First charts from Onkor... Do I need a different mask?

[ParanoidAndroid]

My AHI for the past seven nights (which comprises all of my usage so far) is 14.81. Does this mean I should be using a different mask or could it be just getting used to the process? I have a couple of images I went to post (screen shots of some graphs in Onkor), but there's no "attachment" function here. All my online photo storage links back to me personally, so I can't put stuff up there without jeopardizing my relative anonymity.

Basically, it looks like I do rather poorly the first hour of my sleep, and then fairly well the rest of the night. But the first hour or so is enough to throw off the averages.

Any thoughts?

Do we eventually reach a level of trust where we can upload images? Or is it just something this forum doesn't permit?

Also, when I look for detail on the events, I can't seem to get any. There's a little tab reading "See Event Definitions", but clicking on it does nothing. Anyone have a legend of the abbreviations in Onkor?

Thanks!
Eric

Just for last night (the AHI is lower here than the overall average):
Owner ParanoidAndroid
Therapy Start 25 Jun 2011 01:50 (Sat)
Therapy End 25 Jun 2011 09:54 (Sat)
Therapy Time 8h 3m
Off Time 0h 2m
Elapsed Time 8h 4m
AHI 11.81
OA 2.11 (17 events)
CA 2.61 (21 events)
H 7.08 (57 events)

[Pugsy]

Can't do attachments at this forum. Just the way it is set up.
That AHI is way too high. How is leak line? Pressure settings? If leaks is not a factor then more pressure is needed.

The legend is same as with with this report of mine.

BTW you can use photobucket to host report images as I do with this one and no one knows who it goes to.

[ParanoidAndroid]

OK... I set up a new account. Here's the results from yesterday. I tightened the straps, and I didn't notice much in the way of leakage. So I am wondering if it was just too loose. I'll get today's results up shortly.




The fact it goes from 5 to 6 with virtually no incidents makes me feel like I am compromising the seal in this graph. Especially at the start of the night.

[ParanoidAndroid]

Hmm... last night, not any better, actually worse. Here's a close-up of a problem period...

[Pugsy]

The pressure of 9 cm. Is this what the titration study suggested?

In your sleep study report was there any mention of having many more events while sleeping on your back or in REM staged sleep? Do you have a copy of your sleep study? If not I suggest you get it.

Do you sleep in one main position? If so, which position?

Your clusters of events are very similar to what mine looked like when I started at prescribed 8 cm. I am documented worse in REM. I ended up with 10 cm pressure needed to break up those clusters.

If yours are related to sleeping position you might try staying on your side as much as possible. If your clusters are REM events I suspect a bit more pressure will be needed.

You don't want clusters like that.

[ParanoidAndroid]

Yes, 9 is what the titration study suggested. But I do not have the sleep study, itself. Only what I was told by the equipment provider.

Normally, I sleep on my stomach. Since the CPAP, I've been sleeping on my back. I need a new pillow, because as a stomach sleeper, I've mashed a deep hole into this one that doesn't seem to go away when I fluff it. Sinking into the pillow puts it in contact with my nose, which moves the mask.

As a complete newbie, I'm just getting used to the whole thing. At times, I have woken up with my mouth just a bit open, and air flowing out. Not often, but I'm looking at solutions like the blue masking tape. I'm afraid of the claustrophobic feeling that might impart, but I don't want a full-face mask if I can adapt to the nose pillow. Also, I have woken up to feeling no pressure in my mouth, and I've woken up to my cheeks wanting to puff out. Usually this happens at the break of day when the sun starts to peek in. Two days, I woke up with my stomach inflated. But I think I'm getting better at not swallowing air.

On the positive side, I already feel more awake during the day. I don't doze during movies anymore, and I can also stay awake during boring meetings. Before, I was going to the bathroom several times in the night. Now, if I go at all, it's once (hope that's not TMI).

Thanks for the advice. I'll get my study, and I'll ask about raising my pressure.

[Pugsy]

Those clusters of events could be related to position since you are sleeping on your back predominately. It is common to have "worse" OSA in the supine position. You can continue to try to figure out some way to stay off your back. I suspect that alone will help the AHI come down some.

Before, I was going to the bathroom several times in the night. Now, if I go at all, it's once (hope that's not TMI).

Not too much information at all. Nocturia is common symptom of OSA and often the first improvement seen with cpap.
It was for me too.

[ParanoidAndroid]

OK, so last night went significantly better. I slept on my side. I got one heavy cluster, but the numbers are much much better. Today I went out and bought a firmer pillow. I am hopeful I can sleep on my side with it and not sink in enough to disturb the mask.

AHI of 7.72. That's a move in the right direction!

[Pugsy]

That is much better. Those clusters at around 3 AM mark could be if you rolled onto your back or even REM stage related. Let's see how tonight goes. When you get the clusters broken up you will be off to a really good start. You are very close now.

[ParanoidAndroid]

Thanks for following and replying, Pugsy! The support is very much appreciated. I'll upload my chart tomorrow evening.

[avi123]

Hi, I am trying to figure out what conclusions can you draw from this FLOW trace. Could you pick a Central apnea event and slow down the scale of the FLOW window to below 5 min and have the apnea line on the right?

It seems to me that you might have either CSAS or Complex Apnea syndrome. I say it b/c of the hi number of hypopneas. Similar to the poster BrianinTN.

From Resmed:

What is complex sleep apnea?

Complex sleep apnea (CompSA) is a form of sleep apnea in which central apneas persist or emerge during attempts to treat obstructive events with a continuous positive airway pressure (CPAP) or bilevel device.


CompSA is characterized by the following:

•The persistence or emergence of central apneas or hypopneas upon exposure to CPAP or bilevel when obstructive events have disappeared
•CompSA patients have predominately obstructive or mixed apneas during the diagnostic sleep study, occurring at least 5 times per hour
•With use of a CPAP or bilevel, they show a pattern of central apneas and hypopneas that meets the Centers for Medicare Services (CMS) definition of CSA (described below)

A diagnosis of central sleep apnea (CSA) requires all of the following:

•An apnea index > 5 [Apnea index (AI) - A measure of the severity of sleep apnea; the number of apnea events per hour]
•Central apneas/hypopneas > 50% of total apneas/hypopneas
•Central apneas or hypopneas occurring at least 5 times per hour
•Symptoms of either excessive sleepiness or disrupted sleep

Note: our machines can't distinguish between obstractive or central Hypopnea.



What did your Sleep Study say?


The way you have the graph now it's hard to check the respiration cycles shape, individually, for periodicity. Such as in here:






The above polysomnogram represents Cheyne Stokes breathing and occurred subsequent to continuous positive airway pressure titration for OSA in the same patient in the previous media file. Cheyne Stokes breathing has a classic crescendo-decrescendo breathing pattern.

Or this:




This polysomnogram demonstrates central sleep apnea and Biot respiration in a patient receiving long-term morphine for chronic pain. The Biot pattern may be irregular without any type of periodicity, or it can consist of runs of similar-sized breaths alternating with central apneas.

[ParanoidAndroid]

Hello Again,

I need to get charts, but it is very late, so I will do that another time. Just wanted to pop in and say that I've slept on my side the past three nights, and it has made a huge difference in my therapy...

"Files dated" - AHI
6/27 - AHI 13.34
6/28 - AHI 7.72 -- Slept on side
6/29 - AHI 5.95 -- New, firm pillow in place of worn soft one.
6/30 - AHI 3.65

I'm going to say my issue is solved for now, but I am so glad I found ONKOR, just so I can monitor this stuff. We'll see how the next few nights go (when I can sleep in a bit on the weekend).

avi123, thanks for the post and all the details. If I begin to see my AHI climb, I'll raise the possibility of Complex Apnea to my doctor. I have not gotten my complete sleep study results. I am going to call for that. But I think my problems were from sleeping on my back (which I hate). The new pillow lets me sleep on my side without disturbing the mask, and I feel a lot better sleeping. Still, you wanted to see a 5 minute period surrounding an incident. I will get you that when I should not already be in bed.

Thanks again!
Eric

[Pugsy]

Good job Eric. That last report is great. Amazing what a little position change will do. Especially since you prefer to be off your back anyway. Looks like you have a good understanding and handle on things now. You should do very well.

My bad thing is REM and it doesn't matter if I am on my side, back or probably standing on my head.

[ParanoidAndroid]

One last post, and I'll consider this a closed issue. Last night, after my big, weekly cleaning, I decided to bump up to the large pillows on my SwiftFX from the medium. I was getting more air, and I couldn't cause a leak out the sides of the pillows if I tried! Numbers are still looking pretty good...



Now... if only I could be so disciplined as to go to bed at a decent time! The other night, I chatted online until an obscene hour -- making my logs a confessional of my bad habits as much as the machine's efficacy (I did get another hour's sleep, btw... I took the mask off intending to get up, but let my eyes close and slept another hour and a half without it). But I am still blown away as to how much the fog has lifted from my waking life.