SleepyHead data is weird

Below is the data for my 3rd day of a full mask. It didn't look right to me, and then I noticed
this line: ModeCPAP Mode APAP

I'm using my Resmed as a CPAP, not APAP. Maybe this is the reason for the poor numbers? AHI of 6.59 is
the highest it's been in a long time. All the other data showed low AHI but a high leak rate.
I've been SO groggy lately. It's horrible! I wake up too soon with a horribly dry mouth, too.

Lastly, the tech also recently increased my pressure from 5-8 to 5-10.


AHIApnea Hypopnea Index 6.59
ResMed S9
AutoSetModel 36005 - 23131184160
PAP Mode: APAP
Min 5 Max 10 (cmH2O)
Date Sleep Wake Hours
3/30/2017 17:32:59 11:00:17 04:42:06
Large Leak 13.52%
Clear Airway 0.21
Unclassified Apnea 0.00
Obstructive 4.47
Hypopnea 1.91

Event Breakdown

Statistics
Channel Min Med 95% Max
PressureTherapy Pressure (cmH2O)
W-Avg: 8.13 5.00 8.58 10.00 10.00
EPAPExpiratory Pressure (cmH2O)
W-Avg: 5.51 4.00 5.58 7.00 7.00
Minute Ven t. Amount of air displaced per minute (L/min)
W-Avg: 6.19 1.00 5.88 9.88 23.50
Resp. RateRate of breaths per minute (Breaths/min)
W-Avg: 19.13 2.00 18.80 23.80 47.60
Flow Limi t. Graph showing severity of flow limitations (Severity (0-1))
W-Avg: 0.10 0.00 0.01 0.56 0.98
Leak RateRate of detected mask leakage (L/min)
W-Avg: 9.04 0.00 6.00 32.40 98.40
SnoreGraph displaying snore volume (?)
W-Avg: 0.07 0.00 0.04 0.26 0.76
Insp. TimeTime taken to breathe in (Seconds)
W-Avg: 1.56 0.10 1.50 2.02 12.68
Exp. TimeTime taken to breathe out (Seconds)
W-Avg: 1.65 0.06 1.68 2.16 4.60
Tidal VolumeAmount of air displaced per breath (ml)
W-Avg: 318.88 60.00 300.00 520.00 1040.00

Total time in apnea 00:11:13
Time over leak redline 13.518%
Machine Settings

ModeCPAP Mode APAP
Pressure MinMinimum Therapy Pressure 5 cmH2O
Pressure MaxMaximum Therapy Pressure 10 cmH2O
EPRResMed Exhale Pressure Relief Full Time
EPR LevelExhale Pressure Relief Level 3cmH2O
Session Information

CPAP Sessions
On Date Start End Duration
ResMed Session #1490909579
3/30/2017 17:32:59 17:41:01 00h 08m 02s

just post a chart.

palerider wrote:just post a chart.

Tried. Not enough brain power today.

The settings point to apap mode...and the pressure numbers seem to reflect apap mode.
In fixed cpap mode the pressure numbers should be pretty much the same all the way across.
What was it supposed to be in cpap mode?

You might go into the setup menu and see what the machine is actually set at.

There is a bug in SH sometimes with setting information that is right above the statistics column but usually the pressures reported in the statistics will still be correct.

Only 4 hours 42 minutes of use last night? How come?

DeeCPAP wrote: Lastly, the tech also recently increased my pressure from 5-8 to 5-10.

This is what the above numbers seem to reflect...and that's not cpap mode.

In cpap mode the pressure is fixed except for when EPR kicks in.

Need to see your pressure graph I guess to see if the pressure is acting like cpap or apap.

Pugsy wrote:The settings point to apap mode...and the pressure numbers seem to reflect apap mode.
In fixed cpap mode the pressure numbers should be pretty much the same all the way across.
What was it supposed to be in cpap mode?

You might go into the setup menu and see what the machine is actually set at.

There is a bug in SH sometimes with setting information that is right above the statistics column but usually the pressures reported in the statistics will still be correct.

Only 4 hours 42 minutes of use last night? How come?

DeeCPAP wrote: Lastly, the tech also recently increased my pressure from 5-8 to 5-10.

This is what the above numbers seem to reflect...and that's not cpap mode.

In cpap mode the pressure is fixed except for when EPR kicks in.

Need to see your pressure graph I guess to see if the pressure is acting like cpap or apap.

I don't know if this data will help. I'm so groggy I can't think straight. Let me know if this helps.
I also made JPG screenshots but don't know how to upload them (I tried copy and pasting but it didn't
work).

A Week (not sure)
Mode Autoset
Max pressure 10
Min pressure 5
Max ramp 20 min
Start pressure 5
ERP Full time
EPR level 3

1 month
Days used 30/30
Avg usage 5.9
Pressure 8.8
Leak 24/L min
';'


6 mo. data
days 179/180
Days > 4 148/180
Avg usage 5.6 <--------------maybe too low because of the CPAP MACHINE HELL!
Pressure 8.0
Leak 24L/min

All that stuff is from the summary statistics page.
Doesn't tell us much.
Scroll way down below the statistics to the
Changes to prescription area...that's where any changes are noted. SH keeps a record.

If you can't figure out how to upload a screen shot to the forum...send it as a jpg image file to my private email address...I think you have it.

If you are really only averaging 5 hours or so of sleep...no wonder you feel like crap.

Pugsy wrote:All that stuff is from the summary statistics page.
Doesn't tell us much.
Scroll way down below the statistics to the
Changes to prescription area...that's where any changes are noted. SH keeps a record.

If you can't figure out how to upload a screen shot to the forum...send it as a jpg image file to my private email address...I think you have it.

If you are really only averaging 5 hours or so of sleep...no wonder you feel like crap.

I've averaged, according to the chart, 5 1/2 to 6 hours sleep for over a year. My doc (or his
tech) didn't address it, but that's probably why I've felt poorly.

Thanks, Pugsy. I sent you some graphs via email that I rushed, so let me know if it's okay. (One
is an accidental duplicate). I hope it makes some sense.

I got what you sent.
You have always been in apap mode...never cpap mode that I could see.
Most recent change was the change from 5 min 8 max to 5 min 10 max and I think I see what with the one pressure graph you sent ...you were probably maxing out at 8 all the time because you are maxing out at 10 most of the time.

This particular report is badly fragmented...and obviously not enough hours of sleep ...no where near enough.

Your snore and FL graph so a lot of activity in some times and not so much at the beginning of the session...like maybe you start out on your side and roll over onto your back? Is that what you normally do? REM sleep can also cause the OSA to be worse but from the looks of the time frame from when you started to fall asleep and the increase in pressures and OAs happen...I think it is too soon to think REM related. It wouldn't be impossible but highly unlikely to see REM happen 30 minutes after sleep onset.
Supine sleeping would be the most likely culprit.

It's fairly obvious the snores and FLs are driving the pressure up and it maxes out at 10...and you have a large leak at the same time.
It's also obvious you are definitely in apap mode and not cpap mode. The pressure is not fixed at all. I don't know where you got the idea about cpap.

From what little is available on last night's report...your problem isn't so much the maximum as it is the minimum pressure.
You need to start a little higher minimum and probably increase the maximum also. Especially since you are using EPR at 3.

So from little I have to go on..
1...not enough hours of sleep even if therapy was optimal
2...therapy is not yet optimal at least for part of the night. Some parts of the night it is fine but other parts it goes all to hell.

You are having clusters of OAs and some snores and some FLs...all point to not enough minimum pressure. The OA cluster happened right before the large leak flag (and that appears to have gone to maybe 30 to 35 L/min so the machine is still going to be reasonably accurate and the pressure dropped as expected during the large leak. Most likely the machine trying to better manage the leak and then the session ended.
The second short session about 2 hours later showed the same pattern..nothing going on for about an hour and then the FLs, snores and OAs happen and the pressure goes up...again I suspect supine sleeping. There are a few hyponeas in both sessions...but mainly OAs.
Only 1 CA/central...so it's of no importance.

Whatever is causing the short hours of sleep and the fragmented sleep desperately needs to be addressed.
And the sub optimal therapy pressures that are happening some parts of the night need to be addressed (more minimum probably) or reduce or turn off EPR.
I don't think more maximum is going to do the trick. How much more minimum...dunno but I suspect at least 7cm instead of 5 cm if you are going to continue with EPR where it is at.
And I wouldn't go changing EPR right now...I think that change would likely impact sleep quality more and making your already very fragile sleep more fragile since you have been using EPR at 3 for so long. I don't think you would like the change if you try to change EPR or turn it off. Your body is too used to it. I think you could probably handle increasing the minimum easier than turning off EPR but...that's up to you.

When you are starting out the night at 5 cm... you are only getting a 1 cm drop down to 4 cm with your 3 cm EPR because the machine can't go below 4. If you started the night at 7 cm then you would get the full drop to 4 and it would likely be more comfortable or as comfortable as 5/4.

That's my thoughts at least from the very limited data available from last night.
Something is causing a dramatic change in pressure needs 30 minutes to an hour after sleep onset. Sleep position comes to my mind first...REM doesn't normally happen until about 90 minutes after sleep onset.

Pugsy wrote:I got what you sent.
You have always been in apap mode...never cpap mode that I could see.
Most recent change was the change from 5 min 8 max to 5 min 10 max and I think I see what with the one pressure graph you sent ...you were probably maxing out at 8 all the time because you are maxing out at 10 most of the time.

This particular report is badly fragmented...and obviously not enough hours of sleep ...no where near enough.

Your snore and FL graph so a lot of activity in some times and not so much at the beginning of the session...like maybe you start out on your side and roll over onto your back? Is that what you normally do? REM sleep can also cause the OSA to be worse but from the looks of the time frame from when you started to fall asleep and the increase in pressures and OAs happen...I think it is too soon to think REM related. It wouldn't be impossible but highly unlikely to see REM happen 30 minutes after sleep onset.
Supine sleeping would be the most likely culprit.

It's fairly obvious the snores and FLs are driving the pressure up and it maxes out at 10...and you have a large leak at the same time.
It's also obvious you are definitely in apap mode and not cpap mode. The pressure is not fixed at all. I don't know where you got the idea about cpap.

From what little is available on last night's report...your problem isn't so much the maximum as it is the minimum pressure.
You need to start a little higher minimum and probably increase the maximum also. Especially since you are using EPR at 3.

So from little I have to go on..
1...not enough hours of sleep even if therapy was optimal
2...therapy is not yet optimal at least for part of the night. Some parts of the night it is fine but other parts it goes all to hell.

You are having clusters of OAs and some snores and some FLs...all point to not enough minimum pressure. The OA cluster happened right before the large leak flag (and that appears to have gone to maybe 30 to 35 L/min so the machine is still going to be reasonably accurate and the pressure dropped as expected during the large leak. Most likely the machine trying to better manage the leak and then the session ended.
The second short session about 2 hours later showed the same pattern..nothing going on for about an hour and then the FLs, snores and OAs happen and the pressure goes up...again I suspect supine sleeping. There are a few hyponeas in both sessions...but mainly OAs.
Only 1 CA/central...so it's of no importance.

Whatever is causing the short hours of sleep and the fragmented sleep desperately needs to be addressed.
And the sub optimal therapy pressures that are happening some parts of the night need to be addressed (more minimum probably) or reduce or turn off EPR.
I don't think more maximum is going to do the trick. How much more minimum...dunno but I suspect at least 7cm instead of 5 cm if you are going to continue with EPR where it is at.
And I wouldn't go changing EPR right now...I think that change would likely impact sleep quality more and making your already very fragile sleep more fragile since you have been using EPR at 3 for so long. I don't think you would like the change if you try to change EPR or turn it off. Your body is too used to it. I think you could probably handle increasing the minimum easier than turning off EPR but...that's up to you.

When you are starting out the night at 5 cm... you are only getting a 1 cm drop down to 4 cm with your 3 cm EPR because the machine can't go below 4. If you started the night at 7 cm then you would get the full drop to 4 and it would likely be more comfortable or as comfortable as 5/4.

That's my thoughts at least from the very limited data available from last night.
Something is causing a dramatic change in pressure needs 30 minutes to an hour after sleep onset. Sleep position comes to my mind first...REM doesn't normally happen until about 90 minutes after sleep onset.

Thanks, Pugsy, what you wrote isn't simplified enough for me. I know I need REM sleep, but all I was told is to wear a FF mask to prevent leaks during REM sleep, but nothing more. The tech also increased the pressure. Aren't TECHS or the DOCS suppose to be analyzing the data and letting me know what to do about it? Last night's data may have been much different from the others. Two weeks prior using the DreamWear the data looked good even to me who knows very little about analyzing data.

The last few days I changed from my usual old DreamWear to an Amera View (small) to an Amera View (medium). I'll send you an "overall" view of the data if it will help. I have 2 or more years data that may even be more confusing, but I just sent it you if you want to take a look. Like I said, it's weird because there's no consistency.

Also,I think I have a problem with lowering my chin in my sleep so the inhalation is okay, but exhalation gets clogged -- I hope that makes sense because it's happening. If I lift my chin, it doesn't happen, but then again, I have no idea what I'm doing in my sleep. Maybe the data shows it.


Thanks!

No..the data available really doesn't tell us all that much in terms of what you are doing in your sleep.
The machines only measure the air flow. We can't tell sleep stage or even if you are for sure asleep or not.

Seeing more summary numbers really isn't going to help except confirm what we already know.
Not enough hours of sleep and sub optimal therapy. What you elect to do about it is between you and your medical team unless you wish to take the bull by the horns and do it yourself but I don't get the sense that you fully understand what you are seeing or would be doing and I don't want you to do something because someone else says you should do it. You should only do things that you understand what you are doing and why.

I do have one suggestion since you mentioned dropping your chin...have you tried wearing a cervical collar to bed to sleep with...one of those soft cervical collars. Many forum members elect to do that for various reasons...it prevents the chin drop and closing off the airway and helps the machine maintain an open airway a bit easier.

One other question...has the sleep quality worsened with the new mask? Did you sleep any better or feel any better with the DreamWear?

One more...do you take any medications of any kind? If so what?

Pugsy wrote:No..the data available really doesn't tell us all that much in terms of what you are doing in your sleep.
The machines only measure the air flow. We can't tell sleep stage or even if you are for sure asleep or not.

Seeing more summary numbers really isn't going to help except confirm what we already know.
Not enough hours of sleep and sub optimal therapy. What you elect to do about it is between you and your medical team unless you wish to take the bull by the horns and do it yourself but I don't get the sense that you fully understand what you are seeing or would be doing and I don't want you to do something because someone else says you should do it. You should only do things that you understand what you are doing and why.

I do have one suggestion since you mentioned dropping your chin...have you tried wearing a cervical collar to bed to sleep with...one of those soft cervical collars. Many forum members elect to do that for various reasons...it prevents the chin drop and closing off the airway and helps the machine maintain an open airway a bit easier.

One other question...has the sleep quality worsened with the new mask? Did you sleep any better or feel any better with the DreamWear?

One more...do you take any medications of any kind? If so what?

Yes, I take medications. Also, I've only work the Amera View three times. Two of those times I woke up with my mouth open and EXTREMELY dry, which probably CAUSED me to wake up. The third time was when I used the (small) cushion, but then my nose hurt.
I must admit that after 10+ years I'm feeling very discouraged, especially because I loved the DreamWear -- it felt like not wearing a mask at all, but I opened my mouth and the tech who read the data said I should use a FF. I'm buying a collar tomorrow to see how it goes.