Why Are These SH Graphs So Awful?

Pugsy wrote:I think it's a fair assumption to blame your big leaks on mask movement and not mouth breathing since you finally woke up during the big leaks and the headgear was not on well and the tape was secure for the most part.

Did you get good sleep until the big leaks...most likely unless you woke up with each big leak and for sure probably slept well until the big leaks.
It all depends on how well you slept and unfortunately the machine can't tell you that. You have to sort of rate sleep subjectively.
I have slept through some pretty big leaks myself and slept quite well....so it can happen. Obviously we want to keep them to a minimum but we do the best we can.

Thanks again, Pugsy. I'll try again tonight using the tape and hopefully the gear will stay in place. The headband is a 3 inch wide elastic band that may be part of the problem, but I have other headbands I can try, too, but because of the shape of my head, I need two straps rather than one. None of the bands worked in the past because the pressures weren't set properly and the headgear would be dislodged. I'm not giving up! I need sleep!

BTW, I looked at past SH data, back to 2015 (maybe '14, too), and saw wide variability in the data (but a lot of graphs are missing!). Is it unusual for older SH head graphs to be missing?

DeeCPAP wrote: Is it unusual for older SH head graphs to be missing?

Not unusual because of the way the S9 writes the files to the SD card that contain the data needed for the graphs.
The S9 will overwrite the detailed data files and high definition files after 7 days so if you don't download the data at least once in 7 days (or go longer than 7 days between downloads) the data needed for the detailed graphs simply isn't on the SD card because it gets written over before it ever gets loaded into the software.
Now with the new ResMed machines that doesn't seem to be happening but it was just the way the S9 model did the data.
Summary stuff is kept on the card for a year but the other files for the detailed graphs gets written over...some at 7 days and some at 30 days and I never can remember exactly which ones but to play it safe I always tell S9 users to download at least once a week or some of the detailed graphs won't be available and SleepyHead (and ResScan) need those detailed files to show us the graphs.

I had it happen often when using my S9 because I was lucky to download once a month (have gone 4 to 6 months) and I had lot of nights in SH where the only thing I have available is the summary data. For me that's okay as I really don't dwell too much on those graphs anyway unless I am trying something new like a new mask or something.

I even had some old detailed graphs disappear in SH when I knew that I used to have them...never could figure out what the deal was on that one.
Might have been related to a new SH version or something...that was years ago so I don't remember and at this stage of the cpap game I wasn't really worried about something being missing so I didn't investigate very much.

Just remember that with the S9 if you don't download at least once in a 7 day period there will be some files get overwritten. So if you think you might want it do the download even if you don't look at the data right away.
And of course if the SD card is left in the computer all night...you won't get anything but summary numbers.

Pugsy wrote:

DeeCPAP wrote: Is it unusual for older SH head graphs to be missing?

Not unusual because of the way the S9 writes the files to the SD card that contain the data needed for the graphs.
The S9 will overwrite the detailed data files and high definition files after 7 days so if you don't download the data at least once in 7 days (or go longer than 7 days between downloads) the data needed for the detailed graphs simply isn't on the SD card because it
gets <snip>
Just remember that with the S9 if you don't download at least once in a 7 day period there will be some files get overwritten. So if you think you might want it do the download even if you don't look at the data right away.
And of course if the SD card is left in the computer all night...you won't get anything but summary numbers.

Thanks for the info! I'm allowed a new machine in August.

I just took a "simulated nap" and discovered if I put the elastic headband on first and put the Dreamwear on top of it, it feels more secure on my head and probably won't move if I'm careful when I sleep. I ALSO found that air comes out of my mouth -- not a lot, but probably enough to count. Now what? (I'd rather wear tape than use a FF mask because I'm limited to the FF mask that covers the chin and it's way too bulky for me). Using tape doesn't sound like a safe alternative though.

Back when I started therapy I was doing some pretty serious mouth breathing (out of habit not from nose being stopped up) and I wasn't too keen on a full face mask either for several reasons. I tried chin straps and had minimal success with them but found they were annoying. I had read about taping and at first I thought "no way in hell" but I found out that there might be a need to find a "way in hell". So what I did was put the tape on and practiced just breathing through my nose and mask while awake with the machine off (the biggest fear is that we will suffocate if the power goes out).
Well I found out that I could move enough air through the vents to be comfortable enough and not suffocate. In fact it was so comfortable that I did it for about 15 minutes and finally got bored and quit.
Second fear is "aspiration" so I played with the tape to see just how easily or not so easily the seal could be broken and I found that the tape wasn't like cement and that a good yawn would easily break the seal and get my mouth open. The tape is really like a chin strap...supposed to be a gentle reminder to keep the lips closed but not sealed permanently shut.
Doing both these things pretty much eliminated any fears I had about taping.

First night I taped we had a thunderstorm and wouldn't you know it the power went out. I woke up not in any distress or anything but woke up thinking "why are things so quiet"....then I realized that the power was out.

I discovered taping wasn't so bad after all and ended up doing it for a couple of months and then I started getting lazy and forgetting to put the tape on until after I was all masked up and machine was on and I would "let it go for tonight"...and I got where I was "letting it go" for several nights.
I checked my leak graphs and come to find out I wasn't seeing those big massive leaks I used to see. So I figured that maybe I had broken that old habit of mouth breathing.
Now I would sometimes still see an occasion probable mouth breathing time...maybe 5 or 10 minutes though and barely into large leak territory so I just decided that I didn't care about small short lived large leaks (no matter what the cause) as long as I was sleeping decently and feeling decent.

Even now my leak lines aren't so pretty but I really don't care as long as the leaks don't wake me up and any large leaks are short lived...I shrug my shoulders and move on. I discovered that what I had to do to get "nice pretty perfect" leak lines disrupted my sleep quality more than the short lived large leaks messed with my sleep....the cure was worse than the disease.

If you want to tape...play with it to alleviate your fears whatever they may be.
If you don't want to tape...just work on the known mask movement leaks and then once that issue is resolved you can then decide if you are having any small leaks if they are bad enough to be much of a problem. Not all mouth breathing equals massive therapy loss...did you see the example I posted when I did the known awake mouth breathing experiment?

Sleep is the number one goal IMHO. It all starts with sleep. Best numbers in the world and the prettiest leak graph in the world don't mean squat if you don't sleep decently. Remember the machine can help you out and compensate quite decently for some big leak past that red line of 24 L/min ResMed has made.

Your mask movement leaks are waking you up...for that reason even if they didn't go into large leak territory you would want to fix them.
Work on that first and then see what is left after that hurdle has pretty much been overcome. You will still have some nights where leaks are just ugly.
Heck I still get some of those nights every now and then but when I do I don't sweat it until they start being consistently ugly...then I look for what might be tired and in my case it's usually the headgear stretching out too much so I either shrink it again or get new headgear.

Pugsy wrote:Back when I started therapy I was doing some pretty serious mouth breathing (out of habit not from nose being stopped up) and I wasn't too keen on a full face mask either for several reasons. I tried chin straps and had minimal success with them but found they were annoying. I had read about taping and at first I thought "no way in hell" but I found out that there might be a need to find a "way in hell". So what I did was put the tape on and practiced just breathing through my nose and mask while awake with the machine off (the biggest fear is that we will suffocate if the power goes out).
Well I found out that I could move enough air through the vents to be comfortable enough and not suffocate. In fact it was so comfortable that I did it for about 15 minutes and finally got bored and quit.
Second fear is "aspiration" so I played with the tape to see just how easily or not so easily the seal could be broken and I found that the tape wasn't like cement and that a good yawn would easily break the seal and get my mouth open. The tape is really like a chin strap...supposed to be a gentle reminder to keep the lips closed but not sealed permanently shut.
Doing both these things pretty much eliminated any fears I had about taping.

First night I taped we had a thunderstorm and wouldn't you know it the power went out. I woke up not in any distress or anything but woke up thinking "why are things so quiet"....then I realized that the power was out.

I discovered taping wasn't so bad after all and ended up doing it for a couple of months and then I started getting lazy and forgetting to put the tape on until after I was all masked up and machine was on and I would "let it go for tonight"...and I got where I was "letting it go" for several nights.
I checked my leak graphs and come to find out I wasn't seeing those big massive leaks I used to see. So I figured that maybe I had broken that old habit of mouth breathing.
Now I would sometimes still see an occasion probable mouth breathing time...maybe 5 or 10 minutes though and barely into large leak territory so I just decided that I didn't care about small short lived large leaks (no matter what the cause) as long as I was sleeping decently and feeling decent.

Even now my leak lines aren't so pretty but I really don't care as long as the leaks don't wake me up and any large leaks are short lived...I shrug my shoulders and move on. I discovered that what I had to do to get "nice pretty perfect" leak lines disrupted my sleep quality more than the short lived large leaks messed with my sleep....the cure was worse than the disease.

If you want to tape...play with it to alleviate your fears whatever they may be.
If you don't want to tape...just work on the known mask movement leaks and then once that issue is resolved you can then decide if you are having any small leaks if they are bad enough to be much of a problem. Not all mouth breathing equals massive therapy loss...did you see the example I posted when I did the known awake mouth breathing experiment?

Sleep is the number one goal IMHO. It all starts with sleep. Best numbers in the world and the prettiest leak graph in the world don't mean squat if you don't sleep decently. Remember the machine can help you out and compensate quite decently for some big leak past that red line of 24 L/min ResMed has made.

Your mask movement leaks are waking you up...for that reason even if they didn't go into large leak territory you would want to fix them.
Work on that first and then see what is left after that hurdle has pretty much been overcome. You will still have some nights where leaks are just ugly.
Heck I still get some of those nights every now and then but when I do I don't sweat it until they start being consistently ugly...then I look for what might be tired and in my case it's usually the headgear stretching out too much so I either shrink it again or get new headgear.

Pugsy, thanks. This is great info, so I'm not going to delete any of it. I'm going to continue with the tape, and what I have on hand is masking tape. It worked last night, so if it ain't broke, I ain't gonna fix it, then I'll proceed from there.

What I had on hand was a big roll of that blue tape painters use left over from when I painted my mom's kitchen. Being the ultimate cheapskate that is what I used the 2 months that I taped.
It stuck well enough and at the same time was easy to remove without pulling my skin off.

Pugsy wrote:What I had on hand was a big roll of that blue tape painters use left over from when I painted my mom's kitchen. Being the ultimate cheapskate that is what I used the 2 months that I taped.
It stuck well enough and at the same time was easy to remove without pulling my skin off.

Thanks. I guess masking tape will work, too.

Questions:

If the leak rate is high and the AHI is low, how reliable is the AHI number? In other words, does a high leak mean the AHI is unreliable? Or maybe it depends on the % of time over the red line? If that, what % over the red line would make the AHI unreliable? I hope this question makes sense!




Thanks!

Pugsy wrote:What I had on hand was a big roll of that blue tape painters use left over from when I painted my mom's kitchen. Being the ultimate cheapskate that is what I used the 2 months that I taped.
It stuck well enough and at the same time was easy to remove without pulling my skin off.

Another question. If a five hour sleep session shows the time in apnea is over 6 minutes (with a low leak rate), isn't that considered dangerous?

DeeCPAP wrote:If the leak rate is high and the AHI is low, how reliable is the AHI number? In other words, does a high leak mean the AHI is unreliable? Or maybe it depends on the % of time over the red line? If that, what % over the red line would make the AHI unreliable?

From my personal experience...over 35 L/min seems to make reporting a bit iffy. I had a night where I got various levels of big leak that progressed so it was easy to see the machine not flag anything when leaks weren't large...then when it got over 24 L/min I started seeing a couple of events and then when it got over 30 I started seeing "unknown" apneas which meant the machine sensed something was going on but didn't know what to call it and the when it went over 35 I stopped seeing the "unknown" apneas and no flags at all. Now maybe nothing happened but I kinda doubt it.

SleepyHead defaults to show time over 24 L/min but I actually think that (at least for me) a 35 L/min might be a useful line to use but I never have bothered changing it because my time over 24 isn't normally that great anyway. ResMed uses the 30% of time over 24 L/min as the marker for Mr Frowny face for mask fit. You get Mr Smiley up to 29% of the time. I think that is a bit "generous" myself and instead I use a personal % of 10 % or more before I start worrying about time in large leak. So if I see more than 10% I then look to see how high it went and how long it was up there...mainly I look to see if it went to 35 or more and how long was it at 35 or more.
I never pay attention to SH warnings because they always make things sound worse than they are. I had one the other day that said I had "massive periods of large leak" and it was 2.2% of the night....that's nothing that I would ever worry about.
I am currently using the DreamWear gel pillows. I am pretty sure I am getting some pillow movement leaks. The pillow size is just a tad too big and they don't make smaller.
I haven't decided yet if it is a deal breaker or not for my using this new mask. I don't think it will be because I am fairly comfortable with it otherwise and there's a couple of things I like about the pillows over the P10 pillows. So haven't decided just yet.

What % time in large leak makes the AHI unreliable...that's hard to say because the data is only unreliable for the period of time in large leak where the leak is over 35 L/min (at least for me). So even if you hit big, big leak the data from the other parts of the night is still accurate. A big leak doesn't mess with the data accuracy of the time when not in big leak...only potentially the time in large leak depending on how far into large leak territory.

DeeCPAP wrote:f a five hour sleep session shows the time in apnea is over 6 minutes (with a low leak rate), isn't that considered dangerous?

Not unless you only had 2 or 3 apneas to equal that 6 minutes. And your AHI was like 0.4 or something. How many events did it take to add up to that 6 minutes?

I just looked at my June 6 report...it shows 00.06:45 time in apnea and 1.47% of the time in large leak (over 24). My AHI was around 5 that night.
My leak never hit 30 L/min and none of my events flagged are anywhere near the large leaks.
I looked at the Events tab...all the hyponeas were of 10 second duration and then I looked at the other apneas and none went over 16 seconds.
It took a bunch (37 total in fact) of events to add up to that 6 min and 45 seconds time in apnea....but none were of a duration to be a problem. I can easily hold my breath for 15 seconds and never bat an eye.
It wasn't one of my more stellar nights in terms of AHI but usually my AHI is between 1 and 2 with this machine (also trialing a new machines for last few months and that's another story). I never get all upset over a less than stellar night or two...I only start worrying if things stay ugly (leaks or AHI) for several nights in a row.

Pugsy wrote:

DeeCPAP wrote:If the leak rate is high and the AHI is low, how reliable is the AHI number? In other words, does a high leak mean the AHI is unreliable? Or maybe it depends on the % of time over the red line? If that, what % over the red line would make the AHI unreliable?

From my personal experience...over 35 L/min seems to make reporting a bit iffy. I had a night where I got various levels of big leak that progressed so it was easy to see the machine not flag anything when leaks weren't large...then when it got over 24 L/min I started seeing a couple of events and then when it got over 30 I started seeing "unknown" apneas which meant the machine sensed something was going on but didn't know what to call it and the when it went over 35 I stopped seeing the "unknown" apneas and no flags at all. Now maybe nothing happened but I kinda doubt it.

SleepyHead defaults to show time over 24 L/min but I actually think that (at least for me) a 35 L/min might be a useful line to use but I never have bothered changing it because my time over 24 isn't normally that great anyway. ResMed uses the 30% of time over 24 L/min as the marker for Mr Frowny face for mask fit. You get Mr Smiley up to 29% of the time. I think that is a bit "generous" myself and instead I use a personal % of 10 % or more before I start worrying about time in large leak. So if I see more than 10% I then look to see how high it went and how long it was up there...mainly I look to see if it went to 35 or more and how long was it at 35 or more.
I never pay attention to SH warnings because they always make things sound worse than they are. I had one the other day that said I had "massive periods of large leak" and it was 2.2% of the night....that's nothing that I would ever worry about.
I am currently using the DreamWear gel pillows. I am pretty sure I am getting some pillow movement leaks. The pillow size is just a tad too big and they don't make smaller.
I haven't decided yet if it is a deal breaker or not for my using this new mask. I don't think it will be because I am fairly comfortable with it otherwise and there's a couple of things I like about the pillows over the P10 pillows. So haven't decided just yet.

What % time in large leak makes the AHI unreliable...that's hard to say because the data is only unreliable for the period of time in large leak where the leak is over 35 L/min (at least for me). So even if you hit big, big leak the data from the other parts of the night is still accurate. A big leak doesn't mess with the data accuracy of the time when not in big leak...only potentially the time in large leak depending on how far into large leak territory.

DeeCPAP wrote:f a five hour sleep session shows the time in apnea is over 6 minutes (with a low leak rate), isn't that considered dangerous?

Not unless you only had 2 or 3 apneas to equal that 6 minutes. And your AHI was like 0.4 or something. How many events did it take to add up to that 6 minutes?

I just looked at my June 6 report...it shows 00.06:45 time in apnea and 1.47% of the time in large leak (over 24). My AHI was around 5 that night.
My leak never hit 30 L/min and none of my events flagged are anywhere near the large leaks.
I looked at the Events tab...all the hyponeas were of 10 second duration and then I looked at the other apneas and none went over 16 seconds.
It took a bunch (37 total in fact) of events to add up to that 6 min and 45 seconds time in apnea....but none were of a duration to be a problem. I can easily hold my breath for 15 seconds and never bat an eye.
It wasn't one of my more stellar nights in terms of AHI but usually my AHI is between 1 and 2 with this machine (also trialing a new machines for last few months and that's another story). I never get all upset over a less than stellar night or two...I only start worrying if things stay ugly (leaks or AHI) for several nights in a row.

Thanks again, Pugsy. I'm leaving your entire message intact because it's excellent information. I saw on SH I stopped breathing for up to 45 seconds. On one chart the 45 second event was back to back with another 30 second event and other events, a bunch of them. Maybe stress? I sure can't hold my breath for that long when I'm awake, but now that the settings have changed, it may not happen any more -- hopefully.


BTW, last night I taped my mouth and the tape stayed but I took off the headgear. Again, a nap is usually more successful - the numbers and the graph look good, but as I mentioned, I usually can't nap, even if I stay in bed for an hour, but this time I did. So, there's progress. I do have a better understanding of the SH software. I sent a friend to this website and he's adjusting the settings. He told me he feels like he's been through a war when he wakes up. I can't wait to see what he says about the new pressures.

I used a chin strap over the top of the headgear. To hamper my taking it off while half asleep. It's just another layer you have to navigate. I'd keep adding stuff till the mask stays on. just don't cover the vents on the mask.

ajack wrote:I used a chin strap over the top of the headgear. To hamper my taking it off while half asleep. It's just another layer you have to navigate. I'd keep adding stuff till the mask stays on. just don't cover the vents on the mask.

I tried the chin strap over and it slipped around my head, causing a lot of leaks. It felt more secure with the frame on top of the chinstrap because it makes the frame tighter, but it's not a good idea to try something once and give up. Unfortunately, some of us (raising my hand here) are in a hurry to get things resolved. For now, I'm going to use Pugsy's idea and just use the tape for a night or two. It works during short naps, probably because I can sleep on my side without changing positions, but time will tell.

Again, thanks Ajack!

I meant in addition to the tape for the mouth leak, it was just an option to try to keep your mask on, but if it hasn't worked for you. You may need another physical barrier that can help you keep the mask on. There would be other ideas, like headbands, but as I don't mouth leak (FFM), I haven't gone into it much.

ajack wrote:I meant in addition to the tape for the mouth leak, it was just an option to try to keep your mask on, but if it hasn't worked for you. You may need another physical barrier that can help you keep the mask on. There would be other ideas, like headbands, but as I don't mouth leak (FFM), I haven't gone into it much.

I'm not sure if my last message was clear enough. I tried the 3" elastic headband. It was better when the frame was on the bottom rather than the top -- the frame felt more secure. Ideally, I won't have to use the headband at all. (It's one of my fondest dreams at the moment ). I'll use the tape for now, then deal with the other variables later because I'm also trying to figure out whether the medium or large cushion is better for me. More air comes from the larger cushion (I think) and may factor in with air flow. I still get that "puff" or "glug" sound when I bend my head forward when resting on a pillow half-reclined. I"m planning to keep the setting causing the fewest "puff-glug" sounds. Ideally there are none, but right now they're still there. Again, time will tell. Thanks, Ajack.

I hope you (and others read the research I posted today -- alleviating apnea without a cpap machine. The future looks bright, but sadly, maybe too late for those of us who've struggled for a long time before finding success.