First night SleepyHead data - can anyone help?

I seemed to wake up a lot. Felt like I normally feel this morning (not great).

I don't get why it seems to be so much worse than the night before. Or is it not? My AHI is higher. What exactly is the blue line on the bottom chart showing?

Two things that have been different the past two nights are that I slept with a Breathe Right strip and the humidifier actually had water missing in the mornings.

The blue line that is going all over the place on the total leak graph?
Look at the first hour on the leak graph...nice pretty much stable looking line with minimal movement...that's the baseline where your mask is likely not doing any excess leaking and what you are seeing is the expect vent rare or what is term intentional vent rate.
After that 1st hour something changes and there is leaking...now if it is mouth breathing a little or mask movement we can't tell but there's some leaking...it never reaches large leak territory though so it isn't compromising the sleep therapy part of things and we can trust the data.

Now my 2 thoughts at the moment in regards to what we see here on this report and your reporting not feeling as good as the numbers show are these.
1...while the leaks are technically within acceptable limits they are enough of them to perhaps disturb your sleep quality in general...in other words perhaps disturb your sleep either by causing awakenings/arousals that you may remember or low level arousals that you don't remember and it's possible that the sleep cycles are disrupted a bit.

2..now that we have another nice solid night of apparent sleep in general where we can maybe see patterns and clusters....while that AHI is technically acceptable over the entire night you actually had some clustering of OAs, hyponeas and a few RERAs show up. Flow limitations..disregard that blank line because in fixed mode the FL flagging is turned off. We need APAP mode to get FL flags (if they happened)...and I am betting there would be some clustering about the same time as the other clusters.

The 2 most common causes for when we see little clusters like this where it's apparent the pressure is not quite sufficient are supine sleeping or REM stage sleep or a little of both.
The pattern of the clusters strongly points to REM stage sleep to me. It's something I have a lot of experience with because my OSA is 5 times as worse in REM sleep as in non REM sleep and it was very common for me to see much higher pressure needs in REM sleep than in non REM sleep. Sometimes markedly higher pressure needs in REM.
I don't know how much more pressure you need...but for sure at least a little more.

You can go here and scroll down on the right and look at a normal hypnogram to get an idea of the REM pattern.
http://en.wikipedia.org/wiki/Sleep

Are those clusters maybe a reason or part of a reason for your not feeling so great?....Yeah, maybe. Can't say for sure but it's possible that they can be a factor.
Often when people don't feel the good numbers it isn't any one thing but instead it's a combination of probably multiple things affecting how we sleep and feel.
For this reason I tend to just keep looking at what could be improved and try to improve on it and hope it helps.

So in your case..
Leaks are a potential factor from a sleep quality stand point but they aren't bad enough that the machine can't handle them.
The clusters point to sub optimal therapy during the time of the clusters only..the rest of the time things look good and there is potentially enough going on during the clustering to impact how you feel.
I can't guarantee that if the clusters were gone or at least broken up that you will feel a huge improvement but it is at least something to try.

The fix for the clusters....more pressure and I expect 1 cm would probably do a good job unless you are like me and need a LOT more pressure sometimes in REM (assuming these are REM but the same thing would apply if it were related to supine sleeping).

Your machine has APAP mode available but it is limited to 30 days though I can tell you how to get more than 30 days but what you have to do is not something you want to do while you are under any insurance compliance and DME monitoring.

I was originally saving this discussion for a couple of days from now but might as well have it now.
You have 2 choices (assuming you are comfortable changing the settings on the machine yourself)
1..try 8 cm fixed cpap pressure
2..try APAP mode for a few days and see where the pressure wants to go to fix those clusters. If trying APAP mode I would use minimum of 7 and maximum of 10 right now because I would want to limit the chance that increased pressures made the mask seal more difficult to keep. Then see where it wanted to go and decide what to do at that time.

If you aren't comfortable making changes by yourself...run them by your doctor (not the DME because the DME can't change anything without the doctor's okay).

Thanks so much, Pugsy!

I do feel like I might have been doing a good bit of mouth breathing last night, because I woke up with dry mouth definitely a few times. I think there may tend to be mask movement as well, just because of how I like to sleep (on my side with my face really smooshed into the pillow). I wonder if those things combined are just keeping me from getting rest. I also wonder if I might need to tighten up my headgear a bit.

What worries me (and maybe it shouldn't, but that's me) is the fact that I had ZERO apneas or hypopneas during my sleep study. Just 72 RERAs. Now I'm having apneas and hypopneas since I've been on CPAP. Should that be the case? Or is it just because of the issues I may be having with possible mask movement and/or mouth breathing? I should be getting better, not worse!

I do know that during my study, REM sleep was pretty much where all of my RERAs happened, I believe.

I started wearing the Breathe Right strips because my nose has been stuffy, and thought that might help keep things clear. But....I dunno now.

So, even though I'm still in the compliance phase for insurance, I should be okay to go into APAP mode for a few days, and even change the pressure? Or should I call the doctor before doing either of those?

Again, thank you so much for your help. It is meaning the world to me right now, even if I'm still feeling a bit lost!

Insurance companies never know your machine settings nor do they care...all they care about is if you are using the machine.
Now the doctor or DME might get their panties in a wad if they notice that you have changed a setting but all they can do is slap your hands.
They might not even notice.

I can't comment on why the sleep study showed nothing but RERAs (was this study the diagnostic study or the sleep study with cpap) except that while these machines are good they can sometimes mistake awake/semi awake breathing irregularities as some sort of event and flag something that might not have been flagged in a sleep lab setting because the tech knows if you are asleep or not...the machine doesn't have a clue as to your sleep status.
Also..the sleep lab setting is one night in a foreign environment where sleep is sometimes very fragile and we don't always sleep as deeply in the lab as we do at home.

If all you had on the diagnostic sleep study were RERAs...makes me wonder how the insurance was okay with covering a cpap machine unless it went through on RDI numbers and not AHI.
RERAs can cause a lot of serious damage to sleep quality though and the multiple arousals can of course make our sleep in general much less restorative. So it is worth it to try to reduce the RERAs in hopes of improving our sleep in general and thus how we feel during the day.
Unfortunately it does seem like it takes longer to see improvement and the improvement seems to come on more gradual than for people who had high AHI numbers.

If your sleep study mentioned more RERAs in REM then that goes along with what we are seeing on your reports here.
Quite common in fact.

I have only had the one diagnostic sleep study in the lab. They never woke me up to put CPAP on me during the study. Then I did the auto-titration at home.

I also wonder why the insurance company okayed a CPAP, unless like you said, it was the RDI. I don't really know much about AHI vs. RDI.

I'm looking at the report now, and in the summary it says:

"In the 336 minutes of diagnostic sleep time, the patient demonstrated a total of 72 sleep disorder breathing events. This achieves an elevated RDI of 13. When one looks at the REM period RDI, it is much higher at 33. Both of these indices are an indication for a CPAP titration. Adequate time for a CPAP titration was unavailable."

And it says that stage 2 sleep was over represented, and only 11% of the total sleep time was spent in slow wave sleep.

If all that means anything relevant to this or not, I have no clue!

Last night:



I just thought of something - when I get up to use the bathroom at night and unhook the tube from the mask, is that showing as leaks?

LibbyLou wrote:when I get up to use the bathroom at night and unhook the tube from the mask, is that showing as leaks?

No. If it did show that leak it would be well over a 100L/min when the mask/you were no longer attached.
Now it might have been responsible for the small brief LL flag you had the other night if that was when you got up.
If it goes on very long you get a black bar across the top LL where you see green now.
Black bar means breathing not detected but the machine is on. I don't know exactly how long that has to go on to get a black bar though.

Ah, okay. Thanks!

Hoping for an even better night tonight. Trying not to change anything quite yet, but if I have to end up doing that, then I certainly will.