Leaks, Apneas, and Disturbed Sleep – Some Examples

[Jay Aitchsee]

Or, The Importance of Leak Management

Below are the results of two consecutive nights sleep. I think it is a good example of how relatively minor leaks can produce disturbed or non-restorative sleep. What makes this example especially good is that the daytime activity of both days was nearly the same, including meals. Being consecutive is also a plus. Two consecutive mirror image days tend to rule out unknown variables skewing the results.

Both nights have relatively good AHI's, 1.6 compared to 2.4. Both are quite acceptable by the standards we are used to. The leaks of the first night are great. The leaks of the second night, not so good, but certainly not really terrible. The second night's leak line only crosses the dreaded “red line” for about 20 minutes the whole night. That coupled with the relatively “good” AHI of 2.4 might make one wonder why they felt so bad in the morning (which I did).

Now look at the second night's apneas. Most seem to be related to the leaks. Did they occur because the CPAP pressure was too low or couldn't compensate for a loss of pressure due to the leaks? Or, are they the apnea of one holding their breath because the leak disturbed them? Don't know. Probably both. Either way, an increase in AHI seemed to occur with an increase in leak level.

Finally, look at Zeo. The major leaks and apneas of the second night occurred right where there should have been Deep Sleep, but the disturbance wouldn't allow it. Consequently, only 8 minutes of Deep Sleep was recorded compared to 41 minutes the night before.

So, what it looks like to me is that a relatively small increase in leak level with a relatively small increase in apneas wiped out most of one night's restorative sleep. I believe this illustrates the importance of really good leak management and may explain why some still feel fatigue even with “good” numbers.

J

[Always tired]

Jay,
On previous nights do you usually have deep sleep in that 1:00 to 2:00 time frame? Were you aware of the leaks or fighting the mask at some level?
Good job.

[Jay Aitchsee]

On previous nights do you usually have deep sleep in that 1:00 to 2:00 time frame? Were you aware of the leaks or fighting the mask at some level?

Yes, most significant periods of Deep will occur in the first cycle, 90-120 minutes after falling asleep. I usually fall asleep around 1130 and my first sleep cycle will usually include a short period of REM followed by Deep and Light ending with another period of REM. In this example, I was not aware of the leaks or mask until around 4 AM coinciding with the Zeo report of Awake.

One thing to rember about the Zeo graphic representation is that it is kind of "prettied up" by only showing sleep stages in 5 minute intervals, similar to a moving average. I haven't done it for this example, but I know if I looked at the 30 sec interval data it would show some intervals of Deep within that first cycle, just where it should be. That's most likely where the 8 minutes of Deep that Zeo reported but did not depict on the graph occured. In this example, there were not enough contiguous 30 sec intervals of Deep to make it to the graph. The 30 sec interval data is among the data obtained using "export data" function of the Zeo site.

J

[Jay Aitchsee]

See here for a Chart of Deep Compared to AI: viewtopic/p779163/Charting-ResScan-and- ... ml#p779163

[cosmo]

I'm always tracking to see what events do to my sleep cycle as well. I have two monitors so I normally just have all of the programs open and compare them like pictured. I'll track each event.

This screen shot was made for a different zeo thread.


Its good to see there are other apnea geeks out there as well

[Jay Aitchsee]

OK, here's another example of two consecutive nights, one with deep sleep (the short black bars on the top Zeo chart) and one without. The difference in the two appears to be the leaks.

The top set, last night, shows a small leak during the time I normally experience deep, after the first REM stage. The leak is small, doesn't last long, and I move into deep sleep.

The bottom set, the night before, shows a leak beginning after the first REM period which continues and increases until I appear to wake, preventing the transition to deep. Interestingly, the leak rate for this night is reported with a 95 percentile of only 12.0, which by itself wouldn't cause much concern just looking at the numbers.

Typically, I roll onto my back once I fall asleep. The first REM period usually depicts where this occurs. Once on my back, I usually move from REM to light, then into deep, then to REM as I roll back to my side (as determined by time-lapse video recordings).

Lately, I've been experiencing these mountain peak leaks during the time I should be in Deep - when I'm on my back. Thinking about these leaks, I realized they started about the time I changed the routing of my hose in my overhead “buddy” type system. Last night, I didn't use the overhead routing and voila, no leaks!

I think I was catching the hose when I rolled onto my back, pulling the mask from face, causing the leaks. Of course, I won't know for sure until I get a few more nights, but the odd shape of the leaks gives me confidence that this was the problem.

[Always tired]

I think I was catching the hose when I rolled onto my back, pulling the mask from face, causing the leaks.

Jay,
Regarding the big leak in the bottom graph. Did the sequence go something like this--big leak, at some level you were aware of the leak and possibly adjusted either hose or mask,--that interrupts the first sleep cycle where most deep occurs and you get little if any deep--you wake--back to sleep--later sleep cycles produce less deep--and finally you wake up feeling not so good? Maybe crappy would be a better word? How did you feel after the 2nd night vs 1st?

How are you routing the hose now, from the side? I have ordered one of the overhead systems because I'm always adjusting for mask leaks because of probable hose tension.
AT

[Jay Aitchsee]

AT, I felt better the morning with some deep. I think your sequence is correct, except that I am not conscious of big leaks in first cycle, or I don't remember them. Probably, because I'm in the habit of taking 5mg ambien at bedtime. I am usually conscious of leaks later in the night.

I went back to routing from the side. In my typical side setup, I clip the hose to the bottom bedsheet about shoulder high, that keeps from pulling the blower off the stand, and then I clip the hose to my nightshirt over my belly and that keeps the run of the hose fairly straight out of the mask.

For clips, I just use suspender type with short straps of that stick-to-itself velcro used for cable bundling threaded through the D ring.

I do not have a "hose buddy". I just brought the hose over my iron type headboard. That worked pretty well until I changed the routing slightly a week or so ago. I changed from side to over the headboard because I thought the air was too warm running under the bedclothes. I only use "pass over'' humidification, not warmed.

Your Hose Buddy sytem will probably work better than my over the headboard as you'll have move options for adjusting the hose run.

J

[Jay Aitchsee]

And here's the exception. A near perfect respiratory night with minimal Deep. It doesn't necessarily invalidate my previous assumption that leaks disturb sleep, but it does show there are other factors involved. My morning feel is that I didn't get enough sleep and I remember awakening several times after 03:30.
It is possible this result is caffeine related. I did have a cup of green tea and a square of dark chocolate around 20:00 the evening prior. Generally, I try not to consume caffeine after 12:00