren't trying to breath.. Not because floppy airway tissues are blocking the air flow. More pressure won't/can't fix central apneas. The machine won't respond at all to central apneas. It's going to sit there and twiddle its little thumbs until something happens that makes it think the airway is physically blocked by something and then if you have enough of whatever it is then it will do something.

OAs can happen without any warning signs and the machine might not think it needs to do anything about those OAs because there are none of the usual warning signs (snores and FLs)....it's not common but it can happen.
Or if it is an awake OA false positive...there won't be any snores or FLs anyway...so it probably won't do anything.

These machines were never really designed to be put under the microscope like we are doing. Their reports are really more for trends and patterns because there is just so much potential for variation in a single night that we can't really put all our eggs in the one night basket.

As to why I do this? I worked in the medical field for nearly 40 years. Retired now but people that work in the medical field usually do it because they like to help people. Makes them feel good to help people.
I have been in your shoes sort of...someone helped me long ago...I am just paying it forward and it makes me feel good in the process...win-win for me.

Try 1.0 cm more minimum. If the aerophagia monster shows up...cut it in half.

Even zipped the SD card contents will likely be too large to send as an attachment to an email. Smaller contents we can do it but you have too many nights with lots of data. It's going to be a huge file even zipped. We will need to use some place for you to upload the file to so that I can go get it.
I have done this often. I can use my dropbox account...when I am ready for it I will give you a link to my account so you can share your zipped file and I can go get it and unzip it and plug it into my software. Once in my software I can go poking around and see just how much of your stuff looks real or awake.
I don't have the time right now and we aren't ready for me to do that anyway just yet.
I want to see if we can get the AHI down by normal means first...and not invite the aerophagia monster over for a visit in the process.
So yes 10 min and 12 max for now.

BTW.....when you tell your friends about me...I am a she and not a he.
Don't worry, I am not offended. I often get mistaken for a he. We used to have gender as a choice on our profiles but that went away a while back with a forum software change. Not a big deal but I do like for people to know that women can know this stuff too...it's not just a man's world.

You know if you look back from when you first started here...we have actually made significant progress. We aren't maybe where we would like for you to be in the grand scheme of things but we are getting there.
You are getting some sleep and you are using a mask you halfway like instead of struggling with something you don't like.
If it wasn't for the aerophagia monster lurking in the shadows we would be further along.
I am lucky in that he doesn't come see me often but he has come for a visit in the past and he's not a fun house guest. Made me extremely ill when he came calling so anytime anyone mentions him....I am ultra cautious about what I suggest someone do because I know first hand that he can make us really ill. For some people it's just more complicated than a little belching or farting...I have been there and done that so I want to try to help you and at the same time avoid him.

[huydts]

Hey Pugsy,

Tonight was a bad one. Couldnt get much sleep.
The lower pressure (10) was too high, The monster was coming a litle bit ( not much , but enough to cause discomfort ) I had a very dry mouth, so dry i had to drink. And pee more then twice.
The p10 started halfway again with its super anoying leaking sound. I then had to move my head up to close the gap and eliminate the sound.
I did that 20 times or so, then i was sick of it. Unfortunately you cant tighten the p10 more then just play with the straps.. in combination with the monster trying to come by and the leaking sound i decided to lower pressure by 0.5 and i switched mask to the dreamwear under the nose. I then saw my AHI was alrdy 8.x.. so that made me al litle bit restless.. Anyway i fell back to sleep, ut i didnt sleep comfy.

I woke up having a pretty high AHI 9.30. I'm not sure what happened?

My p10 i snow in a waterbin to regain its elasticity.. not sure if thats the solution but at least i have to try something.
I Still notice when i use nosepillows vs nosemask the pressure seems to come in way harder, i feel my cavitys being filled with air. Dont have that sensation with nose masks.
But then again, nose masks arent as comfy as the pillows.

Maybe the swift fx is good for me? since that one is an adjustable one?

So uhmm... hope you will find time today to have a look again

Btw we can use www.wetransfer.com to send large files. It works very well

by Pug have a nice day.