It knows when you are sleeping, but will it tell you?

The F&P SleepStyle CPAP machine has an auto-ramp-like feature that supposedly detects when you are sleeping or awake, as do ResMed machines and others. However, the daily statistics that the F&P machine displays and sends to its smartphone app do NOT include an indication of what percentage of the therapy time you were sleeping versus awake. [So far in my case, I've probably been awake during the therapy for nearly as long as I've been sleeping.] Furthermore, it is not clear to me whether or not the machine's AHI estimate of apnea events per hour includes the time that you were awake (which could cause the AHI to greatly underestimate your apnea event frequency).

I saw a few pictures of the ResMed CPAP machine display and smartphone app and I did not notice an indication of sleep versus awake time. Does ResMed share this information with users? Anyone know whether ResMed machines exclude the time that you are awake when calculating its AHI?

MJS_ wrote: ↑

Wed Apr 05, 2023 7:01 pm

The F&P SleepStyle CPAP machine has an auto-ramp-like feature that supposedly detects when you are sleeping or awake, as do ResMed machines and others.

That is an auto start/auto stop capability, which senses that you have put a mask on, or taken it off.

It is not in any way related to detecting/reporting whether you are asleep or awake.

None of these machines can tell you for sure that you were asleep or not. They might make an educated guess based on breathing pattern but they can't tell for sure and they sure can't/won't report awake time vs asleep time.

Any AHI calculated on the number of events will be doing the math based on how much time the machine was running...no matter if you were awake for half the night or not.

Example....lets say someone has 24 apnea events over an 8 hour period that the machine was on so the AHI would be 3.0.
Doesn't matter if you only slept 6 of those hours...the machine still reports based on the 8 hours the machine was on.

Also...since the machine can't tell if we are asleep or not it can and will flag awake breathing irregularities as some sort of apnea event...I think of them as false positives...but they don't count in terms of treatment itself because awake flagged stuff don't count. You must be asleep for anything flagged to matter in terms of therapy effectiveness.
Now a lot of awake flagged events can point to poor sleep quality but we have to look at what might be causing the awakening and not so much for setting adjustments depending on what it is showing and how many of whatever.

So....these machines don't report awake times because while they make educated guesses...they don't have any way to measure brain waves (EEG) which is need for accurate determination of sleep or wake status.

ResMed really only promotes its version during the auto ramp feature anyway. With auto ramp engage the machine will suspend ramp based on your breathing either when it thinks you are asleep or after 30 minutes...whichever comes first.
After auto ramp is suspended the ResMed machine no longer really looks at awake vs asleep anything.

santa claus knows when you are sleeping and when you are not.

a cpap machine does not.

billbolton wrote: ↑

Wed Apr 05, 2023 7:31 pm

MJS_ wrote: ↑

Wed Apr 05, 2023 7:01 pm

The F&P SleepStyle CPAP machine has an auto-ramp-like feature that supposedly detects when you are sleeping or awake, as do ResMed machines and others.

That is an auto start/auto stop capability, which senses that you have put a mask on, or taken it off.

It is not in any way related to detecting/reporting whether you are asleep or awake.

Uh, no.

Pugsy wrote: ↑

Wed Apr 05, 2023 7:36 pm

None of these machines can tell you for sure that you were asleep or not. They might make an educated guess based on breathing pattern but they can't tell for sure and they sure can't/won't report awake time vs asleep time.

Any AHI calculated on the number of events will be doing the math based on how much time the machine was running...no matter if you were awake for half the night or not. ....

Now a lot of awake flagged events can point to poor sleep quality but we have to look at what might be causing the awakening and not so much for setting adjustments depending on what it is showing and how many of whatever.

This is extremely helpful to know, and quite disturbing it is not made clear in the F&P promotional materials, user manual, or smartphone app! Is ResMed any better at disclosing this info, or did you learn this from other sources? This information will certainly help me interpret my CPAP therapy data in a more valid manner!

F&P led me to believe the machine knows when I'm sleeping so I wrongfully guessed it would take this into account when calculating its AHI. It would not surprise me if my breathing has been more disturbed while awake than asleep, since I've been aware of feeling like I'm suffocating (while awake) and deliberately manipulating my breathing to try to understand and reduce the air leaks and noises that my face mask was making. In addition to the CPAP-induced insomnia, I've watched television with my equipment on and running in an attempt to adjust to it.

I'm in the process of resolving the two issues that have most contributed to my CPAP struggles. First, the nice young girl who conducted my sleep study guessed that I needed a medium-size mask without actually measuring my face, and that recommendation appeared in the final report despite the fact that I struggled with air leaking from the top of the mask during the sleep study. Two days ago, I managed to meet with a more experienced sleep tech who measured my face and told me I needed the large size. The second issue has to do with my F&P machine's uncontrollable heated air tube. Because of my mask air leaks, the machine had to pump extra air through the mask which would quickly dry out my mouth unless I set the humidity to a medium or higher level, which in turn caused the uncontrollable heated air hose to deliver rather hot humid air that made me feel like I was suffocating.

Once my CPAP-induced insomnia is resolved, I think I will delete all my prior CPAP therapy data so that the fresh data is not contaminated by low sleep efficiency. Does ResMed provide the ability to delete individual sessions of data (rather than all your data) so that your total data set is not confounded by unrepresentative sessions during which you experienced insomnia or other atypical issues? It appears F&P does not.

Thanks Pugsy!

Well, Sensawake might work. It looks for Fig. 7:



IIWM, I'd call that Wake.

And technically, they are looking for "Troubled Wakefulness" not "Wake". Stable breathing during wakefulness should slip right by.

Rubicon wrote: ↑

Thu Apr 06, 2023 2:11 am

And technically, they are looking for "Troubled Wakefulness" not "Wake". Stable breathing during wakefulness should slip right by.

Another excellent and important point which the F&P literature fails to disclose! I now understand that no CPAP machine will provide a useful record of my sleep habits until I get my CPAP-induced insomnia under control

Thanks!

MJS_ wrote: ↑

Wed Apr 05, 2023 11:39 pm

This is extremely helpful to know, and quite disturbing it is not made clear in the F&P promotional materials, user manual, or smartphone app! Is ResMed any better at disclosing this info, or did you learn this from other sources?

It's common knowledge that sleep/awake cannot be accurately determined without EEG.

Get an Apple Watch. Their accuracy is not definitive but still fairly good compared to polysomnography (EEG).

Compared with polysomnography, agreement (and Cohen's kappa) for two-state categorisation of sleep periods (as sleep or wake) was 88% (κ = 0.30) for Apple Watch; ... require improvement for the assessment of specific sleep stages.

https://pubmed.ncbi.nlm.nih.gov/36016077/

MJS_ wrote: ↑

Wed Apr 05, 2023 11:39 pm

Does ResMed provide the ability to delete individual sessions of data (rather than all your data) so that your total data set is not confounded by unrepresentative sessions during which you experienced insomnia or other atypical issues? It appears F&P does not.

No. ResMed machines don't let you pick and choose which data/sleep session gets to stay and which can be removed manually.

MJS_ wrote: ↑

Wed Apr 05, 2023 7:01 pm

So far in my case, I've probably been awake during the therapy for nearly as long as I've been sleeping.

It's a good bet that you slept longer than you think. Time passes slowly when you are awake worrying about insomnia.

ChicagoGranny wrote: ↑

Thu Apr 06, 2023 7:09 am

It's common knowledge that sleep/awake cannot be accurately determined without EEG.

If this were common knowledge, ResMed and F&P would not advertise that their machines can be set to ramp up the air pressure after detecting you have fallen asleep. For example: https://www.youtube.com/watch?v=BrGGgYolGfI

Pugsy wrote: ↑

Thu Apr 06, 2023 7:19 am

MJS_ wrote: ↑

Wed Apr 05, 2023 11:39 pm

Does ResMed provide the ability to delete individual sessions of data (rather than all your data) so that your total data set is not confounded by unrepresentative sessions during which you experienced insomnia or other atypical issues? It appears F&P does not.

No. ResMed machines don't let you pick and choose which data/sleep session gets to stay and which can be removed manually.

I'm not surprised given the general disdain that the medical and public health fields have towards patients' right and ability to utilize data to make informed decisions about their own healthcare.

Does the OSCAR software provide this capability?

MJS_ wrote: ↑

Thu Apr 06, 2023 8:15 am

Does the OSCAR software provide this capability?

Well...yes and no. You have to remember that OSCAR can only report whatever data points the machine can gather and if the machine can't gather something then OSCAR can't report it.
That said...we can manually remove a sleep session from the overall report but ONLY IF there are multiple sleep sessions where the person creates a sleep session by turning the machine off and then on again to start a new sleep session.

Example....I woke up several times last night but I didn't turn the machine off when I woke up so I don't have a time frame in last night sleep session that is separate from the rest of the night. Now I haven't looked at the data from last night yet so I don't know how many false positive flags I might have but I know I will have at least a handful. I always have false positives and usually about 75% of any AHI I might see are related to awake flagging of events....it's my normal since I also have some sleep maintenance insomnia issues unrelated to sleep apnea and instead related to pain issues that cause me to wake up.
Since I don't make the effort to create new sleep sessions by turning off the machine and then turn it back on I know I am going to have a few false positives and I just have to mentally remove any false positives from the AHI calculation process and live with it.

How to remove any sleep sessions that you don't want included (assuming that you created multiple sleep sessions) is easy...just go to OSCAR detailed report and scroll down to the bottom on the left side of the detailed data to where the sleep sessions are listed and click on the unwanted session to manually remove that session from the calculations.
So it will adjust the AHI at least on the OSCAR reports. It does nothing to the data the machine actually reports or what is stored on the SD card. All you are doing is manipulating the data shown on the detailed report from OSCAR.