Sleepyhead stats on leakage - how to interpret?

Okay, so DreamMapper says my F&P Simplus full-face mask = 100% "fit" nearly every night (if I clamped it on any tighter, it would meld with my face!). When I wake up, the skin covered by it is moist from the Dreamstation humidifier (although my throat is often bone dry - go figure). That would seem to suggest a decent seal. However, the Sleepyhead startup screen says I had major leakage. If true, this could explain my seeming inability to achieve a consistent AHI in the single digits, let alone >5.

Here's last night's SH readout, plus 7 and 30 day avearges:

Leak Statistics
Average Leak Rate 13.92 14.74 11.39

90% Leak Rate 22.00 23.00 21.00

% of time above 7.14 10.36 8.12
Leak Rate threshold

Is this telling me that I'm losing effective air pressure 20+ percent of the time? Sorry if it's a seemingly obvious question, but I'd rather not guess. If that's indeed the case, I either need to shave my beard (my wife would rather not have to look at my unadorned mug every day), or I have a mask issue to resolve. The Simplus medium recommended by the supplier never has seemed to be big enough or perhaps it's simply not the model for me.

Thanks much,

MC

Please read what I just wrote in this thread about SleepyHead and red line leak threshold and Respironics machines.
viewtopic/t157946/Last-nights-SleepyHead-data.html

90% Leak Rate 22.00 23.00 21.00

Is this telling me that I'm losing effective air pressure 20+ percent of the time?

No...this does not mean 20% big leak time
what it means is 22, 23 and 31 L/min leak and for the way the Respironics machine reports leak it is probably meaning very little excess leak.
I would need to see your detailed report but do you see any LL (large leak) flagged time over on the events graph???? I suspect minimal to none.

90% numbers mean "at or below for 90 % of the night"

Respironics machines report total leak which is the mask's expected vent rate plus any excess leak. So you always have the vent/intentional leak rate being reported even if no excess leaks.
ResMed machines and those nice sub 10 leak rate numbers..that's because ResMed machines remove the mask vent rate prior to reporting leak numbers.

I have a segment in the SleepyHead tutorial explaining the differences in how SH reports leaks and what they mean. I do need to clean things up and make it easier to find and read...but that's a work in progress. Have you seen the tutorial...top of the announcements page.

No, Pugsy. The LL line is clear. So if no leaks, I'm completely at a loss to explain why my OAs and CAs are so high. When you say 'my report,' do you mean the graphs or data or both?

Here's the night's list:

AHI 15.23
Philips Respironics DreamStation
Auto CPAPModel
PAP Mode: CPAP

Fixed 12.5 (cmH2O)

Date Sleep Wake Hours
12/27/2017 01:10:32 05:30:10 04:12:06
Periodic Breathing 3.20%
Large Leak 0.00%
Clear Airway 5.95
Obstructive 8.09
Hypopnea 1.19
RERA 0.48
Flow Limitation 0.00
Vibratory Snore 0.00
Vibratory Snore (VS2) 1.19 (presume this is the tube rattle)
Pressure Pulse 12.14
Breathing Not Detected 0.00%

Thanks,

MC

When I say "report" I usually mean detailed data page if at all possible so that I can see both the statistics and the graphs..
So that I can see not only what has happened but when it happened.

When I see data like this I don't know when things happened and sometimes when they happened is very important. That's where the graphs come into play.

Your high AHI...assuming you were asleep when the flags were made...your pressure isn't doing a good job and you need more pressure.
Now it might be that the bulk of this AHI is from awake breathing false positive flags and if that is the case the bad sleep needs to be fixed first and then see if the pressure needs fixing.
The centrals/clear airway apneas...more than I would want to see but they may or may not be real so they would go on the back burner for now.

Oh...the Flow limitation being 0.00...means nothing because in fixed cpap mode that data point is turned off. I am betting if in auto mode you would see a lot of FLs.

mrcrayola wrote:AHI 15.23
Philips Respironics DreamStation
Auto CPAPModel
PAP Mode: CPAP

Fixed 12.5 (cmH2O)

Date Sleep Wake Hours
12/27/2017 01:10:32 05:30:10 04:12:06
Periodic Breathing 3.20%
Large Leak 0.00%
Clear Airway 5.95
Obstructive 8.09
Hypopnea 1.19
RERA 0.48
Flow Limitation 0.00

So I did a screen shot but how do I post that here? Tried drag-n-drop but to no avail.

How to post images. I prefer imgur.com...easier without all the crap.
https://sleep.tnet.com/reference/tips/imgur

Examples in this thread of what we like to see. Don't need all the graphs that SleepyHead offers and you can get all that is needed in one image.
viewtopic/t103468/Need-help-with-screen-shots.html

How to organize the graphs...3 pages so be sure to read them all but do NOT do the full page toggle that is mentioned. There's a bug in SH and you may not be able to get out of full page easily.
https://sleep.tnet.com/resources/sleepyhead/shorganize
You won't have a Flow limitation graph..so don't bother looking...those are ResMed machine data points.

To embed the image using imgur...
Log in to your imgur account...select the image you wish to share and click on it so it is front of you and there is a box of addresses on the right side that includes thumbnails (at the bottom).
Click on "Large Thumbnail" then copy the last line in the box of addresses (linked to BBCode) and paste it in the body of your text here.
You will see the address...click on preview to see if the image shows up.

Doing it this way will make a decent size image (but not huge) and we can click on it to enlarge it if we need to.
Like this


And here's an example of a Respironics report.

Okay, here's the link: https://imgur.com/a/f69A6

Thanks, Pugsy!

MC

Do you have copies of your sleep studies? The diagnostic sleep study and the titation sleep study?
If so, any mention as to when/if the OSA is worse like when on your back or during REM?
If you don't have the copies of the reports...get them.

Do you remember waking often during the night?
That one wake up at 5:00 AM...did you ever go back to sleep or were you wake from the time you turned the machine off and back on again?

Do you take any sort of pain medication?

Have both studies, although the second one is such a poor printout that it's difficult to read.

>> If so, any mention as to when/if the OSA is worse like when on your back or during REM?

A split decision on the initial study. Periods of OSA in both non-REM (2) and REM (2, which makes for more dramatic dreams!). During three of the four major OSA periods, I was supine. For the other, I was on my left side.

Oddly, the titration study captured no OSAs, even when the pressure setting was 4.0. Another strange reading was a substantial increase in hypopneas when the pressure reached 7.0. Granted, that was likely triggered by other factors during that time frame.

>> Do you remember waking often during the night?

Nope.

>> That one wake up at 5:00 AM...did you ever go back to sleep or were you wake from the time you turned the machine off and back on again?

I attempted to go back to sleep with the CPAP but gave up around 5:45, at which time removed it and went back to sleep without it.

>> Do you take any sort of pain medication?

I often take a single ibuprofen tablet prior to going to bed, to reduce nasal inflammation. No prescriptions.

And I just realized that SH is still recording events during the ramp, so my unchecking "ramp events" per another thread didn't change things after all.

MC

mrcrayola wrote: And I just realized that SH is still recording events during the ramp, so my unchecking "ramp events" per another thread didn't change things after all.

One thing to try and I don't know if it will work or not...but try "rebuilding the data"...top of SleepyHead under "CPAP".

Are you using EPR...looks like you are but maybe at 1 ...try turning EPR off and see what happens.

I am concerned about the clustering (which usually means more pressure is needed because of either supine sleeping or REM) but I am also concerned about the centrals when seem to be new to therapy and for some people that might be related to EPR or the pressures used...or they may simply be post arousal centrals related to the OAs and hyponeas and if that is the case they should reduce if the OAs and hyponeas are reduced.

Why are you using fixed cpap pressure and not auto adjusting mode?
How did they/you come up with 12.5 when lower pressures during the titration study seemed to reduce the numbers adequately?
When doing experiments with changes...keep changes to a minimum so we better know if the change impacted anything or not.

For now...first change to try...turn off EPR and see what happens with the OAs and the centrals.

Just realized you're a woman. Thought sleep issues were more an old guy's conundrum. I welcome the diversity, with apologies.

>> One thing to try and I don't know if it will work or not...but try "rebuilding the data"...top of SleepyHead under "CPAP".

Don't see that. Ugh.

>> Are you using EPR...looks like you are but maybe at 1 ...try turning EPR off and see what happens.

Expiratory pressure relief? Don't know, but I'll look at it tonight.

>> I am concerned about the clustering (which usually means more pressure is needed because of either supine sleeping or REM) but I am also concerned about the centrals when seem to be new to therapy and for some people that might be related to EPR or the pressures used...or they may simply be post arousal centrals related to the OAs and hyponeas and if that is the case they should reduce if the OAs and hyponeas are reduced.

I'll be big time bummed if I can't sleep on my back and have the CPAP resolve my issues. I have injuries to both shoulders - one due to a collision with a vehicle (me colliding with it!) and the other due to over-exuberance in conquering an ice/snow wedge using my blower (literally putting my shoulder into it). My impression is that most of my events occur while on my back.

>> Why are you using fixed cpap pressure and not auto adjusting mode?

I tried APAP for four days, but my AHIs were 17+, 11+, 19+, and 15+. It wasn't producing better results than in CPAP mode, which was the way the vendor set it up, so I returned to CPAP mode.

>> How did they/you come up with 12.5 when lower pressures during the titration study seemed to reduce the numbers adequately?

The final prescript was 12, which produced a -0- AHI during the titration study. They kept increasing the flow rate until they got to null and, hence, the prescript.
I recently returned it to 12, which produced AHIs of 8, 10, and 12, followed by 22+, 8+, and 13+. I bumped it to 12.5 to see if that would produce an improvement, but the one-day reading at that setting was last night's 15+.

Thanks, Pugsy. Appreciate your dedication to helping us newbies!

Cheers,

MC

Sorry I made a typo where the rebuild the data is.

Up at the top of SH....File, View, Data and Help...it's under Data....not CPAP...I had a brain fart I guess...brain thought one thing and fingers typed something else. Probably because it is called "rebuild cpap data".

Okay, rebuild complete.

Oops...I forgot to address this concern you had.

mrcrayola wrote:I'll be big time bummed if I can't sleep on my back and have the CPAP resolve my issues. I have injuries to both shoulders - one due to a collision with a vehicle (me colliding with it!) and the other due to over-exuberance in conquering an ice/snow wedge using my blower (literally putting my shoulder into it). My impression is that most of my events occur while on my back.

Actually don't worry about supine sleeping at the present time. I mentioned it as mainly a possible explanation for the clustering...it could easily be REM also. I am not much of one to suggest modifying sleeping position unless there is an urgent need to do so for some reason or other.
I think that people should be able to sleep in any position that lets them sleep comfortable and let the machine deal with it with by maybe using the auto adjusting pressure mode if at all possible.
Besides modifying sleeping position is easier said than done for any number of reason and I don't see the need to go there unless all other options fail and we haven't even begun to try your various options.

You might also be like me where your OSA (and pressure needs) are markedly different during REM stage sleep (it's quite common) and we can't do anything to restrict REM nor would we want to. Let's cross the supine sleeping bridge a bit later.

For now I want you to keep everything the same with the exception of turning EPR off.
If you don't have the clinical/provider manual...get it here and read up on what your machine can do which includes turning EPR off or altering the setting.
https://sleep.tnet.com/home/files/resme ... -guide.pdf

There's more experiments in my mind but this one I want to do first.

Also...can you look back and get me a detailed report from when you were in auto/apap mode? I just want to see what was going on..pick the best of the bunch and I understand the choices are limited.

And yes, I am female...and a lot of people seem to not notice the F in the profile and assume that this stuff is a man's domain but all it takes is someone who pays attention to detail and can think outside the box at time.

I don't expect a miracle just by turning EPR off....I just want to see what happens to the centrals.

The time after the wake up..you didn't go back to sleep so those events are likely what we call SWJ or Sleep/Wake/Junk and not real and we mentally remove those from our evaluation process. The machine only measures air flow and has no way of knowing if you are asleep or not.
Our awake/semi awake breathing is often very irregular when compared to asleep breathing and the machine can sometimes call that irregular breathing some sort of apnea event but it really isn't.

Since you are fairly certain that the other parts of the night you were asleep...we will assume that those are real for the time being but may do a bit more investigation in that area later.

Good morning, Pugsy. Thanks for everything. It's a privilege to be mentored by a pro. And thanks for the manual, but I use a Philips Respironics. I forgot to look for an EPR setting last night. I presume my machine has one. I do have access to the therapy settings, so I'll look again.

I had a much better sleep last night. At my first awakening, my AHI was 6, with my final AHI around 9. Had a cluster of events in the last hour or so of sleep. Suspect they're related to REM, as you suggest.

I will do image grabs of the APAP results and post them later today or tomorrow. I need to start at the top of my to-do list first, however, which includes shipping a guitar to a niece and tying up end-of-year financial matters.

Have a fantastic day!

MC