Good night, Bad night

Just Started therapy two months ago, haven't seen my Doc since the sleep test, I have my first appointment in a couple weeks. I have been lurking on this site from day one, lots of information to absorb....ugh! Sorry but I can't figure out how to download the graphs?
I have had sleep problems for years, never really thought anything about it until I started falling asleep at work. Since the first night of cpap........I loved it! No more waking up with my face planted firmly nose down onto a steel desk only to be awakened the thunder of the phone ringing or an employee that isn't quite sure what to do.

Things are much better, no more falling asleep at work AND NO MORE WAKING AT NIGHT TO GO TO THE BATHROOM....I love it! However I do seem to be in a fog for the first half of the day......as if I didn't have my coffee. Is this sleep debt? I there really such a thing? I'm groggy not sleepy these days. I seem to wane from good nights and then bad nights. My sleep study put me at 22 AHI with cpap I'll have a couple nights at maybe 9 and then down to 3. last night was 5.8

Questions:

Is there really such a thing as sleep debt?
From my stats posted does it look as though my Doc will raise my pressure setting?
How do you post graphs?

Any insight or thoughts of wisdom would be helpful

Thanks
Art





CPAP Statistics
57 days of CPAP Data, between Fri Jan 15 2016 and Fri Mar 11 2016
Details Most Recent Last Week Last 30 Days Last 6 Months Last Year
CPAP Usage
Average Hours per Night 07:56 06:18 06:52 07:02 07:02
Compliance 100% 86% 93% 95% 95%
Therapy Efficiacy
AHI 5.80 5.37 5.12 5.17 5.17
Obstructive Index 1.76 1.25 1.55 1.46 1.46
Hypopnea Index 1.26 0.95 1.16 1.14 1.14
Clear Airway Index 2.77 3.13 2.40 2.57 2.57
RERA Index 0.63 0.43 0.48 0.47 0.47
% of time in Cheyne Stokes Respiration 0.00% 0.00% 0.00% 0.11% 0.11%
Leak Statistics
Average Leak Rate 2.19 2.71 4.01 4.19 4.19
90% Leak Rate 3.60 6.00 9.60 0.00 0.00
% of time above Leak Rate threshold 0.03% 0.29% 0.45% 0.37% 0.37%
Pressure Statistics
Average Pressure 10.08 9.48 9.64 9.47 9.47
Min Pressure 6.00 6.00 6.00 6.00 6.00
Max Pressure 12.00 12.00 12.00 12.00 12.00
90% Pressure 11.52 11.38 11.56 0.00 0.00

Changes to Prescription Settings
First Last Days AHI FL Machine Pressure Relief Mode Pressure Settings
Fri Jan 15 2016 Fri Mar 11 2016 57 5.13 0.00 AutoSet (37028) EPR: Full Time 3cmH2O APAP Min 6 Max 12 (cmH2O)

Machine Information
Brand Series Model Serial First Use Last Use
ResMed AirSense 10 AutoSet (37028) 23151873978 1/15/2016 3/11/2016

Your minimum pressure is 6 but you are spending most of your time between 9 & 11cm. I would increase my minimum slowly up to that. Put it up to 7 for a few nights , then up to 8 and so on. Check you details carefully each night.

Yes there is such a thing as a sleep debt. When i first started, my body craved sleep, wanted to sleep all the time. I believe it can take a while to pay it off, especially if you are still not getting optimized sleep. You should also never sleep, even nap, without the machine. That is a step backwards in paying off the debt. Google the term sleep hygiene and that will give you other tips to help optimize your sleep.

There are a million threads on posting images here. Find one.

Are you using a nasal mask or a full face one? IF you're a mouth breather once asleep and on a nasal mask, you're likely losing a lot of 'therapy' air that way, and might want to look into a FF mask.

steamsweeper wrote: Things are much better, no more falling asleep at work AND NO MORE WAKING AT NIGHT TO GO TO THE BATHROOM....I love it! However I do seem to be in a fog for the first half of the day......as if I didn't have my coffee. Is this sleep debt?

Could be. Some folks experience it. Others not so much.

Or it could just be that your body is still learning how to deal with the new, and better sleep situation.

How do you post graphs?

The images have to first be uploaded to an image sharing site like imagur or photobucket. Then put the link inside a pair of Img tags. There are lots of posts with explicit instructions.

From my stats posted does it look as though my Doc will raise my pressure setting?

Let's look at some of that summary data that you did post:

CPAP Statistics
57 days of CPAP Data, between Fri Jan 15 2016 and Fri Mar 11 2016
Details Most Recent Last Week Last 30 Days Last 6 Months Last Year
AHI 5.80 5.37 5.12 5.17 5.17
Obstructive Index 1.76 1.25 1.55 1.46 1.46
Hypopnea Index 1.26 0.95 1.16 1.14 1.14
Clear Airway Index 2.77 3.13 2.40 2.57 2.57
RERA Index 0.63 0.43 0.48 0.47 0.47

The sum of the OAI and HI is well under 5.0, even though the overall AHI is still above 5.0. The largest part of your machine reported AHI is the CAI and increasing pressure is not how you address CAs. My guess is that the doc is not going to increase the pressure based on this data.

The CAI is not so high as to be setting off alarms that scream Something Must Be Done. Did your titration stud mention CAs at all? It's not uncommon for PAPers to have some CAs scored by the machine night after night, but usually the number of them is still low enough to keep the overall AHI < 5.0. So it's worth keeping an eye on them and asking the doc what s/he thinks about the significance of them. The CAs also probably warrant some caution when it comes to pressure increases since some people get pressure induced CAs.

Are you spending any time lying in bed while awake with the machine on? If so, that might explain the CAs: Wake breathing is different from sleep breathing and some of the natural irregularities in wake breathing get mis-scored by our machines as sleep disordered breathing. And it's not uncommon for the "not real" events to be scored as CAs. Looking at the detailed data so that we know when those CAs are happening is pretty important in figuring out whether they're most likely mis-scored events occurring during periods of time when you have a high probability of being awake or whether they're likely to be real CAs scored when you were sound asleep.

Leak Statistics Most Recent Last Week Last 30 Days Last 6 Months Last Year
Average Leak Rate 2.19 2.71 4.01 4.19 4.19
90% Leak Rate 3.60 6.00 9.60 0.00 0.00
% of time above Leak Rate threshold 0.03% 0.29% 0.45% 0.37% 0.37%

Your machine is a Resmed A10 AutoSet. That means all the leak numbers reported in SH are excess leak numbers. In other words, they represent the leak detected above the expected leak rate for your mask.

The 90% Leak Rate numbers are more important than the Average Leak Rate numbers. (To see why, see my blog post Average, Median, 95% numbers: A guide to those who don't remember their introductory stats.)

Your 90% Leak statistics shows that for at least 90% of the time your machine is running, the leaks are well below the ResMed Redline of 24 L/min. In other words, whatever leaking is going on is small enough and/or short enough to not have any significant affect on the efficacy of your therapy.

That said, it's important to ask: Do you often wake up feeling like you have to fiddle with the mask because of small, but irritating leaks? If so, you need to address the leaks because they're interfering with your ability to get uninterrupted sleep. If the leaks are not waking you up, they're small enough and/or short enough to ignore.

Pressure Statistics Most Recent Last Week Last 30 Days Last 6 Months Last Year
Average Pressure 10.08 9.48 9.64 9.47 9.47
Min Pressure 6.00 6.00 6.00 6.00 6.00
Max Pressure 12.00 12.00 12.00 12.00 12.00
90% Pressure 11.52 11.38 11.56 0.00 0.00

Given the fact that the OAI + HI < 5.0, but the CAI > 2.5, there are some good reasons to not increase the max pressure or to not increase it by much. (A small percentage of CPAPers have problems with pressure-induced CAs, and for this group of CPAPers, more pressure can lead to more CAs and less effective overall therapy.)

You might do better if the min pressure was increased. And given the fact that the 90% pressure is sitting right at your max pressure, it's possible the doc might suggest bumping up the max pressure to 13 or 14. Then again, he might not since the obstructive stuff is nicely controlled by the given pressure.

Julie wrote:Are you using a nasal mask or a full face one? IF you're a mouth breather once asleep and on a nasal mask, you're likely losing a lot of 'therapy' air that way, and might want to look into a FF mask.

Julie, the leak numbers indicate that there is very little leaking going on. In other words, the OP Is not losing a lot of therapy air given those 90% Leak Rate numbers.

Robysue

Thanks for your thoughtful input! Most of my CA's develop in the last couple hours of my sleep. For the last 30 years I've been a five to six hour sleeper....ha that is until a got plugged into my cpap (apap) a couple months ago. I'm thinking, I get a little restless after six hours and my internal clock is wanting to wake me up but my body says...."stay in bed and sleep you fool". I do toss and turn these days before getting up, so maybe you are correct in regards the recorded CA events. I'll try and post a flow rate graph.

Thanks for the input
Art