CPAPtalk.com

palerider wrote:

SleepyMcgee wrote:Ugh, not sure why these arent displaying but the links do work. thanks

because photobucket sucks, please use imgur.com instead.

Yeah, I added them to Imgur and the last few are hosted there.

Check with your doctor about maybe having the Vitamin D and testosterone levels checked.
They aren't usually included in routine labs and both if low could affect energy levels.

Your recent report dated 10/14 is pretty darn boring...which is good in terms of therapy but bad in terms of maybe helping us figure out why you don't feel the good numbers.

thanks. To clarify though, that was a 'good night'. I felt amazing the next day...I have no idea why the hyponeas were virtually eliminated at a pressure of 6 that night and then two nights later they were back and I was tired out again.

SleepyMcgee wrote: have no idea why the hyponeas were virtually eliminated at a pressure of 6 that night and then two nights later they were back and I was tired out again.

We don't sleep the same each night.
Maybe it's positioning....maybe you end up on your back more on the "bad" nights and maybe you need more pressure when on your back.
Maybe it's related to REM stage sleep because sometimes our OSA is worse in REM sleep and we need more pressure in REM than in the other sleep stages.
Maybe it's a little of both.

Normally your machine at these settings should/would increase if either of the above were the problem but your machine doesn't really seem to want to move much from the minimum pressure. Those spiky looking things are just normal pressure probes.
I don't know what to make of the machine not really wanting to do much except that the normal triggers to increase the pressure just aren't happening.

I am wondering what would happen if you used a fixed pressure...might be worth trying.

Pugsy wrote:

SleepyMcgee wrote: have no idea why the hyponeas were virtually eliminated at a pressure of 6 that night and then two nights later they were back and I was tired out again.

We don't sleep the same each night.
Maybe it's positioning....maybe you end up on your back more on the "bad" nights and maybe you need more pressure when on your back.
Maybe it's related to REM stage sleep because sometimes our OSA is worse in REM sleep and we need more pressure in REM than in the other sleep stages.
Maybe it's a little of both.

Normally your machine at these settings should/would increase if either of the above were the problem but your machine doesn't really seem to want to move much from the minimum pressure. Those spiky looking things are just normal pressure probes.
I don't know what to make of the machine not really wanting to do much except that the normal triggers to increase the pressure just aren't happening.

I am wondering what would happen if you used a fixed pressure...might be worth trying.

Thanks. I'm seeing virtually no obstructive apneas. As for set pressure, last night I set the min and max both to 6. Much worse than before for some reason. You can see ahi creeping up since I changed min to 6 on Friday (I know, the DreamMapper stuff is relatively useless. Just using a screenshot to illustrate point).

Thanks again.


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You may be one of those people who simply feel a huge difference even with not all that huge of a difference in AHI.
Meaning that while I can't tell much of a difference in how I might feel with an AHI of 2 to 3 and less than 1.0...maybe you can. It wouldn't be impossible.

If it were me I would more likely try and even higher minimum pressure than 6...and I would also consider trying single pressure but more than 6 min and 6 max...maybe 7 min and 7 max or even 8 min and 8 max.
Your machine isn't finding the usual triggers for increasing the pressure so about all you can do is increase it manually in the form of more minimum to see if you come to a point where you feel better more days than you feel bad.

You are going to have to pick a change and be prepared to stick with it for probably at least a week...and keep a careful journal daily of your results so that you can look back on it for any trends or patterns. You can't keep chasing last night's results with frequent changes. I know it's tempting but it just creates a situation where you can't ever really evaluate for long term trends or patterns.

Finally...you know it's entirely possible that something else is going on that the machine can't fix no matter how good you get the therapy dialed in. The best AHI in the world doesn't guarantee the miracle...no matter how much we wish it to.
You do have some options though to try before you give it the "this is the best it gets".

Oh...when you say the home study was inconclusive...what does that mean? Low AHI or no sleep?

Pugsy wrote:The Respiration rate graph is useless..............

Out of curiosity, why do you say this Pugsy? (Full disclosure: In another forum, I advised the OP to show respiration.) We see from this one that breathing is erratic, there are humps in it (which I look for as first step to postulating REM stages), and it seems to have a downward slope over the night. (That would be clarified with the "average" line overlay.) If there are steady below average segments, they hint at awake periods. In this case the features are not readily correlated with data in the other channels, but you don't know unless you look.

OTOH, while the orthodoxy is to include the Flow Rate graph, at full outward zoom, what does it really reveal? It contains respiration variance, but without zooming, we can't see it. At normal zoom, it always looks pretty much the same to me. What sort of correlations are you looking for? For me, the FR is extremely valuable in 3-minute windows, where, as you know, various inferences may be drawn.

I know you are empirical and focused on results. Agreed I tend more toward analytical with eye on full picture. (Not to mention I share the ultimate goal of improving health and feeling better ) Still I'm curious to hear why you feel the Respiration graph is useless at first shot, and what (correlations?) you look for in the Flow Rate graph.

-Ron

Pugsy wrote: "this is the best it gets".

I'll be flying all over the world chasing mystic potions and chants before I relegate myself to living with one night of good sleep a week!!

Pugsy wrote:Oh...when you say the home study was inconclusive...what does that mean? Low AHI or no sleep?

I slept horrendously that night and I dont believe the unit found any compelling evidence of sleep apnea. I dont recall the exact terminology. Dr. is fighting with insurance to get an in house sleep study done.

Thanks again for the insight. I'll kick up the maching to 6.5 or 7 and give it a whirl for a while.

rkl122 wrote:Out of curiosity, why do you say this Pugsy? (Full disclosure: In another forum, I advised the OP to show respiration.) We see from this one that breathing is erratic, there are humps in it (which I look for as first step to postulating REM stages), and it seems to have a downward slope over the night. (That would be clarified with the "average" line overlay.) If there are steady below average segments, they hint at awake periods. In this case the features are not readily correlated with data in the other channels, but you don't know unless you look.

Because I don't particularly agree with your postulating for one thing and another is that about 4 graphs is about all we can get and still see the graphs well enough for evaluation. So most of us choose the basic 4 graphs and then if something else is needed we just ask for something else.
I start with the basics and work from there. If I need something else then I just ask but I don't think that respiration rate is particularly reliable for evaluation of sleep stages. You are certainly free to believe whatever you want but I don't find respiration rate all that useful and certainly not at the expense of other potentially more useful graphs.

Erratic breathing may or may not mean anything more than a horny dream or a nightmare or whatever.
My own respiration graphs are all over the place every night all night long. No way in hell to postulate sleep stage or even sleep or awake at this scale shown on these graphs. If (big IF) I wanted to check out a respiration rate or flow rate or any graph for that matter to maybe help identify sleep or awake status...I wouldn't use this scale...I would ask for a zoomed in section pertaining to a particular time frame.

A person needs all the data usually gathered during an in lab sleep study to know for sure what sleep stage a person might be in...then they compare known awake time to known sleep time and go from there...and those graphs are zoomed in on a breath by breath scale and not at the scale shown here.

So if I want to look....I will want to look at a scale that might actually tell me something useful and it sure isn't this scale...but I prefer zoomed in flow rate over even zoomed in respiration rate myself.
You are of course free to prefer whatever you wish but IMHO respiration rate isn't particularly useful.

SleepyMcgee wrote: I'll be flying all over the world chasing mystic potions and chants before I relegate myself to living with one night of good sleep a week!!

And I don't blame you one bit.

There are some options to try to see if we can get you to having more good nights than bad nights.
Our hands are a bit tied in the sense that there's nothing horribly earth shattering standing out on the reports that we could maybe blame and target for improvement.
The fact that you seem to feel better with a really low AHI does give us something to start with to at least try.
The bulk of your AHI is obstructive in nature...the OAs, hyponeas...are obstructive and any FLs or RERAs also point to something obstructive potentially messing with sleep quality.
How do we fix obstructive stuff...more pressure to hold the airway open better and thus hopefully prevent the collapsing. For some people apap mode will do the responding and get the job done but for some reason whatever is going on with you isn't triggering the machine to increase the pressure so we go to manually increasing it.

I don't know if the minor changes in pressure you are seeing (those pressure probes) are maybe impacting your sleep quality or not but it wouldn't be impossible and thus the idea to try minimum to equal maximum to eliminate the pressure probe changes. I would still leave it in auto mode so that the FL flagging is still available (it's turned off in cpap mode) and even though you aren't having many FLs....I would still want to know about them if they happened.

It wouldn't be impossible for you to have some arousals or awakenings that you don't remember. It's normal to awaken after a REM cycle but most people won't remember that awakening.
If you are remembering dreaming...you are waking more than you think and remember dreams can happen during any sleep stage and not just REM.

There are other sleep disorders besides sleep apnea. The machine can only fix sleep problems directly related to sleep apnea. It would be nice if you had a real sleep study to know if anything else might be going on but you don't have that right now so we deal with it the best we can.
Keep trying stuff in an effort to get you where you have more good nights than bad nights.

Pugsy wrote:

SleepyMcgee wrote: I'll be flying all over the world chasing mystic potions and chants before I relegate myself to living with one night of good sleep a week!!

And I don't blame you one bit.

There are some options to try to see if we can get you to having more good nights than bad nights.
Our hands are a bit tied in the sense that there's nothing horribly earth shattering standing out on the reports that we could maybe blame and target for improvement.
The fact that you seem to feel better with a really low AHI does give us something to start with to at least try.
The bulk of your AHI is obstructive in nature...the OAs, hyponeas...are obstructive and any FLs or RERAs also point to something obstructive potentially messing with sleep quality.
How do we fix obstructive stuff...more pressure to hold the airway open better and thus hopefully prevent the collapsing. For some people apap mode will do the responding and get the job done but for some reason whatever is going on with you isn't triggering the machine to increase the pressure so we go to manually increasing it.

I don't know if the minor changes in pressure you are seeing (those pressure probes) are maybe impacting your sleep quality or not but it wouldn't be impossible and thus the idea to try minimum to equal maximum to eliminate the pressure probe changes. I would still leave it in auto mode so that the FL flagging is still available (it's turned off in cpap mode) and even though you aren't having many FLs....I would still want to know about them if they happened.

It wouldn't be impossible for you to have some arousals or awakenings that you don't remember. It's normal to awaken after a REM cycle but most people won't remember that awakening.
If you are remembering dreaming...you are waking more than you think and remember dreams can happen during any sleep stage and not just REM.

There are other sleep disorders besides sleep apnea. The machine can only fix sleep problems directly related to sleep apnea. It would be nice if you had a real sleep study to know if anything else might be going on but you don't have that right now so we deal with it the best we can.
Keep trying stuff in an effort to get you where you have more good nights than bad nights.

I'm going to set min to 7 and max to 8.5 and give it a few nights. Thanks for the input

Question I should have asked first...does the data show that I 'have' sleep apnea? Since the home test wasn't conclusive and I'm in insurance purgatory regarding a sleep study I figure I should ask!!


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SleepyMcgee wrote: Question I should have asked first...does the data show that I 'have' sleep apnea?

That's a really good question and the cold hard truth of the matter is that from what I have seen here there isn't anything definitive that we can rely on to show for sure obstructive sleep apnea. We've got a maybe based on the machine showing lower AHIs with more pressure but we don't ever really know what the AHI was before it lowered.
The drawback to using the machine even at a minimum of 4 cm (with no ability to increase) is that the 4 cm pressure does have some therapeutic value despite it being relatively low. In other words if you did a night with the pressure at 4 cm and the AHI was still below 5.0 we don't know if the pressure gave us the AHI being nice and low or if nothing much happened to give us the low AHI.

If we saw a lot of movement from the minimum pressure upwards where we knew the machine sensed something it didn't like then we would have a more definitive answer. Like if your pressure went up to 9 and stayed there or went up there for a good part of the night.
These machines respond to snores, flow limitations, OAs and hyponeas (within whatever criteria they use) which either are warning signs (FLs and snores) or full blown obstructive events and if the machine doesn't respond we can't tell for sure why it didn't respond.

About the best we can do is give the machine a shot and see if it helps or not and since you say you do have some days where you see marked improvement then we sort of assume that something was going on and there was some help even if not consistent help. Obviously we want more consistent "good" nights because we like feeling better during the day and we want more of those days.

I have been wondering about UARS...Upper Airway Resistance Syndrome...in your situation. Now I am NOT saying that is what is going on here but your history and these reports does seem to make me want to at least think about UARS being a possibility.
Google it and read up on it. CPAP is still the first line of therapy but we are hindered a bit with UARS patients in that these machines don't really gather the data that we might find helpful in evaluating therapy.
To some extent the FLs and RERAs might help but there's no guarantee that they would.
UARS patients have to rely a lot more on how they feel than what they see on the reports because in all likelihood their AHI wasn't all that exciting in the first place. There is a specific test for UARS but it involves a sleep lab and some sort of device (PES) to actually measure things and if your insurance company won't pay for a regular sleep study then the chance of them paying for that type of sleep study would be similar to a snowball in hell's chance of survival.
Most of the time UARS diagnosis has come about more from a rule out situation...rule out typical OSA using standard measures and go with history and see what's left as a possible.

If I were in your shoes...and I had some good nights even if not as many as I wanted...and without cpap therapy I never had any good nights....then I would proceed with various trials in an effort to maximize the number of good nights which gave me good days no matter what the official diagnosis was. I wouldn't care so much about the name on the face as I cared about improving how I felt.
If (big IF I know) you do have some sort of UARS thing going on here from what I have read is that you may do better with a higher pressure...meaning higher than what is needed to get an acceptable AHI because AHI isn't a good yardstick for UARS patients. You would have to go more on how you felt than what you see on the reports.

Without having a conclusive sleep study showing X number of apnea events per hour we just don't know for sure what these AHIs you are having might really mean. It might be that in a lab setting your AHI wasn't all that high anyway. We just don't know.

But it doesn't stop you from trying to improve how you feel. I know it's frustrating having the occasional "good" night/day to tease you but at least you know it can get better. That's far better than someone who never gets a taste of "better"...IMHO.
So you keep trying things to see if you can zero in on anything to help improve the number of good nights.
You still have some options available and by no means have you yet exhausted all potential ideas in your search.

Ok. Upped my pressure to 6.5 last night and raised the max to 9.5. Very strange results. I feel 'just ok' this morning. Fatigued etc but not a complete zombie. AHI went way up to 4+ and my 95% pressure went to the max 9.5. I've never had a night with a 95% so high. I hover between 5.5-7.5 for 95%...Any feedback??? Thanks EDIT: Adding both 'large' and 'huge' thumbnails as the 'huge' is a comfortable reading size in my browser. Thanks again!

Well that looks more like a machine doing it's job fighting OSA. Some movement of that pressure line. Would be nice to know why it did it last night and not other nights....but you know women....never satisfied.

I wonder if you happened to be on your back more last night.
There probably is some REM stage sleep involvement as well but REM doesn't normally last quite so long...especially that first time where the pressure went up.

Google "sleep stages" and look over the normal hypnograms to get an idea how REM normally occurs and the pattern and time frame for how long each stage usually lasts.

Something changed last night. Unfortunately we don't know exactly what changed but the 2 usual culprits are sleep position or REM or maybe a little of both.

I am going to to out on a real long and real skinny limb here...this is just a WAG (wild ass guess) but maybe your OSA is rather mild or not particularly diagnostic when on your side but more obvious when on your back and/or need more pressure when on your back and maybe REM is involved to some extent too.
I don't think REM is the lone culprit because we would assume that you had normal REM on those other nights when the machine sat by and pretty much twiddled its thumbs.

Maybe we should give the machine room to roam past 9.5 just in case it wants to. I didn't think it wanted to based on the previous reports but this one changed my mind. It won't go up unless it has a good reason to want to up so there's no urgent need at this point to have a tight range.

Pugsy wrote:Well that looks more like a machine doing it's job fighting OSA. Some movement of that pressure line. Would be nice to know why it did it last night and not other nights....but you know women....never satisfied.

I wonder if you happened to be on your back more last night.
There probably is some REM stage sleep involvement as well but REM doesn't normally last quite so long...especially that first time where the pressure went up.

Google "sleep stages" and look over the normal hypnograms to get an idea how REM normally occurs and the pattern and time frame for how long each stage usually lasts.

Something changed last night. Unfortunately we don't know exactly what changed but the 2 usual culprits are sleep position or REM or maybe a little of both.

I am going to to out on a real long and real skinny limb here...this is just a WAG (wild ass guess) but maybe your OSA is rather mild or not particularly diagnostic when on your side but more obvious when on your back and/or need more pressure when on your back and maybe REM is involved to some extent too.
I don't think REM is the lone culprit because we would assume that you had normal REM on those other nights when the machine sat by and pretty much twiddled its thumbs.

Maybe we should give the machine room to roam past 9.5 just in case it wants to. I didn't think it wanted to based on the previous reports but this one changed my mind. It won't go up unless it has a good reason to want to up so there's no urgent need at this point to have a tight range.

I was more aware of my 'awake' time last night as I was 'determined' NOT to be on my back at ALL. Of course, who knows if I was successful in staying on my sides once asleep but I was aware of moving from one side to the other quite a few times throughout the night.
Thoughts on any pressure adjustments? Should the min come up a bit? I'll move the max to 12 or so...Thanks again for the continued input.

Are there any suggestions out there on sleep devices that could better analyze whats going on in my brain etc? Assume for the sake of discussion that money is no object...Just for fun.