Need some help (data review)

Last night I slept with my chinstrap again and have my leak under control. But I am still having too many central apnea events.
Here is my charts from last night.

after all these events I took my mask off and slept for a few hours before waking and putting it back on for another 45 min before getting up for the day.

Any thoughts would be helpful. My pressure is 9.

https://docs.google.com/document/d/14fl ... t?hl=en_US

None of the leaks was above the red line which is good. Your graph shows NO obstructive apneas. Is it possible?
What was your sleep study diagnosis?

With the Remed S9 Elite and Autoset you get clusters of Central Apneas and Hypopneas when you fidel with the mask, stay awake, or start and stop the machine often. To get valid results you need actually to sleep for at least 4 hours.

Do you have copies of your sleep study and the titration sleep study?
Was there any mention of centrals in either one?

avi123 wrote:None of the leaks was above the red line which is good. Your graph shows NO obstructive apneas. Is it possible?
What was your sleep study diagnosis?

Could you post your Stats like this:

Can you give a short run-down on what these figures may indicate? In the alternative is there a site that would give a brief explanation with ranges of good figures?

As I was looking at these items on my own readout, it looks like this system considers all data after midnight on Tuesday the 19th for example as having occurred on the 19th even though all of it occurred after midnight on Tuesday which in reality was on the 20th on Wednesday. Is this normal or is my system out of date?

Roger, the default setting is from 12 noon to the next day's 12 noon. But you could change it in the setting. What do you mean by "good figures"of the S9 Elite? In my case I never got an AHI below 7. So I am not a good example according to mavens on this board. Ms Butterfly (aka robysue) is an expert on what we should look for as "good" results for treatment. But you probably saw my remark on my signature line which you could Google or follow this link:

http://www.respiratoryreviews.com/sep02 ... Index.html


Please pay attention to: Because the AHI is imperfect, Dr. Rapaport views it as a marker for the apnea-hypopnea syndrome and not as a definitive metric. He has found the AHI most useful for detecting severe apnea-hypopnea syndrome.

He defines severe cases as those with an AHI of 30 to 50 events per hour or greater. “This is definitely bad … and I want to treat it,” he stressed. Obstructive sleep apnea symptoms are also likely to be severe enough to warrant treatment in patients with an AHI of about 20 per hour; SDB can probably be ruled out at an AHI of about 10 per hour.

Dr. Rapaport cautioned against over-interpreting the “gray zone” between AHIs of 10 and 20 per hour. “I do not quite know what that means,” he acknowledged.
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As I understand it, Dr.David Rapaport is saying that :

Those posters, on this board, who have an AHI of 10 and below (with or without CPAP treatment), probably, do not suffer from an SDB, but could suffer from an underlying medical condition.



Hey Roger, that lady from TX who at one time suffered from COPD and who wants now to make a trip to hi elevation, I would suggest that she gives up that trip. Even with a bottle of Oxygen. Before stopping to smoke 35 years ago, I smoked for 30 years before. Trying to go up Pike's Peak, 20 years after stopping, I turned around and took the next cog wheel train down. Same at the restaurant at the top of Sandia mountain. I was lucky to be able to go down right away.

Roger2 wrote: Can you give a short run-down on what these figures may indicate? In the alternative is there a site that would give a brief explanation with ranges of good figures?

Short version.
In general we strive for AHI less than 5. (Whatever combination it takes)
Leak line well below the red 24 L/min line because the way ResMed reports leak means it is all excess leak..

It would be easier to answer specific questions. There is no web site that tells us how to analyze our own numbers that I am aware of. There just are too many little variances between people and even with normals.

There is a software tutorial that may help with some general explanations.
http://montfordhouse.com/cpap/resscan_tutorial/

Encore has a Help section with Glossary for definitions. I don't know if ResScan has such a help section.

justbreathe,

I've looked at the charts you posted at: https://docs.google.com/document/d/14fl ... t?hl=en_US

That's a whole lotta events for somebody on CPAP. How many nights have you been using CPAP? And is this night rather representative or is it an outlier with far more events than you typically see? Or somewhere in between "typical" and "worst you've seen on CPAP"?

You also express concern that these are central apneas. But I'm not so sure that massive numbers of those apneas are flagged as "centrals" because when I look carefully with my severely myopic eyes close to the computer and without my glasses on (so I can really see the close up data), a whole bunch of those apnea bars look RED, not black to me. One thing you have to be aware of with the ResScan software is that when a whole bunch of OAs pile up on top of each other, they "hide" each other and the black outlines of the bars wind up making it hard to see which color the bars are.

So---first task is to zoom in on those nasty clusters and see if there are any black CAs at all. My guess is that once you zoom in close enough where no events are falling on top of each other, you will see NO or VERY FEW black CA flags at all in your data. If you don't know how to zoom in on the data, post a question about that and someone should be able to give you instructions. And once you do have zoomed in views of the clusters of apneas occurring between 23:00--23:30 and 01:00--01:30, post the pictures of the zoomed in data so we can better determine the color of those flags, the numbers on those flags (which are the time each apnea lasted) and the amount of time between those apneas. None of this detail is clear in the global picture you currently posted.

Next, as avi123 observed, none of the leaks go above the RedLine, which is good: The Resmed engineers believe that the level of your leaks is not enough to compromise either your therapy or the quality/accuracy of the data recorded by the machine. I'll also observe that each of the three main leak periods seems to last LESS than 30 minutes AND the two huge apnea clusters occur at times when you are NOT LEAKING at all---according to the ResScan data.

Hence, my take on the leaks: Big time leaking is NOT what's behind those two really bad apnea clusters. But whether those half-hour long moderately large leaks are worth worrying about is another question all together: If any of those leaks was large enough to bother you---in the sense of waking you up or making you feel restless, then fixing the leaks is worthwhile to increase your comfort. And since there is "mask off" time after the first of the three big leaks, there may be some evidence that the leaks are indeed bothering you physically enough to worry about fixing them. But fixing the leaks isn't likely going to fix those large apnea clusters since they are occuring when your unintentional leak rate is 0 or very, very close to 0.

It's worthwhile to note that the time between the end of the first nasty cluster (23:30ish) and the beginning of the second nasty cluster (1:00ish) is about 90 minutes---roughly the length of an average sleep cycle. So it's reasonable to ask: Are these nasty clusters occurring during REM cycles?

Which brings us back to both avi123's and pugsy's requests about information concerning your diagnostic sleep study. What was your diagnostic AHI? What was the breakdown between OAs, CAs, and hypopneas? Was your AHI much, much higher during REM? Was your AHI much, much higher on your back? Did you have any supine REM sleep in your diagnostic sleep test and if so, what was the AHI during supine REM?

And then there are similar questions concerning your titration study: How long were you sleeping at 9cm? Did you have any REM at 9cm? Did you have any supine sleep at 9cm? Did you have any supine REM sleep at 9cm? Because if the answers to one or more of these questions is NO, then my guess is that you might well be under titrated at 9cm.

This is last nights reading;

Device Settings

Therapy Mode: CPAP Set Pressure: 9.0 cmH2O EPR: Full_Time
EPR Level: 3.0 cmH2O

Leak - L/min:
Median: 0.0 95th Percentile: 4.8 Maximum: 12.0

AHI & AI - Events/hr:
Apnea index: 0.1 AHI: 0.8 Obstructive: 0.0
Central: 0.1 Unknown: 0.0 Hypopnea index: 0.7

Usage:
Used Days >= 4 hrs : 1 Used Days < 4 hrs : 0 % Used Days >= 4 hrs :100
Days not used: 0 Total days: 1 Median daily usage:6:59
Total hours used: 6:59 Average daily usage: 6:59

Roger2 wrote:This is last nights reading;

Device Settings

Therapy Mode: CPAP Set Pressure: 9.0 cmH2O EPR: Full_Time
EPR Level: 3.0 cmH2O

So you are running in straight CPAP mode with EPR set to 3 and running full time. At the beginning of each exhale, the pressure drops from 9cm to 6cm and this happens all night long. The pressure is increased back up to 9.0 right around the time you start your inhalation.

Leak - L/min:
Median: 0.0 95th Percentile: 4.8 Maximum: 12.0

Last night the S9 could not detect any unintentional leaks for at least 50% of the night since your median leak rate was 0.0 L/min

95% of the time your unintentional leak rate was AT or BELOW 4.8 L/min. So for 5% of the night your unintentional leak rate was AT or ABOVE 4.8 L/min. To get an idea of how long (measured in minutes) you were leaking ABOVE 4.8 L/min, multiply the usage time (in hours) by three minutes since 5% of one hour is three minutes.

At some point in the night the S9 detected an unintentional leak of 12.0 L/min. This might have been a short lived leak or it could have been when you pulled the mask slightly to readjust it or scratched your nose or any of a whole bunch of other things

Over all, your leak data is very good!

AHI & AI - Events/hr:
Apnea index: 0.1 AHI: 0.8 Obstructive: 0.0
Central: 0.1 Unknown: 0.0 Hypopnea index: 0.7

These are all well within the desired "AHI < 5.0" target range. You machine is showing an AHI of 0.8, which indicates that it is detecting an apnea or hypopnea about every 75 minutes on average. (1 event in 1.25 hours gives an AHI equal to 1/1.25 = 0.8.) Most of your events are hypopneas, not apneas. Given that your usage for the night was 6:59, which rounds to 7 hours, we can compute the number of events you actually had overnight:

(Number of events)/7 = 0.8. So (Number of events) = 0.8*7 = 5.6 = either 5 or 6 events because there is round off error.

(Number of CAs)/7 = 0.1. So (Number of CAs) = 0.1 * 7 = 0.7 = 1 CA (rounding up here makes sense because 0 CAs would give a CAI = 0.0)

(Number of Hypopneas)/7 = 0.7. So (Number of H's) = 0.7 * 7 = 4.9 = 5 H (rounding up because 4.9 is so close to 5)

Putting the second two computations together we see that the total number of detected events for the night really is 6.

Now, while the interpretation of AHI = 0.8 is that you are averaging about one event every 75 minutes or so, without the detailed data, you really don't know if those 6 events were spread out relatively uniformly over the entire night---i.e. one every 75 minutes or so. They could just as easily have been bunched together: If you had all 6 events in a 15 minute period in the middle of the night (say in a REM cycle), and no events the rest of the night, the AHI would still be 0.8. There's no way to tell which case is closer to reality unless you have the detailed data of when the events occurred.

Usage:
Used Days >= 4 hrs : 1 Used Days < 4 hrs : 0 % Used Days >= 4 hrs :100
Days not used: 0 Total days: 1 Median daily usage:6:59
Total hours used: 6:59 Average daily usage: 6:59

Since the reporting period is just one day, that means you used the machine for 6 hours and 59 minutes during the night in question. Since 6:59 is greater than 4 hours, the "Used Days >= 4 hrs" is ONE and the "Used Days < 4 hrs" is (obviously) ZERO as is "Days not used". The Used Days data is more meaningful over longer periods of time IF you are having trouble managing to use the mask in the first place (so Days not used is above ZERO) or IF you are having trouble keeping the mask on all night (so Used Days < 4 becomes an important figure as does % Used Days >= 4 hrs, which becomes a rough bench mark for when you're using the mask "close enough" to ALL NIGHT to count as being compliant for insurance purposes.)

Hope that helps.

I have uploaded a spreadsheet to google docs with the data from my resmed s9 elete from the first five days of use. I will scan and upload my sleep study and cpap titration later. Most of my apnea events during testing were Hypopnea. I also have savere PLMD. I had blood work done Monday to check for causes of my PLMD.

https://spreadsheets.google.com/spreads ... c&hl=en_US

justbreathe, I am almost certain that you suffer from a Central Sleep Apnea Syndrome (CSAS).

Read the following data on it to see if it is so:

http://emedicine.medscape.com/article/304967-overview

If you do not have copies of your sleep studies (first one and titration) I suggest that you make arrangements to get them now.

Way too many centrals. You need to know if you have had them all along or if they are just now appearing. When are you scheduled for follow up with your doctor? He/she needs to be aware of your reports.

Here is my sleep Study results. I could not figure out how to make the picture show up here.

Page 1
https://docs.google.com/document/d/1PnM ... t?hl=en_US
Page 2
NA
Page 3
https://docs.google.com/document/d/1YYJ ... t?hl=en_US
Page 4
https://docs.google.com/document/d/18Ba ... t?hl=en_US
Page 5
https://docs.google.com/document/d/1bDn ... t?hl=en_US

justbreathe wrote:Last night I slept with my chinstrap again and have my leak under control. But I am still having too many central apnea events.
Here is my charts from last night.

after all these events I took my mask off and slept for a few hours before waking and putting it back on for another 45 min before getting up for the day.

Any thoughts would be helpful. My pressure is 9.

https://docs.google.com/document/d/14fl ... t?hl=en_US

I don't think that I can explain why the difference between the results from your sleep study and your recent CPAP Log (which BTW shows wrong dates as 8/15/11 to 8/19/11).

The CPAP Log shows a possibility of CSAS:

https://spreadsheets.google.com/spreads ... n_US#gid=0


But the sleep study does not, necessarily:

https://docs.google.com/document/d/18Ba ... t?hl=en_US#

Your initial sleep study does mention significant number of centrals with no improvement on cpap. I don't know why this wasn't addressed unless they were thinking that they might be related to the the PLMD.

An in depth discussion with your doctor is needed to figure out the best course of action and what level of centrals is acceptable or what they they want to do about it.