CPAPtalk.com

chunkyfrog wrote: Your wellness will speak for itself.

That's a good bottom line to remember.

My line has been:

1) I recognized that I have a problem
2) I identified the problem
3) I am treating the problem

It hasn't really been received real well, but it's good enough for me. I don't realistically think I can focus on exercise or undergo a dramatic change in my dietary habits until I address the sleep deprivation.

Used again last night - AHI down a little more at 16.3.

Here are the plots as suggested by Pugsy:



(also finally figured out how to use linked bbcode in imgur, I think)

Felt ok the morning, although hard to be objective about this.

Could not figure out how to get rid of pie chart. There was a bit of summary stats scrolled off bottom:



Note that I took a 30min nap with the machine around 3pm. I definitely slept - it said my AHI was 41. This nap was characteristic of my (probably) narcoleptic daytime sleeps, with wakeful dreaming and sleep paralysis. I was vaguely conscious of having stopped breathing from brief semi-arousals caused by gentle puffs of air from the CPAP re-starting breathing.

I've mentioned above that I had an MSLT when younger, with results indicative of narcolepsy. Did not follow up at the time because it was a research study and not a clinical exam (I had not complained of sleepiness, thinking it was normal).

The pie chart turn off trick is in Preferences (which is under File...upper left corner)...click on Preferences then click on the "Appearance" tab...then look on the right side for "show event breakdown in pie chart" ...I think it is the 3rd one down from the top. Just remove the check mark.

Ignore any short naps...naps always mess up the AHI for any number of reasons and often we don't sleep as soundly during a nap so we get a lot of SWJ sleep/wake/junk getting flagged.

Last night's report...half the AHI was primarily CA (plus the nap's numbers are in there but we can remove them easily...more on that later) and the rest of the AHI was mainly hyponeas but the machine didn't go wild with the pressures trying to fix the hyponeas which has me scratching my head a bit.

I would suggest maybe changing the minimum apap pressure to 7 and see what happens with the OAs and hyponeas. The CAs we can't fix with pressure using this machine and at this point we don't know if they need fixing anyway.

To remove the nap numbers from the AHI calculation ....scroll way down to the bottom of the statistics to where you see the sleep sessions. Double click your mouse on the session that is the nap (looks like it is the first session) so that the bar turns from green to red. That turns off that session and the data/events that occurred during the nap will be removed from the overall AHI calculations.

Thanks so much for these tips - put kids in bed and about to crash now. Will try tomorrow!

Ok yesterday I didn't nap at all, so plots should be easier to read. Was really tired at end of day, and crashed on sofa (with cpap) at 9:30pm.

I see a large and prolonged leak period - I suspect this is from sleeping on my side; the sofa pillows weren't ideal for this and I did notice that the mask was pushed aside a bit and there was some leakage.



AHI came out at 17.71, although I'm not sure this is a reliable number given the segment of data missing (from leak?)

SleepyHead is still showing more 'clear airway' (central) events. These look similar to the respiratory effort traces I'd collected earlier:

A few questions:

1) are the event flags (clear airway, obstructive apnea) assigned by the SleepyHead software based on raw data imported from the CPAP, or has the CPAP system itself assigned those event flags?

2) does anyone know what is the algorithm used by SleepyHead (or the CPAP machine) to decide when there is an event, and if that event is a CA, OA, or other?

3) does anyone know where I could find detailed technical information on how CPAP machines work (specific models or in general)? I will of course Google but this forum has a huge head start...

Thanks for any advice!

Is the large leak time frame you are thinking about big blank spot from about 12:30 to 2:00?
There is no large leak flag during that time and no breathing not detected either. Looks more like the machine was totally off during that time frame. You may have turned it off and not remembered it and turned it back on and not remembered it. I did this when I first started therapy and on a rare occasion see evidence of it on my reports now but it isn't nearly as common now as it was when I first started therapy.

The other Large leak flags are short lived and I wouldn't worry about them.

The bulk of your CA clustering appears at the very beginning of the night and at the approx 4:45 to 5:15 AM mark which looks like was preceded by the machine being turned off...so we assume you were awake when you turned it off.
So next question is approx how long do you think it is taking you to fall asleep these times? Is it possible that you were awake during these times? If you were awake they simply don't count in the evaluation.

Back to the stuff we know the pressure can fix...the OAs which are still too numerous.
I really think that you need to try a higher minimum pressure...like at least 7.
Let's fix the OAs in the usual manner with a little higher minimum and see what's left needing fixing.
If going from 5 to 7 is too big of a jump and you are uncomfortable go up in small stages.

Normally I would suggest you continue at the 5 for a few more nights but what I really usually mean is "unless it's obviously not working well and it's unlikely to change" .....no sense in wasting time.

We aren't ignoring the centrals...we are keeping one eye on them but in the mean time fix the OAs because we know they need fixing. Once you are sleeping better and more soundly and we can't blame central clustering on maybe awake time then if the centrals are too high we worry about them then.

The breathing doesn't look classic CSR though...looks more like awake breathing to me at least the zoomed in portion above. Plus the machine isn't flagging PB during those central clusters...it's flagging a tiny bit of PB when not much of any events is happening which leads me to believe it's just plain ordinary PB and not CSR but could you zoom in on a PB (green) flow rate and let's look at that pattern just to make sure?

Recent questions

1....the machine does the flagging...SH just reports what the machine reports. If we used Encore software it would show the same flagging.
The only time SH does any flagging from its calculations is if we change the flagging and go to user flagging and I don't advise that newbies do that unless they really have a grip on what they are seeing...mainly useful for the UARS situation and you most certainly don't appear to have a UARS thing going on.

2...short version is the "event/whatever it ends up being flagged" has to last at least 10 seconds to earn a CA/OA or hyponea flag and those are what makes up the AHI.
FL flagging...RERA flagging...different criteria...same for PB flagging.
There is a certain amount of reduction in air flow that needs to be met during those at least 10 seconds.
OA flags mean 80 to 100% of the air flow is reduced...so high or total blockage or total lack of air flow.
Hyponeas more of a reduction in air flow but not totally blocked...50 % I think is for Respironics.
Flow reductions...less than 50% or maybe less than 10 seconds at higher % of reduction.

Centrals...the machine uses the pressure pulses (little puffs of air) to evaluate the lack of airflow to determine if the cause of the lack of air flow is tissue collapse related (that gets OA or hyponea flag) or if the airway is open and that earns a CA flag. I think it checks for a bounce back of that little puff of air that would indicate bouncing off collapsed airway tissue and no bounce back/echo would mean open airway.

3....I can't think of anything at the moment other than the detailed information (which isn't all that detailed) given in the clinical manual. Maybe someone else knows of something more detailed.

Pugsy wrote:Is the large leak time frame you are thinking about big blank spot from about 12:30 to 2:00?
There is no large leak flag during that time and no breathing not detected either. Looks more like the machine was totally off during that time frame. You may have turned it off and not remembered it and turned it back on and not remembered it. I did this when I first started therapy and on a rare occasion see evidence of it on my reports now but it isn't nearly as common now as it was when I first started therapy.

Thanks! I think I know what happened - I got up to pee, and unhooked the tube. That is the leak rate going way up... the machine may shut off automatically after a certain period when the mask is clearly off. I may also have hit the power button at some point (when getting up to pee again) turning the machine off when I thought I was turning it on. Eventually (after going pee yet again) I might have succeeded in turning it back on. Regarding all the bathroom breaks, I've been tested for diabetes, prostatitis, etc. and thus far all looks normal (I know this is verging on TMI).

The other Large leak flags are short lived and I wouldn't worry about them.

Yes - these look more in line with previous nights.

The bulk of your CA clustering appears at the very beginning of the night and at the approx 4:45 to 5:15 AM mark which looks like was preceded by the machine being turned off...so we assume you were awake when you turned it off.
So next question is approx how long do you think it is taking you to fall asleep these times? Is it possible that you were awake during these times? If you were awake they simply don't count in the evaluation.

I just about always fall asleep nearly immediately (2-5min) after putting my head on the pillow. I was reading my son a story earlier and was falling asleep while reading (he was not amused!)

Back to the stuff we know the pressure can fix...the OAs which are still too numerous.
I really think that you need to try a higher minimum pressure...like at least 7.
Let's fix the OAs in the usual manner with a little higher minimum and see what's left needing fixing.
If going from 5 to 7 is too big of a jump and you are uncomfortable go up in small stages.

Ok I have to figure out how to do that. I have to confess I still don't really understand how the CPAP machine works, other that in general it uses positive pressure to keep the airway open. I can feel the pressure fluctuate, and have been awakened by a pressure rise that seems to be re-initating a pause in breathing, but should read up in more detail on what it's trying to do.

Normally I would suggest you continue at the 5 for a few more nights but what I really usually mean is "unless it's obviously not working well and it's unlikely to change" .....no sense in wasting time.

I seem to have stabilized at an AHI of 16-17, which does seem too high. Agree would be good to know sooner rather than later.

We aren't ignoring the centrals...we are keeping one eye on them but in the mean time fix the OAs because we know they need fixing. Once you are sleeping better and more soundly and we can't blame central clustering on maybe awake time then if the centrals are too high we worry about them then.

This makes sense. I am sleeping but suspect not very soundly/deeply.

The breathing doesn't look classic CSR though...looks more like awake breathing to me at least the zoomed in portion above. Plus the machine isn't flagging PB during those central clusters...it's flagging a tiny bit of PB when not much of any events is happening which leads me to believe it's just plain ordinary PB and not CSR but could you zoom in on a PB (green) flow rate and let's look at that pattern just to make sure?

Here are a couple of PB events:



Thanks again for all your advice!

The first image of PB looks CSRish and has a couple of centrals...if you had a lot of this we would probably want to investigate further.
The second image is just regular Periodic Breathing (which by definition is just a waxing and waning of the air flow that lasts at least 2 minutes. CSR Cheyne Stokes Respiration is just one form of Periodic Breathing but it isn't the only form.

In general you don't seem to be having a large amount of flagged PB time and even if it was all real CSR I don't think that this small of time is alarming.. Given your history of poor sleep quality I wouldn't worry about the PB at this time.

If you are indeed going to sleep rather quickly...those centrals may be sleep onset centrals which may or may not need to be worried about. Cross that bridge later.
Right now fix what we can fix with this machine (everything but the CAs) and see what's left once the OSA side of things is optimally treated.
If the OSA side of things is better treated...might get lucky and have less CAs and better sleep quality.
Right now you are still having enough OAs and hyponeas to cause significant arousals which of course doesn't help the sleep quality.

Pugsy wrote:The first image of PB looks CSRish and has a couple of centrals...if you had a lot of this we would probably want to investigate further.
The second image is just regular Periodic Breathing (which by definition is just a waxing and waning of the air flow that lasts at least 2 minutes. CSR Cheyne Stokes Respiration is just one form of Periodic Breathing but it isn't the only form.

In general you don't seem to be having a large amount of flagged PB time and even if it was all real CSR I don't think that this small of time is alarming.. Given your history of poor sleep quality I wouldn't worry about the PB at this time.

If you are indeed going to sleep rather quickly...those centrals may be sleep onset centrals which may or may not need to be worried about. Cross that bridge later.
Right now fix what we can fix with this machine (everything but the CAs) and see what's left once the OSA side of things is optimally treated.
If the OSA side of things is better treated...might get lucky and have less CAs and better sleep quality.
Right now you are still having enough OAs and hyponeas to cause significant arousals which of course doesn't help the sleep quality.

Thanks Pugsy,

I looked at the user settings on my DreamStation, and didn't see where I could modify the pressure settings. There does seem to be a 'Provider' mode that's activated by holding down certain buttons while connecting to AC power. However, I'm supposedly on a one month 'titration' (paid for with the clinic) and have to confess that I'm not sure what this means. The tech at the clinic activated a modem in the DreamStation, but I'm not sure if this is purely for them to download results or if they will also make adjustments to settings over the course of the month.

I will call the clinic tomorrow to ask how this is supposed to work - I'm a bit wary of changing pressure settings if the clinic expects that they'll be the only ones doing it (I'd be comfortable trying it but don't want to interfere with the clinic's game plan).

Thanks to Pugsy, I was able to change my minimum pressure setting from 5 to 7 cmH2O. This did result in an all-time best AHI of 10.5!



SleepySaid still says that this is horrible, but it's a lot better than it was with 5cmH2O. I noticed the higher pressure, and that there were more mask leaks (there would be a kind of farting sound periodically which woke me up - yes, it was the mask ). I suspect this could be addressed by slightly tightening the straps (or maybe eating less beans). I had read here about aerophagia, but haven't experienced it until last night with the higher pressure.

All this leads to a few more questions:

• 1) what does SleepyHead mean when it keeps saying my results are horrible?
  
  2) I've heard a lot of talk about titration, and realize I wasn't sure what it meant. My prescription has a minimum (5) and maximum (15 cmH2O) pressure; is titration simply the process of increasing the minimum gradually until the AHI is below some acceptable level (or just as low as possible)?

Thanks again for all the help - it's encouraging to see data and watch it improve. I also think I feel somewhat better this morning.

leptic wrote:1) what does SleepyHead mean when it keeps saying my results are horrible?

Sometimes SH exaggerates things. One has to be able to understand the perspective and look at overall picture and SH sometimes doesn't do that very well. Like when SH tells me that I had massive leaks and I look and maybe 15 minutes was bad.
We already know that AHI of 10 isn't going to be where we what to be

I think you are likely going to still need more minimum pressure but give the 7 cm a couple/three nights to see what happens and allow you get adjusted to the new minimum.

Your CAs reduced ...which leads me to have hope that your CAs are post arousal CAs related to the OAs and hyponeas and if we can reduce the OAs and hyponeas further that maybe the CAs will reduce also and we won't be having to keep one eye on them.

9 cm minimum would be my next suggestion.

The minimum pressure is the most critical pressure. It has to hold the airway open pretty much all the time as a baseline and then increase when the tissues start to collapse. It doesn't do these increases in the blink of an eye...it takes several minutes and if it has to go too far then it allows events to happen while it is trying to get to where it needs to be.

Titration...in a sleep lab the tech has the luxury of testing various minimums quickly to see how it holds the airway open so the tech keeps raising the pressure to where the apnea events are better prevented.
These machines works best when preventing the collapse in the first place...not fixing after the fact.