System one seems to miss out on a lot???

Hi,

I have been using my system one and in two weeks am feeling much better. Last night I used an oximeter that told me that there are (seemingly) a lot more O2 de-saturation events than the system one is telling me there are events at all. I am attaching scans of my Encoreviewer report from last night as well as the pulse oximeter report.

Other than snores, the Encoreviewer says that there were only 4 events to note in the whole night. The O2 saturation report looks like I was having more "events" than that - at least a dozen or so that dropped my O2 levels close to or below 90%. I know that these probably aren't artifacts as they are usually accompanies by a hefty rise in my heart rate.

Any comments as far as this goes? It also seems as soon as I went to sleep (within 5-10 min) my heart rate dropped as did my O2 sat to about 94 (from a resting awake O2 sat of about 97-98). Is this normal?

Why would I have so many dips in O2 if there were no events as detected by my System One? Or are the vibratory snores really instances where I am having a hypopnea and it is not showing as a hypopnea?

Here is the Encoreviewer report:



Here is my oximeter report:



Sorry that the start times are not correct. I messed up on both recordings - but generally I slept a bit short of 7 hours -- you just have to look at hours 1,2,3, etc. to compare - not actual times. Thanks.

jonquiljo wrote:Other than snores, the Encoreviewer says that there were only 4 events to note in the whole night.

Hi,

I have an S8 VPAP 25. When I run it in auto mode, I feel like a zombie despite having almost no events recorded. When I put it into fixed mode a few CM higher, I sleep like a kitten. I don't know why that is, but I know that I don't seem to react well using auto mode. I also had a lot of snores when I first started, and I felt yucky the next morning when that happened. All it took was a bump in pressure of 1 cm to knock them out.

In looking at your data, it looks like your pressure level is hunting where it switches back and forth between two pressure levels. Add that to the mild desats and your snores, and I think that there is a possibility that you do not do well in auto mode, much like what I found when I ran in auto mode. To experiment with this, try running in a fixed pressure mode for a few nights, and see if things are any better. I'd pick a pressure that is a little higher than what you see in auto mode. Watch to see if it knocks out the snores, and if your O2 level is a little more stable.

-john-

Yes it is normal for your saturation and heart rate to drop after falling a sleep. your body is in a different phase which doesn't require as much O2 as it does when you are active - it is rest period even for your heart and lungs - so it makes perfect sense.

Technically 88% is the line that is considered too low which is why it is marked on the saturation report and called out specifically in the text. Looks like you spent 12 seconds below 88% - which looks to me like the System 1 is doing its job for you. You have to remember that your APAP detects hypopneas by measuring air flow or lack of air flow so I wouldn't expect it to be as sensitive as the Oximeter which is reading your blood directly via the laser. Probably why Resmed sells an Oximeter adapter for they S9 which costs about $270 just for the adapter then you have to purchase a specific Oximeter not sure that the therapy is any better with the Oximeter but at least the reports are correlated for you.

Though with those pulse events it may indicate that you are waking up, possibly not due to OSA since it looks like from your numbers your OSA is well treated by the System 1. Do you by chance have Periodic Limb Movement Disorder or Restless Leg Syndrome they can cause you to awaken independent of OSA? I have both and my pulse events are almost twice what my respiratory events are on the oximeter reports - similar to yours, so I'm just wondering what is causing you to have so many pulse events.

I wouldn't worry to much about your O2 levels if your reports continue to look like this but the pulse is something to investigate.

BTW I just checked my O2 sat while typing this and mine was at 92%. On the System 1 my O2 sats were dropping down to 74% which is why I'm on O2 and APAP when I sleep now. That resolved my O2 desats but my pulse events are still 18 per hr which indicates that I'm still waking up often but I know the reason why - now if I could just find the right medications to resolve it.

Hope that helps
John

slaaplekker wrote: Do you by chance have Periodic Limb Movement Disorder or Restless Leg Syndrome they can cause you to awaken independent of OSA?

Well, I thrash in my sleep a lot - but that's only a disorder if you are my wife. Seriously, though - I do toss and turn a great deal. It seems to be diminished on the CPAP these days. I will say in the 2 weeks I have used this machine I have never felt better in my life. I only get 6-7 hours of sleep a night and have been busy and working my butt off on things - but I still keep on going! I haven't felt this way since I was 21 and sleeping around in college! (though at 57, I now feel alive enough to play that way again )

I think I will raise my "lower" pressure from 8.0 to 9.0 over the course of a few days and see what happens. At that point, I will take the best starting pressure, add 1cm to it and switch to CPAP mode and see what will go on. I want to see if I can get those snores to go down. Somehow I think they are something else - others have told me that the VS index on the system one can indicate lots of things aside from snores. Can you get a real "snore-meter" to listen to you at night?

I will admit that I take Ambien at night and during that time I could be awake and talking to someone and not remember it the next day. My wife has supposedly had conversations with me and I don't remember a thing. So it is very possible that I am waking myself by either snores or body movements. But the pulse events are a bit strange. I thought it was something I might be dreaming as I do "act out" in my sleep and have hurt myself (sprains, tendinitis, etc.) in my sleep. For a while a few years ago I developed tendinitis in both elbows from whatever I was doing in my sleep - probably fighting off wolves or something like that.

jweeks wrote:In looking at your data, it looks like your pressure level is hunting where it switches back and forth between two pressure levels. Add that to the mild desats and your snores, and I think that there is a possibility that you do not do well in auto mode, much like what I found when I ran in auto mode. To experiment with this, try running in a fixed pressure mode for a few nights, and see if things are any better. I'd pick a pressure that is a little higher than what you see in auto mode. Watch to see if it knocks out the snores, and if your O2 level is a little more stable.

How true. I didn't want to post my data publicly because it didn't look anything like stuff I have seen posted and I was embarrased to ask for help. (Same machine) I knew something had to be "off" somewhere, but didn't have any idea as to where to start.

Got a suggestion from someone who said it looked like I wasn't tolerating the changing pressures very well. Switched my machine to straight CPAP and shut off all the Flex. WOW. First night my husband woke me up because I was snoring so badly with my hybrid mask! Raised the pressure .5 and snoring stopped. Last two nights have been much, much better, but my numbers still not optimal. Will raise pressure another .5 tonight for a few nights.

My VS are waaay high, also, but have been slowly getting better with this change in therapy. Good luck to you!

L

Janknitz wrote:
WHY are you sweating the small stuff??? You could tweak yourself into oblivion and never be satisfied.

My advice for the time being is that if it ain't broke, don't fix it. Relax and enjoy feeling better for a change.

Amen. There are a lot of folks posting poor, or perceived poor results the day after they make an adjustment or buy software. Bad nights happen, so do bad weeks! If there is ANY benefit to relying on your DME and Doc, it's that you have to wait for awhile to see your reports and make changes. The fact is, regarless of whether your new to CPAP or have just made a "tweak", it's going to take your body awhile to adjust.

We live in a time that promotes instant gratification, and that's not always a good thing. I certainly don't mean to imply anything regarding this post itself, just something I've noticed in my short time on the forum.

Janknitz - you've been on here for a bit and your advice is always sound. You should start a thread on this very topic. Folks just need to take a deep breath (no pun intended) and give their treatment a chance. Perfection is not the goal - we just need each day on treatment to be better than our last day without.

Janknitz wrote: Data is very helpful when there are problems. I don't see any problems here. If you weren't feeling well, if your sats were below 88% for a large percentage of the night, if you weren't sleeping well, it would be worth tweaking.

How true! I perhaps am an ex-scientist who is playing too much with the numbers. I have a bad habit of trying to do that even though it has been many decades since I ever collected data for a living.

Last night was different, though. I raised my lower pressure from 8.0 to 8.5. My wife had to come and wake me during the night for a totally unrelated reason (our dog had knee surgery 2 months ago and it seems to have failed or something really wrong is happening - yest I am freaked out and very upset!). Anyway, since I was a lot more awake than usual, I did actually notice that I was mouth breathing on occasion. Remember, I take Ambien to sleep -so normally I would not remember these things if I noticed them.

Now did was it the change from 8.0 to 8.5 that made me mouth breathe --- or did my "external awakenings" just alert me to the problem? I just got a Mirage Quattro FF - perhaps its time to give it a try. It feels comfortable. I just didn't want to mess with variables until I was sure I was getting optimal therapy.

needsomezees: You are absolutely right! I was more unsure of my oximeter data than I was about my therapy or optimization. My Dr. could care very little about any of this. Around here - they all want to get their few dollars for a fee and go on to the next patient. When they do have advice it is generally poorly thought out, etc. That's why people here at this site are so invaluable. I have seen too many physicians ignore too many people to trust them beyond a point. I would rather place my confidence in a bunch of informed non-professionals any day! Going to places like this has saved my butt on many occasion over the years - especially when the physicians and experts gave their half thought out opinions. I am not kidding.

I don't think that you can judge whether you are mouth breathing while asleep. The fact that you can remember mouth breathing means that you were awake at the time. Breathing changes substantially when asleep.

Jonquiljo
My statement was prompted more by what Janknitz wrote. Again, not specific to your post. I hesitated to post, and should have saved it for a stand-alone. I definitely don't want to discourage ANY questions, instead, I simply want to encourage patience. Wish I had some good advice for your issue, but alas I have gone OT on your post. Good luck!

I've always assumed that I did a lot of mouth breathing as I could breathe more out the "other end" than I could out my nose. Actually what woke me up sometimes was this roaring sound out my mouth - like something from "The Exorcist"! I'll do the nasal mask one more time tonight and give it a break.

My "hobby" has been paining part of the house lately and I try to think about anything but that when I am not doing it. Maybe I should just go to sleep.

I'm into type-A hobbies - always have been. My wife has forbidden me to do most of them anymore. I guess that's why people get married - so they can stay out of trouble and stay alive!

Well I looked at my report and exorcist-mouth happens a lot - it just strangely didn't happen on the day I posted above. I read the card from last night and there were a few of them. Mostly I run a leak of 20-25 lpm when perfectly sealed (mouth included), but last night my mouth-open episodes ran 10-15 minutes each at 40-45 lpm. Apparently, I can only leak about 20 lpm (at about 10cm) through my nose and out my mouth - pathetic! I looked back and yes, they show to varying times and degrees on most of my graphs. The interesting thing is that, if anything, they are preceded by an event (usually flow limitation or hypopnea) and seem to not have events occur at the same time. That means that exorcist mouth is benign with regard to sleep events - except that it may be waking me a bit. And I guess I have been sleeping though it - or not remembering it. I'm not playing with the numbers here - I want to make sure that this mouth-event is not waking me too.

Given that - I will try the Mirage Quattro FF mask tonight. The thought of me sleeping with a nasal mask with my mouth open and roaring is a bit disconcerting when I picture it. Wearing this thing to begin with - is well ..... not sexy to begin with. At my age, that is upsetting but not important. Gotta drop that youth minded ego! The problem is that California is so youth-oriented that it's hard to fight it. I digress, but you get the idea. I'm only 50-something and I'm not dead yet. Not even close as far as I am concerned.