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Omne, I glanced quickly at your waveforms and I agree with Pugsy. It looks to me like most of your events are post arousal. I also agree that, most likely, your O2 drops are artifacts from the Pulse-Ox loosing good contact during movement related to the arousal, if they are rapid drops. If you look up this thread, I posted a pulse-ox trace with a likely post arousal CA. There is a break in the trace indicating a loss of signal. It could well of been a spike.

It's a little tricky getting the pulse ox results to line up with the events to see exactly what's going on. One thing I learned, is that the pulse ox signal lags real time (and the events) by about 20 sec due to time it takes a condition effect to travel from the heart/lungs to the finger tip. If you are loading it into SleepyHead, you can load the same pulse-ox session more than once and adjust the time manually to correct as necessary. All the sessions loaded will be displayed on the same graph, but you can turn off the ones you don't want in the Detail Window on the left side. Just click the session from green to red.

So, it looks to me that you are experiencing a lot of disturbances, but as Pugsy says, we don't know from what. It could be the therapy that is disturbing, or it could be a myriad other things. What I tell everybody is that once your OA and H are treated, there's not much more a cpap can do. It can't fix poor sleep from other causes. It then becomes a process of elimination that has to start with Good Sleep Hygiene. No caffeine, regular bedtimes, etc., etc.

I would want to nail down the SO2 for sure. Low O2 levels could be disturbing. Then maybe you could get your doctor to order a trial with a bi-level, a loaner from the DME without having to buy one. I have rented a machine from a DME myself without a specific authorization and paid out of pocket. I don't know if that's possible for you, but if the doctor doesn't want to order an insurance based trial, it something to consider.

P.S. Another problem that you could be running into (I'm not familiar with the Dreamstation algorithm) it could be running the pressure up after a "false" apnea is scored and the increased pressure itself is disturbing. You might try a fixed pressure, CPAP mode, and see if the results are any better. Pick a moderately low pressure that seems to have squashed most of non post arousal OA is the past and work up from there.

What are you using for a Pulse Ox? I've found the CMS50F(blue face) to be a lot more user friendly and reliable than the 50E. Amazon had them for $89 a while back.

That's why I don't pay attention to momentary oscilloscopy curves on my charts; I prefer to listen to the medianites.

avi123 wrote:That's why I don't pay attention to momentary oscilloscopy curves on my charts; I prefer to listen to the medianites.

go home, Avi, you're demented.

Jay Aitchsee wrote:Omne, I glanced quickly at your waveforms and I agree with Pugsy. What are you using for a Pulse Ox? I've found the CMS50F(blue face) to be a lot more user friendly and reliable than the 50E. Amazon had them for $89 a while back.

Actually I'm using a CMS50I wrist mount. More comfortable. I lost a lot of oximetry files so I'm rebuilding them up again.

Omne wrote:

Jay Aitchsee wrote:Omne, I glanced quickly at your waveforms and I agree with Pugsy. What are you using for a Pulse Ox? I've found the CMS50F(blue face) to be a lot more user friendly and reliable than the 50E. Amazon had them for $89 a while back.

Actually I'm using a CMS50I wrist mount. More comfortable. I lost a lot of oximetry files so I'm rebuilding them up again.

Right, what I guess I meant was a wrist model is more reliable. I don't know about the 50I, but I've found the 50F to be really easy to use with SleepyHead.

Jay Aitchsee wrote:

Omne wrote:

Jay Aitchsee wrote:Omne, I glanced quickly at your waveforms and I agree with Pugsy. What are you using for a Pulse Ox? I've found the CMS50F(blue face) to be a lot more user friendly and reliable than the 50E. Amazon had them for $89 a while back.

Actually I'm using a CMS50I wrist mount. More comfortable. I lost a lot of oximetry files so I'm rebuilding them up again.

Right, what I guess I meant was a wrist model is more reliable. I don't know about the 50I, but I've found the 50F to be really easy to use with SleepyHead.

Actually I'm having a problem, hopefully with an easy fix. When I import the oximetry data into SH the sleep time syncs perfectly but the oximetry graph always goes an extra 12 hours past my wake time. Actually past the time I'm inputting it.

I assume I'm missing something. I have just been highlighting the actual time but it does get annoying.

Jay Aitchsee wrote:Right, what I guess I meant was a wrist model is more reliable. I don't know about the 50I, but I've found the 50F to be really easy to use with SleepyHead.

the I is like the F, only with multiple recording sessions, so you don't have to download data every day, or every time you use it, (naps and such).

Omne wrote:

Jay Aitchsee wrote:

Omne wrote:

Jay Aitchsee wrote:Omne, I glanced quickly at your waveforms and I agree with Pugsy. What are you using for a Pulse Ox? I've found the CMS50F(blue face) to be a lot more user friendly and reliable than the 50E. Amazon had them for $89 a while back.

Actually I'm using a CMS50I wrist mount. More comfortable. I lost a lot of oximetry files so I'm rebuilding them up again.

Right, what I guess I meant was a wrist model is more reliable. I don't know about the 50I, but I've found the 50F to be really easy to use with SleepyHead.

Actually I'm having a problem, hopefully with an easy fix. When I import the oximetry data into SH the sleep time syncs perfectly but the oximetry graph always goes an extra 12 hours past my wake time. Actually past the time I'm inputting it.

I assume I'm missing something. I have just been highlighting the actual time but it does get annoying.

oximitry is rather buggy in SH of late, many people can't get it to import at all in the beta

did you use Sh to set the time on your I?

palerider wrote:did you use Sh to set the time on your I?

I used the SH start time for the offset when I loaded the data.

Omne wrote:OK, question. I looked at the waveforms for a couple of nights. As an example In one 50 minute period I had what appear to be 11 post arousal events, Hs and CAs. Irregular breathing before and lasting a after.

Now that I know that, what do I do about it? There doesn't seem to be any correlation with pressure or flow and they seem to happen randomly and throughout the night. They're still causing my SpO2 to drop into dangerous levels. Does this mean that the CPAP isn't going to be able to prevent them or are they treated exactly the same as any other event just from a different cause?

Omne, if you look at some of the portions of your example above and compare them to the examples of Nasal Mask Waveforms I just posted, I think you'll see why I questioned whether you were wearing a nasal mask or if your chin drops out your FFM. If the chin drops out of a FFM, exposing the mouth, it is essentially converted to a Nasal Mask and the waveforms start to take on the same appearance. I think many of the results you are seeing are interface related, especially if you are seeing some significant leaks as well.

As a departure from what is normally recommended, maybe you should consider a Nasal Mask, like the P10, with a mouth cover like the one here viewtopic.php?f=1&t=112758#p1086296 Pillows seal easier and more effectively than a FFM and mouth leaks can be controlled to some degree with the cloth, which is far more comfortable than tape.

Omne wrote:

palerider wrote:did you use Sh to set the time on your I?

I used the SH start time for the offset when I loaded the data.

that wasn't what I asked.

I'm using SleepyHead 9.8.
To synch the Pulse Ox, I set CMS50F time to the computer and then sync the S9 to the CMS50F every few days, maybe once a week. When I load the CMS50F file into SleepyHead (load data file), I choose "use the oximeter time clock" and I can sync it literally to the second. As I mentioned somewhere, pulse ox events are real time delayed by about 20 sec due to the time it take an event effect to travel from the Heart/lungs via the circulatory system to the finger tip. But the imported file start time can be reimported right over the top of the first and manually adjusted if necessary. All files imported will be displayed, just turn the sessions off for the non desired.

Omne, I suspect your synch problem may be with your Dreamstation (can't set the clock), or perhaps more likely your CMS50I is set wrong. 12 hours in advance. 24 hour time?

Buy ResMed

palerider wrote:that wasn't what I asked.

Then I would have to say no.

kudos to you jay, very helpful post!

Omne wrote:

palerider wrote:that wasn't what I asked.

Then I would have to say no.

I don't know if it still works, but there's a 'set time' button on the oximeter page wherein SH sets the time on your I to whatever the computer clock is set to. your 12 hours extra sounds like you set the oximeter to 02:15 instead of 14:15 for example.

or, maybe it's just another bug.