Followed Board Advice - Please Compare 2 Days

[Pugsy]

To be honest I don't know what you could learn from an in lab sleep study unless it might be if your pressure needs have changed over the years.
Or if you have lost significant weight there is always the remote chance that your OSA severity might have lessened or the pressure needs have changed.

Often doctors just revert back to "let's get another sleep study" when they can't think of anything else and the sleep study becomes a fishing expedition and the hope that they get lucky and catch something.

I don't see anything here that would lead me to suggest another sleep study might offer something earth shattering in terms of new information.

[MurrayNevada]

Good morning Pugsy,
I raised the minimum pressure to 9.5 as you suggested. Interesting night last night: At about 9:15 pm last night I attached a different mask (AirTouch F20) to my APAP in order to fit it and maybe give it a go. I did fall asleep but it was very uncomfortable(at bridge of nose) and the air venting from the mask"s hose attachment was also uncomfortable. That mask is being returned. I had had enough by 11:00 pm and attached the mask I have been using (Simplus FF Mask). It was much more comfortable and I slept with it on for the remainder of the night. Below are the screen shots of last night and the night before for your review. I hope I didn't skew things by my short attempt with the AirTouch F20.
Thank you,
Mike

[Pugsy]

How about we try opening the max up and let's see where the machine wants to go if it can?
You hit 14 cm briefly last night and had some clustering of events at the time you hit 14 and the machine probably would have gone higher and maybe they wouldn't have happened if the machine could have gone higher.

Set the max to 20 and let the machine sort it out. It won't go anywhere without a good reason to go there.

[MurrayNevada]

Good morning Pugsy,
I set the maximum pressure at 20 for last night as you suggested. Something Odd: The results I posted for 5-23-18 yesterday are now different when I look at 5-23-18 on SleepyHead now. The AHI, pressure, etc. are at odds with my posting yesterday. I will attach below the "new" numbers now shown for 5-23-18 on SleepyHead for you to compare with the one posted in my reply yesterday. I am also posting below my results from last night for your thoughts.
Thank you,
Mike
As you can see, the 5-23 data in my post above this one is much different than shown now on Sleepyhead. Last night is also below. They may be in the wrong order but luckily they show the day and dates.

[Pugsy]

You've got one session turned off on that report that looks like it changed. No big deal.
Look down at the bottom lower left where the sessions are and see the green/black boxes...and then see the one that is red/black???
Some how or other you clicked on that session that is red and turned it off and when you turn a session off it changes the stats and omits that session that is red/turned off from the statistics and graphs.
To turn off or back on just click on the red/green/black box.

I am wondering about that cluster at around 3:15 which also has some PB flagged time during the OA cluster.

Can you get me a zoomed in screen shot of that PB flagged flow rate?

[MurrayNevada]

I see what you mean about the red/black boxes in lower left. I'm not sure what it is that you want me to send you regarding flow rate nor how to do it? Should I change my maximum pressure to something below 20 now? I think I had the machine off at about 3:15am this morning for a bathroom break. Maybe this is what you wanted:

[Pugsy]

Leave the max at 20. It being at 20 and not going near 20 doesn't affect the response at all. The minimum pressure is your most critical pressure.

Take your mouse cursor and put it just on the edge of where the green PB starts..then click and drag the cursor to the right side just at the end of the green stuff.
Your graphs will change and you will be zoomed in quite a bit. Not sure if it will be enough to suit me but thought give it a try.

The other way is to go into the Events tab...click on OA tab...you will see a list of OA flagged events with the time....pick one in the middle of that cluster and click on it and the graphs on the right will zoom in automatically.
It's going to be zoomed in a lot closer than than using the mouse/highlight click/drag way.

You end up with something like this.

[MurrayNevada]

Here goes:

[MurrayNevada]

This may be better:

[Pugsy]

Well crap, that didn't answer any questions I had in my head but instead created a couple of new ones.

I am not so sure that you were asleep during those OAs and the PB time. Unfortunately the flow rate isn't as clear cut asleep vs awake breathing to make it easy for me to decide.

We know you woke up turned the machine off at the end of whatever this was.
Do you remember being a wake briefly before you turned the machine off? Did you wake up and lay there for a few minutes and then decide to turn the machine off?

We have a similar OA cluster at the end of the night.

If these clusters of OAs are awake breathing irregularities getting flagged by mistake then your AHI while asleep would be quite a bit lower.
But on the other hand if they are real they could be the cause of the wake up.
If real you need more minimum pressure...if not I think this minimum works well.

I am leaning towards the OA clusters being SWJ sleep/wake/junk and thus mentally removed from the pressure needs evaluation process.

I would not change anything tonight. Let's see if this happens again.

[MurrayNevada]

"We know you woke up turned the machine off at the end of whatever this was.
Do you remember being a wake briefly before you turned the machine off? Did you wake up and lay there for a few minutes and then decide to turn the machine off?"

Yes, I did wake up (both times) and lay there for a few minutes and then decide to turn the machine off. For a long time I have a habit of sometimes holding my breath. I know I did this a few times with the mask on. Could that be the case here?

[Pugsy]

Yes, I did wake up (both times) and lay there for a few minutes and then decide to turn the machine off. For a long time I have a habit of sometimes holding my breath. I know I did this a few times with the mask on. Could that be the case here?

Yep, definitely could be the case.

The machine only measures air flow. It has no idea if you are asleep or awake. Our awake breathing is much more irregular than asleep breathing and sometimes it will flag some awake breathing irregularities as some sort of apnea event and this will of course elevate the AHI but since they are awake flags they really don't count in terms of the overall AHI evaluation.

If you manually remove those clusters from the total events and manually recalculate the AHI then it probably will be about half of what it is showing and thus really better than it initially looks like.

I can't always easily tell if someone was asleep or not by the air flow zoomed in. Sometimes it's pretty clear but sometimes it's not so clear.

Here's an example from Encore of wave form graphs...flow rate breathing...of someone with a lot of arousal/awake breathing with a lot of event flags and none of them are real. They are all awake/semi awake breathing flags and they don't count.
Note the time when the breathing patter is nice and regular and smooth...then compare it to the irregular breathing.
This person doesn't have OSA but instead has some crappy sleep from a lot of arousals causing false positive event flagging.


and here is an example of a central flagged that isn't real. The big gulp of air that is circled means it is a post arousal pause in breathing.

[MurrayNevada]

Good morning Pugsy,
Here is last night for your review. How am I doing and are there any changes I should make?

[Pugsy]

The only thing that really bugs me is the cluster of OAs at 00:30. The machine tried to prevent it but couldn't get the job done.
Try another 0.5 cm increase in the minimum. It's either a REM cluster or you were on your back and I am betting REM because of the timing.

Oh...lose the snore graph so that your other graphs can be a bit larger. Makes for easier reviewing and we don't need the snore graph because we already have the snores flagged on the Events graph.
No need to redo this image..but just mentioning it for future images. Just make your other graphs a bit larger and the snore graph can move down out of view. The Events graph is much more important than the snore graph.

[MurrayNevada]

I'm trying to remove the snore graph but having a problem doing it. I will raise minimum pressure .5cm.