How Important is the Sleep Study? Self-treat user looking for opinions

Best night yet, and longest sleep. I think a lot of the events are happening during the transition to sleep (both at the beginning and after the one awakening), as I don't just turn on the machine and fall asleep immediately. Based on what you said before, I think these are less worrisome than if they were happening when I had already been definitively asleep.

I woke up around 1:48 and was uncomfortable with the humidity and heat settings (too hot, too dry), and the machine had used pretty much none of the water in the reservoir. Turned the tube heat down from 2 to 1 and switched the humidity from adaptive to fixed (left setting @ 3), and that seems to have done the trick. More water used, and without the hot dry sensation in the nose.

I have no recollection of the relatively short duration large leak, perhaps I fixed my mask headgear during sleep. There is a RERA towards the end of it, so maybe that's when I fixed it?

Overall, I think the minimum pressure change was helpful, and the machine never even touched the lowered maximum of 16. Let me know if anything else jumps out at you. Thanks!

Nothing jumps out at me as needing urgently changed especially if we can blame some of those events on SWJ sleep/wake/junk.

Not sure what to make of the VS2 snores...the machine won't respond to VS2 snores but will respond to the other snores.
If they persist...maybe try 0.5 cm more minimum after using this new setting for 4 or 5 days.
Between the RERAs and the snores and FLs...just a little more than I would like to see and usually easily fixed with just a little more minimum pressure..but no urgent need at the moment. Give yourself a few nights at this pressure and see if they persist or not.

There RERAs may or may not be SWJ. Awake breathing irregularities can be any flagged event...not necessarily just a central/CA.

At some point you might want to learn how to dig deeper so you can figure out awake/SWJ vs asleep events.
http://freecpapadvice.com/sleepyhead-free-software
Watch all the videos at the above link. It will help you learn how to figure out awake vs asleep breathing. While not always easy or clear cut...most of the time you can get a good idea.
You have to mentally remove any awake flags from the pressure needs evaluation process. Awake stuff just doesn't count.

Ignore the large leak. It was short lived and you slept through it. Don't worry about it. We can't have perfect leak management all the time and sometimes obtaining near perfect causes more sleep quality problems than letting a little leak slide might cause.

Pugsy wrote: ↑

Wed Jul 25, 2018 6:08 am

Nothing jumps out at me as needing urgently changed especially if we can blame some of those events on SWJ sleep/wake/junk.

Not sure what to make of the VS2 snores...the machine won't respond to VS2 snores but will respond to the other snores.
If they persist...maybe try 0.5 cm more minimum after using this new setting for 4 or 5 days.
Between the RERAs and the snores and FLs...just a little more than I would like to see and usually easily fixed with just a little more minimum pressure..but no urgent need at the moment. Give yourself a few nights at this pressure and see if they persist or not.

There RERAs may or may not be SWJ. Awake breathing irregularities can be any flagged event...not necessarily just a central/CA.

At some point you might want to learn how to dig deeper so you can figure out awake/SWJ vs asleep events.
http://freecpapadvice.com/sleepyhead-free-software
Watch all the videos at the above link. It will help you learn how to figure out awake vs asleep breathing. While not always easy or clear cut...most of the time you can get a good idea.
You have to mentally remove any awake flags from the pressure needs evaluation process. Awake stuff just doesn't count.

Ignore the large leak. It was short lived and you slept through it. Don't worry about it. We can't have perfect leak management all the time and sometimes obtaining near perfect causes more sleep quality problems than letting a little leak slide might cause.

These videos are fascinating. I really like the idea of being able to dig down into it and track what is going on over time. Based on a very amateur analysis similar to what he was looking at, pretty much all of my events were post-arousal and just the process of returning from arousal back to a regular sleep pattern.

I also don't know what to make of the VS2 snores as the shape of the data where they are flagged doesn't really seem much different than elsewhere. There is a bit more abnormality surrounding the VS snores, and they invariably lead to a slight increase in pressure which levels off shortly after.

Overall, it doesn't really look like there were any events of real significance during a sleep pattern. No sudden flat lines without an arousal before hand, no flat lines followed by a sharp increase in oxygen intake/gasping, etc. I do seem to have a relatively high number of short arousal events, but I've always been kind of a toss and turn, untuck the sheets/comforter kind of sleeper. I wonder if this means that I can expect more false flagging of events than someone who sleeps more soundly with less position adjustments. I don't really care if the AHI is not going to be a clean 1.0-esque number if there is no actual detriment to the quality of sleep.

I'm hoping to get a similar lack of significant events (and a similar result) in the next few nights. I had boundless energy today, and needed it for a long, stressful shift.

RobySue did a bit of analysis of the VS2 snores a while back.
You might find it helpful. Scroll to the top to find her first post.
viewtopic.php?f=1&t=155478&p=1182872#p1182872

Very choppy night in terms of staying asleep. For whatever reason, it felt like a struggle to exhale through the gel pillows today. Is it possible for them to be inserted too far?

Other than the loads of arousals, the data looks pretty clean.
^ This is the first cluster. Looks like post arousal to me?
^ The two OA flags do not appear to be legitimate to me as there is no flat line.


^ This event looks like it could be a true apnea. Not sure

Fetou wrote: ↑

Thu Jul 26, 2018 5:34 am

it felt like a struggle to exhale through the gel pillows today. Is it possible for them to be inserted too far?

Yes...and when you do it scrunches up the pillows so the air doesn't move well and you can feel like you are suffocating.
I had it happen with the P10 nasal pillows. The XSmall would try to climb up in my nose and when it did I would wake up feeling suffocated. So I went to the Small size and it no longer tries to climb up in my nose and I have not had one episode of the suffocation thing.

Nasal pillows shouldn't really go up inside the nostril at all. At most the tiny tip of that inner cone goes up in then nostril a very short distance but never touches anything inside the nostril.
Instead nasal pillows should rest gently on the outer part of the nostril.
Often people have the tension too tight which will sort of force the pillows into the nostril and that's too tight.
If you look in the mirror and the first thought through your mind is "piggy nose"...the mask is too tight.

Take a nasal pillow all by itself and not attached to the frame. Place it gently on the nostril and breathe. That's pretty much how tight it should be.
So revisit any mask fitting videos and consider going up a size in pillows if you think it's trying to climb up inside your nostrils.

And yes...I agree with your zoomed in evaluations...the first 2 look like post arousal breathing and the last one looks more real. Not clear cut real because of the slightly larger breathes preceding the flag but more more real than the others.
Sometimes we don't get a clear cut easy to tell flow rate to evaluate.

Real asleep flagged event.


Not zoomed in much but arousal breathing before the flag so a post arousal flagged event.


Same here...post arousal flagged events...not asleep...so not real. This person actually doesn't have OSA (per an in lab study) and 95% of his flagged events weren't real..they were post arousal. He has some really crappy sleep issues and sleep maintenance insomnia issues unrelated to OSA or sleep disordered breathing. CPAP can't fix it.


An example of asleep breathing circled...the other stuff...post arousal. Again crappy sleep quality.

Thanks for the tips on the fitting, that definitely helped me know what I should be going for and fix the issue.

I can see from your examples here that it is possible to have arousal-filled, choppy sleep with a bunch of flags that has nothing to do with obstructive events. Tonight was easier to analyze, as every event flag (of which there were less overall) was clearly associated with a prior arousal. I seem to fall back asleep pretty fast after the arousals, and for the most part I don't remember having woken up. I feel great right now, like every night of sleep is getting better and I am getting more comfortable with the pressures.
Only thing I'm not really understanding is why there are so many sessions logged. Is it possible I breathe through the mouth momentarily and the machine stops detecting the flow? There are microscopic breaks in the leak rate chart where there is no reporting for a moment that corresponds with the session cutoffs. There seems to only be breaks in the EPAP line but not the IPAP line as well. I am almost positive I could not possibly have turned the machine off that many times.

The multiple session thing when obviously there weren't that many sessions...it's been seen before and we don't know why some Respironics machines do that and some don't. Some with a LOT more sessions than you are seeing...like 50 in a night.

And since we don't know why it happens...can't fix it.

My personal opinion...a bug in the machine reporting software and I don't like it and I would be bitching about it to whomever supplied the machine to me.
You should only have the 2 sessions since you actually only turned the machine off once.

Pugsy wrote: ↑

Fri Jul 27, 2018 6:07 am

The multiple session thing when obviously there weren't that many sessions...it's been seen before and we don't know why some Respironics machines do that and some don't. Some with a LOT more sessions than you are seeing...like 50 in a night.

And since we don't know why it happens...can't fix it.

My personal opinion...a bug in the machine reporting software and I don't like it and I would be bitching about it to whomever supplied the machine to me.
You should only have the 2 sessions since you actually only turned the machine off once.

I don't think the craigslister who sold it to me would appreciate the phone call

Quick very random question for you. I was searching for VPAP vs. APAP vs. BIPAP on nothing other than sheer curiosity seeing the terms being thrown around, and I stumbled upon an old thread of yours from ~2012 where you had given a BiPap a try and seemed to really prefer it to the APAP in terms of exhale relief. Do you mind telling me what changed that lead you back to the APAP?

Fetou wrote: ↑

Fri Jul 27, 2018 9:39 pm

Pugsy wrote: ↑

Fri Jul 27, 2018 6:07 am

The multiple session thing when obviously there weren't that many sessions...it's been seen before and we don't know why some Respironics machines do that and some don't. Some with a LOT more sessions than you are seeing...like 50 in a night.

And since we don't know why it happens...can't fix it.

My personal opinion...a bug in the machine reporting software and I don't like it and I would be bitching about it to whomever supplied the machine to me.
You should only have the 2 sessions since you actually only turned the machine off once.

I don't think the craigslister who sold it to me would appreciate the phone call

Quick very random question for you. I was searching for VPAP vs. APAP vs. BIPAP on nothing other than sheer curiosity seeing the terms being thrown around, and I stumbled upon an old thread of yours from ~2012 where you had given a BiPap a try and seemed to really prefer it to the APAP in terms of exhale relief. Do you mind telling me what changed that lead you back to the APAP?

Pugsy just likes to try any machine she can get her grubby little paws on.

Some of us change our underwear regularly... Pugsy changes machines (and presumably underwear too).

VPAP vs BIPAP... Resmed and Respironics names for the same thing... bilevel

Fetou wrote: ↑

Fri Jul 27, 2018 9:39 pm

Quick very random question for you. I was searching for VPAP vs. APAP vs. BIPAP on nothing other than sheer curiosity seeing the terms being thrown around, and I stumbled upon an old thread of yours from ~2012 where you had given a BiPap a try and seemed to really prefer it to the APAP in terms of exhale relief. Do you mind telling me what changed that lead you back to the APAP?

Don't mind at all.
Palerider gave you part of my reasons.
There's a couple more. Money and curiosity. I haven't been able to get my grubby little paws on an AirCurve 10 VAuto at a stupid cheap price.

My ultimate preference for exhale relief (or PS Pressure Support as it is called on a bilevel machine) is 4 cm...but EPR at 3 cm is so close in comfort it isn't an issue for me at all. So the ResMed APAP can give me 3 cm...and when I changed all that I could afford to get was the AirSense 10 and I really was curious about how that special for Her APAP mode worked...so I got a hot deal on the ResMed AirSense 10 AutoSet for Her and changed from 4 cm exhale relief to 3 cm and got to use the new special for Her apap mode. Found out I really like it. I can do just as well with the other auto mode but the for Her mode does a couple of things I rather like. Are they critical to my therapy...no but I like them so why not use them.

I have always been lucky in that I can adapt to change fairly easily and there's actually a wide range of settings that I can use comfortably with success in both ResMed and Respironics brands.
Like I can use fixed settings if I have to. Not what I prefer because I have to use a lot more EPAP just pressure in general on a fixed machine than I do with auto adjusting but I can use it and successfully with just a little bit of compromise.

Using EPR is not 100 % just like PS on a bilevel...there are some very minor timing differences but it is close enough in timing and amount of reduction during exhale that I am fine with it.

Respironics Flex exhale relief on the apap model...the most you can get is 2 cm at the setting of 3 because they do exhale relief a bit differently and then only if a person breathes rather forcefully (which I do). I started my cpap therapy some 9 years ago on a Respironics apap machine...the old M series model. I did well with it and in fact have tried various other Respironics models over the years. I still have a Respironics bilevel as a back up to a back up. It is the auto model though.

I probably won't be trying the DreamStation apap unless someone just gives the machine to me or it's a really stupid cheap price. I have learned that I really like the feel of more than 2 cm exhale relief. Since my main preference is 4 cm...I can compromise with the 3 cm I can get with EPR but I have no desire to reduce it to 2 cm especially with the cost involved.
I am curious but not that curious. Not curious enough to spend money on it.
Besides...I rather also prefer the ResMed slightly more aggressive auto algorithm. With a ResMed apap machine I can use lower minimum pressure and get the same job done that I would need to use a higher pressure on a Respironics machine.
Using lower while awake isn't critical comfort wise but it's just nice to do.

With the Resmed APAP...7 minimum with EPR at 3 so 7 inhale and 4 exhale and I consistently get AHI around 1.0 ish and often much less with an occasional 0.0 thrown in.
With Respironics APAP...I needed 10 cm minimum with Flex at 2 or 3 so that gave me roughly 10 inhale and 8 exhale to get me essentially the same results. I used it for probably 2 or 3 years like that...did quite well with it and then I tried the bilevel Respironics and discovered the wonders of bilevel and the rest was history.

Went through probably at least a half a dozen various bilevel models and now back to an apap.
Rest assured if/when I can get my grubby little paws on an AirCurve 10 VAuto bilevel at some stupid cheap price...I will get one.

About the multiple session thing..it doesn't seem to affect the accuracy of the reported data except the number of sessions.
If you look at the times they are less than a minute. It's not really turning itself off but it sure looks like it is.

I forgot your machine was a craigslist machine and you are right...that seller probably wouldn't appreciate your bitching to him and he probably didn't even notice it. It's not a critical issue....just watch it. I don't know enough about why it happens to be totally comfortable with a huge number of multiple sessions but your handful probably not a big deal.
I did see one that I actually got my hands on to test out...the multiple sessions were intermittent but the machine started dropping old data prematurely...but that machine was having like 50 sessions a night. It was under warranty and was sent back.
If it hadn't been under warranty I would have advised just watching it closely. It seemed to work fine otherwise and I slept with it for about a week to make sure.

At some point in your future you may want to get a back up machine...get a ResMed if you do. You won't be sorry.
Respironics machines are good machines...my personal opinion though...ResMed just a little better and there are some features on it that I think are better for some people.
With your pressure needs I think you are a prime candidate for ResMed's algorithm and EPR....or heck the bilevel auto if you can find one cheap enough.

Thank you for the detailed responses as always. I may have a little bit of your personality, as my machine is achieving great results and has only been by my bedside for 9 nights now, and I'm already scheming looking at other machines just imagining the incremental comfort that may be available.

My pressure needs are pretty high for a good portion of the night, and the max wants to go higher than I will allow right now for comfort reasons. There is an unnatural feeling to breathing out at higher pressures when I wake up and the machine is cranking. I would definitely prefer a lower starting pressure as well if I can achieve the same results, as that would make it easier to go to sleep.

The other wrinkle is that when I tell my Mom about my experience with the APAP, she seems very interested. She has been told to get sleep studies multiple times before, and even got it precleared with insurance once, but unfortunately refused to follow through on account of a dislike of the idea of being observed in that setting. Now that I finally found success without even doing the study, she seems open to trying, but doesn't know how to get a machine and hasn't come around to spending the money. My thought is that if I give her my Dreamstation and get her to feel the benefit of one good night of sleep, it could drastically improve her health. Evangelical CPAP essentially lol. Then she could maybe not always be so tired, wouldn't need caffeine pills, and might sleep through the night for once. I've never seen such choppy sleep before in anyone else, and the snoring and gasping always keeps her just on the edge of sleep. I figure even if she is ultimately too stubborn to adapt to it, which seems as likely as not tbh, it is well worth the attempt. The worst case scenario is i take it back as a backup if she gives up. The best case scenario is a new lease on life for her and a lot less worry about her health on my mind

For me, I've got my eye on the VAuto. I sent an email inquiry last night on a refurb selling for $700 to get more details. The idea of having control of the ipap/epap rise timing is very attractive. I want breathing to feel as natural as humanly possible. For something I will use every night for years, $700 doesn't seem that bad.

Fetou wrote: ↑

Sat Jul 28, 2018 6:52 am

The idea of having control of the ipap/epap rise timing is very attractive. I want breathing to feel as natural as humanly possible.

and that in a nut shell is why I prefer bilevel and while the 4 cm PS is damn near perfect and I don't even notice the machine...EPR at 3 works very well and gets me close enough but if I had my druthers...bilevel auto.
I need the auto because my OSA is worse in REM sleep and sometimes the pressure needs are markedly higher...like 6 to 8 cm higher. While I have used a lot higher all night on a fixed pressure machine to cover REM needs...I prefer not if at all possible because of awake breathing comfort.
Starting out at 7 cm with 4 exhale is a whole lot more comfortable while awake than 16 inhale with 13 exhale (EPR 3).
I am all about comfort. The more comfortable I am the better I sleep and the better I sleep the better I feel during the day.
My sleep is already fragile enough with the arthritis and back/pelvic pain issues.

Your plan for your mom...good plan and a home for the DreamStation most likely....because once you go bilevel ResMed you probably won't want to go back unless you have no choice.

I think going for it. Just got a response that the unit is under 20 blower hours and comes with six month warranty.