Please interpret my Sleepyhead data

[ChasingSheep]

Hi Everyone,

A little about myself:
I am 26 years old and male. For many years since grade school, I never gotten enough sleep due to my habit of staying up late, and doing anything, but sleeping. I suppose I was/am bit of a night owl as I enjoyed staying up late. As a result, I took being tired as a function of never really getting enough sleep. However, as I got into my early 20's and start to realize the importance of adequate sleep, I started improving my sleep hygiene, and ensuring that I got enough sleep every night. However, that was when I started noticing something. On many days, although I had slept enough hours for most normal people, I would still wake up tired. The kind of tiredness I experienced was not the sleepy I can fall asleep at any moment-kind, but the kind where I felt constantly fatigued. I also had a bit of nocturia, where I would wake up once a night to go use the restroom(Never more than once though). Long story short, I went in for a sleep study in March of 2013, and got diagnosed with mild sleep apnea with a 10.1 RDI. I am in good health and weight for my stature. I recently had bloodwork and other tests, that I can't recall off the top of my head, and everything came back normal(I did not get my Vitamin D levels checked, which seems to be a common recommendation on this board).

So why am I here? Like many others that have posted here, I just don't feel the benefits of using my CPAP at all. My numbers are coming back great according to Sleepyhead. I have been very compliant, especially this year thus far. I would wake a lot of days, much more tired than before. Many times with a headache worse than what I had pre-CPAP. I don't have any trouble falling asleep with the CPAP, and even if I wake up in the middle of the night, I could still go back to sleep fairly quickly. I do have a bit of an issue waking up a few times a night, either from mask discomfort, leaks, or some unknown reason. Although to be fair, I'm waking up as many nights, feeling like I need to use the restroom. And I'm not waking up in cold sweat as frequent either. I'm just out of ideas, and would like some help interpreting my sleepyhead data, and maybe someone can point something out to improve my therapy. Thanks

[friar]

I can see nine hours of uninterupted sleep.
Man that is hybernation, can never make more than three myself. Lucky you.

[SleepyToo2]

It can take some time before you start to feel the benefits. If you are waking up less frequently because of needing to use the bathroom, that is a good start. Others will need to comment on the specifics of your graphs. However, they will ask for information on your machine and mask and the pressure range that your machine has been set at. Do you have a humidifier, and do you use it? Are you tightening your mask enough or not enough? Where do you get leaks (if near your eyes that can be a cause for the waking). As you can see, there are a lot of questions before anyone will be able to give you much specific advice!

[Pugsy]

As you already suspect. You look good on paper. There's nothing in the reports that scream out "fix me and you might feel better".

The bulk of those little pressure spikes are test probes where the machine is simply testing the pressure. Couple of time is goes up a little and stays up but not very far and certainly not very long.

Your leak line is excellent. Couple of minor increases that still fall way short of large leak territory.

So you look good on paper but don't feel the good numbers and nothing stands out horribly that might account for it.
A little more increase in apnea events later on during the sleep cycle...probably supine sleeping or REM stage sleep as it's common to have more REM sleep in those time frames after 5 AM.

You do mention some awakenings. It's normal to have a few but when we have very many of them then our sleep architecture gets messed up. It wouldn't be impossible for the awakenings to have an impact on how you feel if you are having a large number.

How is your sleep hygiene? Is 1:15 AM a normal bedtime for you? Is 10 AM a normal wake up time? Or is this bedtime all hit or miss?
Take any meds at all?

On the off chance that you are someone who finds that any pressure change can disrupt quality sleep you might consider a really tight apap range or even minimum to equal maximum in apap mode to mimic cpap mode. Somewhere around 6.5 or 7.0 I would think.

[ChasingSheep]

Thanks for all your input. To answer a couple of questions:

1) I don't typically use a humidifier, although I do fill it for passover purposes. On the rare nights, I do use it, I normally have it at 1 to minimize rainout.

2) My headgear isn't overly tight or loose. I'm somewhere in the medium where my mask stays fairly in place, but it does have the tendency to move while I'm asleep.

3) I am not on any meds at the moment.

4) I tend to keep a pretty steady bedtime/wake up time on the weekdays due to work, but it could differ on the weekends, probably by a few hours compared to my normal bedtime/wake up time. I understand the importance of keeping a steady bedtime always, but it's hard to imagine that the level of fatigue I'm feeling plus headaches are very much correlated at all.

I tend to sleep supine the majority of the night, and my awakenings tend to be in the latter part of the night, so I suppose it makes sense AHI is higher then. I know the graph appears as if I slept uninterrupted, but I try not to turn off my machine even when I awaken.

I think I will try the approach you proposed, Pugsy, and up my pressure and see if that makes any difference.

One last thing, I was wondering if anyone has experienced better sleep(or at least feels like it) after drinking a bit before bed. I don't just mean falling asleep easier, but waking up the next day feeling pretty good as well. I have experienced that quite a few times myself, and is quite puzzled by it, since alcohol tends to disrupt sleep. Perhaps it's because we don't get into the deeper stages of sleep as long or as often, where apneic events occur? How strange..

[Pugsy]

since alcohol tends to disrupt sleep. Perhaps it's because we don't get into the deeper stages of sleep as long or as often, where apneic events occur?

Perhaps.

I think how much alcohol and how soon before bed will also impact things.

I can't drink a beer and go to bed because for every beer I drink I pee 3. So my sleep would be disrupted from getting up to pee half the night.

Alcohol is a central nervous system stimulant...it's going to mess with sleep quality in some manner.

[ChasingSheep]

I've definitely experienced that outflow phenomenon. If only a nightcap were all we needed for a good night's rest.

BTW, what would be considered an unacceptable level of leakage?

[Pugsy]

BTW, what would be considered an unacceptable level of leakage?

First of all, any leakage that wakes a person up needs to be fixed but because it disturbs sleep.
If a person sleeps through the leaks and they aren't huge and even if a big leak it doesn't last long...not a big deal.

With the PR S1 machine and the way it reports leaks I would have to see large leaks over 80/90 L/min for at least 15 to 30 minutes happening often before I would worry. Up to large leak territory the machine can do a good job compensating for leaks so I just let it do its job.
I have used some sort of Respironics machine for years...I have only seen a large leak flag (Encore software will show you) a handful of times. It takes a big leak to earn a Large leak flag with the Respironics machines reporting Total Leak as they do. For me the line was 90 L/min. I can't remember the last time I got a large leak flag but when I did it only lasted about 10 minutes. Slept through it so I shrugged my shoulders and moved on. Not worth worrying about.

I am using a ResMed machine right now so large leak territory is defined a little differently but I hold to the same principles...if it doesn't wake me up and doesn't last long I don't care. I see no sense in going to extraordinary measures to fix a big leak that lasted 10 minutes. Sometimes the cure is more of a problem for sleep quality than the leak itself. That's why I don't jump on the full face mask thing. Don't want one and even if I do a little mouth breathing during the night it doesn't last long and for me to use a full face mask would be more problematic than 10 minutes of mouth breathing might be.

When looking at SleepyHead leak graphs...be sure to note the scale. Sometimes SH makes mountains out of molehills due to the scale involved. Always look for the scale numbers. While your report shown above shows a little bit of a mountain around 4:30...it never reaches even 40 L/min which is well below large leak territory...It looks more impressive than it is. I imagine if you were using Encore to see that leak line there would only be a tiny blip where that 4:30 mole hill is.