Dazed and Confused

grifho wrote:My speculating so far have been concerning mask leak and AHI correlation,

I'm curious as to whether you've gone back in sleepyhead to those days and looked at what was actually happening with AHI and leak.

palerider wrote:

grifho wrote:My speculating so far have been concerning mask leak and AHI correlation,

I'm curious as to whether you've gone back in sleepyhead to those days and looked at what was actually happening with AHI and leak.

ah, good question palerider. No, I haven't had time to look at in depth. But that would be interesting. Based on what you said about my theory originally, I probably was completely wrong as the leaks were too small to be a factor in affecting the AHI. But when I saw the negative correlation (high leak/low AHI), the numbers looked compelling, so I jumped to conclusions and then concocted a theory of why it would be true. The mind looks for patterns and finds them, but many times it's just randomness.

grifho wrote: The mind looks for patterns and finds them, without considering randomness.

indeed, that's why people see faces in the browning patterns on toast... or rock formations on mars... pattern recognition, the brain strives for that.

Hi all, if anyone has any feedback here, it would be welcome. On the night of 2/17 I think my sleep was pretty good, as I felt rested and had good mental energy. And my AHI was low as well. On the night of 2/18 I had an AHI about 3 times as large, and much higher leaks, and felt foggy-headed the next day (today). Both times I wore the mask and chinstrap with adjustments the same, or about the same. Is there anything in here that can tell me what went wrong the second night? I'm still at the same pressure I was, but considering going higher, as it's been recommended here to me. Thanks.

What I see is that almost 19% of your time on the machine you had large leaks. Leaks can cause arousals and false CA's when you are holding your breath and tossing and turning, so I wouldn't be concerned about the increase on the numbers. It's probably not a bad idea for a small minimum increase but that will not solve your leak problem. The question is where are you leaking and I would suspect mouth since you know already that you do that. Even with a chin strap you can breath out of your mouth because it will only hold your teeth together and not your lips. So your options may be taping your lips or a FF mask. Some people just put a vertical 1" wide strip from their chin to above their top lip and this keeps them from having large leaks. Or you may be more comfortable with a FF mask.

what she said (points to OkyDoky's msg)

the leaks aren't therapy compromising, though if there had been any apneas during them, the machine may not have been able to tell which type they were, and might have reported an unknown apnea.

but leaks certainly can disturb sleep to a large extent.

OkyDoky wrote:What I see is that almost 19% of your time on the machine you had large leaks. Leaks can cause arousals and false CA's when you are holding your breath and tossing and turning, so I wouldn't be concerned about the increase on the numbers. It's probably not a bad idea for a small minimum increase but that will not solve your leak problem. The question is where are you leaking and I would suspect mouth since you know already that you do that. Even with a chin strap you can breath out of your mouth because it will only hold your teeth together and not your lips. So your options may be taping your lips or a FF mask. Some people just put a vertical 1" wide strip from their chin to above their top lip and this keeps them from having large leaks. Or you may be more comfortable with a FF mask.

Yeah, I was reading about the false CAs that can occur, so the ones during tossing and turning are where they must have happened. I do have a chronic cough due to reflux, so I'd be concerned if I can't even open my mouth at night to cough, such as with a tape. I do think you're right that the chin strap is not giving me consistent prevention of mouth leaks. But it's odd how variable it is. Here are the large leak percentages for the last 7 days (rounded to the nearest whole number) 9, 18, 1, 1, 1, 19, 17. These are all days with the chinstrap. I never had anything close to a 1 without the chinstrap, so I think that points to the fact that it must have helped with the mouth breathing for those 3 days. I will keep in mind a FF mask, but if I can get back to the magic formula that gave me those "1"s, then I should be good. Just not sure what happened there--maybe I'm adjusting it differently the last 2 nights. Thanks again, okydoky!

I've been trying my nasal mask again for a few nights. I have to strap it pretty tight to get a good seal. I get more leaks than with a FFM, but my AHI is down quite a bit using the nasal (I think I know why). Keeping a good seal, in my experience, is easier with the FFM than the nasal.

palerider wrote:what she said (points to OkyDoky's msg)

the leaks aren't therapy compromising, though if there had been any apneas during them, the machine may not have been able to tell which type they were, and might have reported an unknown apnea.

but leaks certainly can disturb sleep to a large extent.

Good to know they are not therapy compromising, palerider. But as you say--and okeydokey said--leaks can disturb sleep. So that must account for the fact I was so foggy-headed yesterday. My leak percentage is only a little smaller last night, but I feel a lot better so far. Maybe the leaks didn't awaken me so much last night compared to the night before. I suppose if one is fatigued enough, then one can sleep through them. Thanks palerider!

Overall, I gotta say, I'm so relieved to get the CPAP, and have the opportunity to fine-tune the operation, thanks to the help of you and others here. I've dealt with foggy-headedness, fatigue, headaches for YEARS. I've investigated whether the symptoms were due to environmental allergies, food allergies, migraines, and all sorts of things, and have been to naturopaths, regular docs (allopaths), investigated things on my own. Nothing helped. Tons of research and wasted effort and feeling horrible. I should have known sleep would be a factor, but I didn't know I wasn't getting restful sleep, and besides that no one suggested I even get a sleep test. I gotta thank my wife, as she would tell me I snore, twitch around, cough, and basically be like sleeping next to tasmanian devil. So I had it investigated, and they told me I had a 22 events/hr. They called it mild/moderate because the events were not that bad or long, or something like that. I didn't really get the granularity of detail I wanted. It seems very binary to them---either they point you to the CPAP machine or they do not. Oh well, at least they pointed me there. Anyway, not to get more long-winded, but it's great to see a correlation between sleep quality and how I feel. Finally I have some insight and control over it. Just having the insight that the problems are sleep-related is a relief you can't imagine, or maybe you can. The headaches are still there, but at a lesser level, and hopefully they improve even more.

Mudrock63 wrote:I've been trying my nasal mask again for a few nights. I have to strap it pretty tight to get a good seal. I get more leaks than with a FFM, but my AHI is down quite a bit using the nasal (I think I know why). Keeping a good seal, in my experience, is easier with the FFM than the nasal.

Hi Mudrock..good seal, no mouth leak issues, sounds like a good potential two-fer for me. I would just have to overcome my resistance to the FFM covering more of me, so to speak. But then again, I never knew I could adapt to the nasal mask as well as I have...thanks!

Whatever they call it, 22 events/hour is significant. It's like being poked almost awake 22 times an hour throughout the night. No wonder you are tired. Some of these doctors piss me off with their ignorance. Mine told me anything under 6 is "great". Wonder how she'd feel if I went over to her house, and poked her with a stick 6 times an hour the entire time she was asleep? Wonder how she would feel the next day? I'm not really mad at her, it is just the medical field's overall ignorance regarding this condition.

Also, I also find a direct correlation between my AHI overnight and how I feel the next morning. But I also keep in mind I have had this condition for decades, but have only been treated for it for four months. So there is still a sleep debt/deficit to be paid. I try to keep that in mind if I do get sleepy during the day. The therapy is working, but the condition takes a cumulative toll, and IMO, it takes months to get your equilibrium back.

Mudrock63 wrote:Whatever they call it, 22 events/hour is significant. It's like being poked almost awake 22 times an hour throughout the night. No wonder you are tired. Some of these doctors piss me off with their ignorance. Mine told me anything under 6 is "great". Wonder how she'd feel if I went over to her house, and poked her with a stick 6 times an hour the entire time she was asleep? Wonder how she would feel the next day? I'm not really mad at her, it is just the medical field's overall ignorance regarding this condition.

Also, I also find a direct correlation between my AHI overnight and how I feel the next morning. But I also keep in mind I have had this condition for decades, but have only been treated for it for four months. So there is still a sleep debt/deficit to be paid. I try to keep that in mind if I do get sleepy during the day. The therapy is working, but the condition takes a cumulative toll, and IMO, it takes months to get your equilibrium back.

I agree, I thought it a little odd that they would 'downgrade" my 22 events/hr to mild/moderate instead of moderate. If I'm awakened with a stick poking me (using your analogy) for 10 seconds 154 times a night, how much worse is that with the same stick poking me for 7 seconds (or whatever it was) 154 times a night? Either way, I'll be a zombie the next day.

Anything under (or equal to) 6 is great--from the doctor's perspective. I guess it's tempting to hear the number '6', and see it as a great improvement on '30', assuming one had a 30 prior to treatment. But for 7 hours, that's 42 events. I imagine it's worse the more the events are spread out, because if the events are concentrated a bit more then there should be more stretches of sustained sleep. But on the other hand, the lack of getting oxygen in each case could be the same. Or so it seems to me. You guys know more about this stuff than me.

Wow--decades of this condition..it's hard to say when my syndrome started, but certainly at least a decade and a half ago. Yeah, it's gotta take a cumulative toll, right. Best of luck, mudrock. And it may take a while for you (and me), but it's encouraging to know when we're on an upward path.

grifho wrote:They called it mild/moderate because the events were not that bad or long, or something like that.

the mild/moderate/severe rating of apnea is purely based on your uncorrected AHI. there's no measurement standard for the individual events, aside from the 10 second minimum duration.

palerider wrote:

grifho wrote:They called it mild/moderate because the events were not that bad or long, or something like that.

the mild/moderate/severe rating of apnea is purely based on your uncorrected AHI. there's no measurement standard for the individual events, aside from the 10 second minimum duration.

That's interesting, palerider. I had googled for the AHI standards, and it appeared the consensus was that moderate was between 15 and 29. So I asked the sleep technician why my 22 was mild/moderate since it was smack dab in the middle of the moderate range, and he mumbled some reason about the severity of the events or something (hard to understand with his Russian accent), suggesting mine were not as bad on average. As I said, they weren't as forthcoming as I would have liked about the details. So maybe there is in general no measurement standard for individual events, but that this particular Sleep Center must have been doing some adjustment based on the individual events, whether that should have been done or not. And based on what you said, they shouldn't have done that.

grifho wrote: I had googled for the AHI standards, and it appeared the consensus was that moderate was between 15 and 29. So I asked the sleep technician why my 22 was mild/moderate since it was smack dab in the middle of the moderate range, and he mumbled some reason about the severity of the events or something (hard to understand with his Russian accent), suggesting mine were not as bad on average. As I said, they weren't as forthcoming as I would have liked about the details. So maybe there is in general no measurement standard for individual events, but that this particular Sleep Center must have been doing some adjustment based on the individual events, whether that should have been done or not. And based on what you said, they shouldn't have done that.

in today's medical world, it's inappropriate for a technician to give you, or comment on your diagnosis.

I don't know whether that's some stupid law, or just rules imposed commonly in doctors offices, clinics and hospitals.

so, take your mumbled comments for what they're worth.