Sleepyhead Results (Organized Screenshot)

\Hi have been using Resmed S9 APAP since August and I have data on SD card from August 23 until last night. It states that AHI is .76 and that is within the normal range. But I have hypopnea and apnea episodes according to Sleepyhead. So am a bit confused. Please help me interpret the data here below

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I normally don’t help people out, and please correct me if I’ve said anything that is not helpful. But I’ll try.

AHI at 0.62 means that there are some hypopnea and apnea events, but I wouldn’t worry about that – your AHI is very low.

You could consider increasing the minimum pressure as it’s never below 10 anyway. However, this change might not be needed as the pressure doesn’t seem to ever go below it. During this particular night there are no events during the increase of pressure. It happens so quickly that I don’t think it mattes.

You should work on getting your leak rate down by tightening the mask or getting a mask that fits you better.

alexander wrote: ↑

Fri Sep 13, 2019 2:16 am

However, this change might not be needed as the pressure doesn’t seem to ever go below it. During this particular night there are no events during the increase of pressure. It happens so quickly that I don’t think it matters.

It matters, the machine spends the whole night trying to lower the pressure back to the min pressure set.

4 is the right min for almost nobody

elaine10 wrote: ↑

Fri Sep 13, 2019 12:33 am

\Hi have been using Resmed S9 APAP since August and I have data on SD card from August 23 until last night. It states that AHI is .76 and that is within the normal range. But I have hypopnea and apnea episodes according to Sleepyhead. So am a bit confused. Please help me interpret the data here below

Your min pressure is wayyyy to low, I'd bump it up to 12 for starters. And work on the leaks.

palerider wrote: ↑

Fri Sep 13, 2019 6:30 am

alexander wrote: ↑

Fri Sep 13, 2019 2:16 am

However, this change might not be needed as the pressure doesn’t seem to ever go below it. During this particular night there are no events during the increase of pressure. It happens so quickly that I don’t think it matters.

It matters, the machine spends the whole night trying to lower the pressure back to the min pressure set.

4 is the right min for almost nobody

I stand corrected then.

palerider wrote: ↑

Fri Sep 13, 2019 6:31 am

elaine10 wrote: ↑

Fri Sep 13, 2019 12:33 am

\Hi have been using Resmed S9 APAP since August and I have data on SD card from August 23 until last night. It states that AHI is .76 and that is within the normal range. But I have hypopnea and apnea episodes according to Sleepyhead. So am a bit confused. Please help me interpret the data here below

Your min pressure is wayyyy to low, I'd bump it up to 12 for starters. And work on the leaks.

like alexander, i don't try to help people out on the technical stuff. but i decided to look more closely after your suggestion for the minimum.

are saying 12 because her chart shows the pressure rising very quickly to 12 anyway?

zonker wrote: ↑

Fri Sep 13, 2019 9:02 am

are saying 12 because her chart shows the pressure rising very quickly to 12 anyway?

Pretty much that's it. The machine goes to near 12 and essentially stays in that area all night anyway.
Probably not the end of the world to leave the minimum at 4 since the machine never goes down anywhere near it but ideally the starting pressure should be closer to where the machine is going to be going anyway.
Mask fit testing at the higher pressure for one thing...what seals well at 4 cm probably isn't going to do such a good job at 12 cm.
Would also eliminate the potential risk of the machine maybe going to sub optimal pressures for some reason or other.
We don't see it happening in this report but that doesn't mean it might not happen on another night.

Pugsy wrote: ↑

Fri Sep 13, 2019 9:24 am

zonker wrote: ↑

Fri Sep 13, 2019 9:02 am

are saying 12 because her chart shows the pressure rising very quickly to 12 anyway?

Pretty much that's it. The machine goes to near 12 and essentially stays in that area all night anyway.
Probably not the end of the world to leave the minimum at 4 since the machine never goes down anywhere near it but ideally the starting pressure should be closer to where the machine is going to be going anyway.
Mask fit testing at the higher pressure for one thing...what seals well at 4 cm probably isn't going to do such a good job at 12 cm.
Would also eliminate the potential risk of the machine maybe going to sub optimal pressures for some reason or other.
We don't see it happening in this report but that doesn't mean it might not happen on another night.

thanks for the explanation. maybe now that my own therapy has been optimized, my brain is starting to flex it's muscles and letting me think again!

I see that the pressure is responding quite a lot to the significant flow limitations, and that EPR is set to zero. I don’t have the expertise to recommend settings, but I do wonder whether it’d be worth trying an EPR of 2 or 3 and maybe even limiting the maximum pressure, which might also help with leaks.

Miss Emerita wrote: ↑

Fri Sep 13, 2019 9:57 am

I see that the pressure is responding quite a lot to the significant flow limitations, and that EPR is set to zero. I don’t have the expertise to recommend settings, but I do wonder whether it’d be worth trying an EPR of 2 or 3 and maybe even limiting the maximum pressure, which might also help with leaks.

Actually adding in EPR could make the FL situation worse. The usual fix for FLs is more pressure and not less pressure which is essentially what happens when we add in EPR.
While I know of 1 person who swears that adding in EPR helped with FLs and they didn't increase the baseline to compensate....that's not the norm.
All this assuming the FL ugliness is airway related below the nasal mucosa area...more on that later.

Before limiting the max as a leak control measure...I would suggest simply doing the mask fitting at the higher 12 cm pressure.
Goes back to what I said about fitting the mask at the beginning of the night at the 4 cm pressure...seal works great at 4 but not so great at 12....so fit at the beginning of the night to the 12 in the first place.

AND finally....my first question when seeing flow limitation graph looking like this would be is there any nasal congestion going on????
AHI is low...and it's obvious the machine wants to keep the pressure higher because of the FLs...but if those FLs are coming from nasal congestion more pressure isn't going to help.
It wouldn't be impossible for the machine to be going to 12 to try to fix nasal congestion issues and it simply can't.

So.....before advising any changes anywhere with anything....I would want to know if that FL graph ugliness was maybe related to nasal issues. Rule that out first. Make sure that the ugly we want to fix with more pressure is indeed fixable with more pressure and nasal mucosa congestion isn't usually fixable with more pressure. Only the airway below the nasal cavity can be fixed with more pressure.

That's my opinion of things considering what the FL graph looks like.

zonker wrote: ↑

Fri Sep 13, 2019 9:02 am

palerider wrote: ↑

Fri Sep 13, 2019 6:31 am

elaine10 wrote: ↑

Fri Sep 13, 2019 12:33 am

\Hi have been using Resmed S9 APAP since August and I have data on SD card from August 23 until last night. It states that AHI is .76 and that is within the normal range. But I have hypopnea and apnea episodes according to Sleepyhead. So am a bit confused. Please help me interpret the data here below

Your min pressure is wayyyy to low, I'd bump it up to 12 for starters. And work on the leaks.

like alexander, i don't try to help people out on the technical stuff. but i decided to look more closely after your suggestion for the minimum.

are saying 12 because her chart shows the pressure rising very quickly to 12 anyway?

Yes, It's hard to tell on the posted chart, because the pressure variations are a bit squished because of the absurdly low start, but most machines spend the entire night in a cycle of:

• breathing abnormality
• pressure increase
• breathing stabilization
• then as soon as the breathing stabilizes, the machine goes "OH! I was programmed with x as a minimum, I should get back to that because presumably I was programmed intelligently (which seemingly rarely happens until someone gets here)
• pressure drop

and then the cycle starts over again.

You need to have the min pressure high enough to break the cycle, and only rely on the auto function to handle exceptions (back sleeping, REM, whatever else.

I expect elaine10 to need a higher min pressure, but 12 is a start at smoothing things out.

Miss Emerita wrote: ↑

Fri Sep 13, 2019 9:57 am

I see that the pressure is responding quite a lot to the significant flow limitations, and that EPR is set to zero. I don’t have the expertise to recommend settings, but I do wonder whether it’d be worth trying an EPR of 2 or 3

Increasing EPR *LOWERS* the EPAP, the pressure that holds open the airway. So if you're going to increase EPAP, you also have to increase minimum pressure to compensate, or you can end up with more apneas.

Miss Emerita wrote: ↑

Fri Sep 13, 2019 9:57 am

and maybe even limiting the maximum pressure, which might also help with leaks.

NO! You fix the mask to deal with leaks, that is not a valid reason to limit max pressure, all limiting max pressure does is prevent the machine from improving breathing.