Peak AHI

I have a question about peak AHI and how the overview graphs in sleepyhead represent it. My overview page has two graphs giving AHI information. Tbe first graph has dages across bottom and a scale from 0.0 to 140.0 vertical. Each day has a line which is 3 diferent colods and a lot of them the top part is red. This chart shows a lot of peaks over 100 and some days tbat hit the top at 140.0.

On down tbe page is another called peak AHI with dates along bottom and vertically the scale goes from 0.0 to 130.0. It is more of a graph pattern and has one blue and one orange line. The way my numbers jump and dip it is odd looking. That said there are a lot.of daysthat peam at top of 130.0 scale. So my question is why my AHI scale shows 140.0 and tbe Peak AHI.scale tops at 130.0. I max them both out frequently and wonder if an AHI of over 140.0 is just where tbe scale tops out or is a higher figure possible. And just to try and compare myself others I am wondering how common to bave scores over 100? I top 100 at least weekly. Odd thing is a lot of nights i will score 130 then next will be 2.8. Same settings and sleep conditions with over 100 point difference night to night. All my docs say this is really odd but still no explanation or fix. Raise your band if you have many nights over 100. Last night was.one so I am going back to bed for a nap.

Are you talking about graphs that look like these graphs:

The top graph represents the overall AHI for the night graphically. The bars are subdivided into colors so that it is easy to figure out how much of the AHI is made up of CAs (top purple band), OAs (light blue middle band), and Hs (dark blue lower band). The height of the total bar is equal to the NIGHTLY AHI and

NIGHTLY AHI = (# of events scored)/(time the machine was running)

The more purple the bar, the larger the percentage of CAs there are in the number of events scored on the given night.

The lower graph shows the MAX "AHI/Hour" number for each night in blue and the AVERAGE "AHI/Hour" in orange. Exactly how the AHI/Hour is computed depends on your settings in SH. You have a choice of using a running hour computation or a "reset at *:00" computation.

If you use the "running hour" setting, the AHI/Hour is recomputed every minute based on the last 60 minutes of data in the current session of use. So at any given time the AHI/Hour = (# events in last 60 minutes of data). When ever you turn the machine OFF and back ON, the "AHI/hour" is reset to 0.

If you use the "reset at *:00" setting, the AHI/Hour is reset to 0 at the top of every hour. It is also reset to 0 if you turn the machine OFF and back ON. In this setting the AHI/Hour = (# events scored since the "hour" began at *:00).

So the blue line on the lower graph is just the maximum value the "AHI/Hour" number reached during the entire night's worth of data. The Orange line is an (weighted) Average of all the AHI/Hour numbers for the night.

As to why your Max AHI/Hour number is sometimes less than your overnight AHI hour, I'm not sure about that. I suspect it may have to do with how many sessions you have each night OR whether you are using the "reset at *:00" setting for the AHI/hour computations. I'll have to think about the mathematics on that for a bit.

hueyville wrote:That said there are a lot.of daysthat peam at top of 130.0 scale. So my question is why my AHI scale shows 140.0 and tbe Peak AHI.scale tops at 130.0. I max them both out frequently and wonder if an AHI of over 140.0 is just where tbe scale tops out or is a higher figure possible. And just to try and compare myself others I am wondering how common to bave scores over 100? I top 100 at least weekly. Odd thing is a lot of nights i will score 130 then next will be 2.8. Same settings and sleep conditions with over 100 point difference night to night. All my docs say this is really odd but still no explanation or fix. Raise your band if you have many nights over 100. Last night was.one so I am going back to bed for a nap.

Having these graphs top out at above 100 is VERY, VERY unsual and it indicates that the machine is NOT doing its job at all on those nights. On the nights where your AHI > 100 (or your max AHI > 100), you are still physically dealing with apnea that would be at the top of the very severe range on a diagnostic sleep test.

Perhaps this is why the sleep doc met with you right after the last PSG and arranged all the extra testing: Was that last test a titration test? In other words did they have a mask on you during the test? Maybe you had one of these super-duper bad hours (in spite of PAP) while in the lab and that properly caught the eye of the doc. The problem clearly needs to be investigated, and based on what you said in a different thread, it sounds like you now have a sleep doc and medical team who is stepping up to the plate and doing the necessary legwork to figure out what can be done to help you.

The graphs shown are the same I am looking at. Only instead of 0.0 to 10.0 range of upper scale mine go up to 130.0 and 140.0. And I have had the machine checked out and numbers verified. As to my sleep study earlier this week it was a bipap titration with a backup rate. We have done 2 cpap titrations, 1 standard bipap and none were helpful in lowering my numbers. Since starting with the new doc he has been playing it cool and trying to keep me positive but is also honest enough to say I am super screwed up and he cannot find the keh to the lock yet. When he rolled into the sleep lab personally at 7am then sent me to an internist and then the hospital and then back to his office I could see concern on his face. Asking me if it is o.k. to do my next study as an in-patient at the hospital I really got the message. When he said he had to send my info off to some other sleep docs and clinics I knew for sure.I have an issue. I also know why the first group I went to blew me off and another lab I went to actually woke me up at midnight during what was.supposed to be an all nigbt titration and sent me home and then called next day saying they did not think they could help me and advised me to look for another group immediately. I regularly stop breathing till I turn blue. Wife says once she gets me consious that I start breathing again.

hueyville,

My heart goes out to you. I think that the numbers you are seeing on your machine are REAL. And I think that on the last sleep test with the titration study on a bipap with a back up rate, they must have seen something in the data that looked like one of your BAD nights. And that no matter what setting parameters they tried, things didn't improve much (or at all.)

At least this sleep doc has decided to not just write you off as an impossible patient. But I do think you're just about an official "medical enigma" And it's not fun being one (ask Madalot about that.) Hopefully there will be some answers once the current sleep doc gets feedback from the other docs he's communicating with about your case. And I can also see why the new sleep doc is thinking about having you do the next sleep test as in in-patient in a hospital setting.

You also write:

I regularly stop breathing till I turn blue. Wife says once she gets me consious that I start breathing again.

I take it you mean this happens only when you are asleep? Out of curiosity, how long do your worst CAs last according to the SleepyHead data? And how long do the more typical CAs last?

As to how long they last will have to look when get home. I am also still figuring out exactly how to read the software as a newbie to sleepyhead. Actually left house to go to bank and see if my business is still standing. Since the cat has been away the help took today off. Said they would rather work Saturday in sunshine than today in rain. Decent of them because I would have paid them to sit in the shop and ride the clock. Think I should pay them for half a day overtime just to show them I appreciate them not riding the clock days I cant come in and pull work orders for them.

As to quitting breathing, that has been happening for years. Before this sidelined me from mountain climbing completely all my partners stopped sharing a tent with me as sleeping with a dead body freaked them out. Wife spent several years moving to spare bedroom when I would have bad nights. Now she is so scared she stays awake most of the night watching me then sleeps during the day. Odd thing is that I take my meds, lay down and 15 to 30 min later I am eyes closed, snoring and appear to be sleeping. I never fall completely asleep as I hear everything that happens. I do most of my dreaming while awake. I get up and go to bathroom and when lay back down I will be dreaming the entire time I am up. Even if go to kitchen to get a snack. It is like watching 2 televisions at the same time. 1 is reality and other is dream. Like my left and right brain are each doing their own thing without regard for each other. By the way, the head injury that started this all was a 25 foot head first fall onto concrete. Since then is when my centrals began, my thyroid, adrenal glands and all kinds of other stuff has gone haywire. Apparently brain sleep center and a lot of autonomic functions happen in same area. Broke my C2 vertebrae same time thus some signal loss in nerves going through spine there.

It has been a wild ride as I mostly lost short term memory skills for a year. I can remember everything I did last week but I cant remember if I ate lunch today. Next week I will remember everything I did this week but details from an hour ago are fuzzy. That has improved 85% but not completely. It is odd to still remember calculus which I seldom use any more but wife has to remind me to eat. The doctors hoped the sleep issues would improve with time but its getting worse. Apparently the brain can rewire the way memory is stored and recalled but damage to autonomic function areas is different.

While scared for the first time in my life I am very happy that after the first two clinics gave up on me the new doctor seems to be willing to keep me on and try to help. I am going to miss his new spiffy sleep lab but if being in the hospital will aid in diagnosis it will be worth it.He had me in an MRI machine by lunch time after I was released from the lab but I think next time he wants to slam me in the tube immediately. Or he is just plain scared I will die in his lab.

I am right now looking at last night in sleepyhead. I opened the events tab and it tells me that I had 42 centrals. When I expand that it shows each event numbered #001 through #042. Beside each event is the time it was recorded. If I click on any event it moves my graphs to that time. I compress the view size slider and the graph gets more detailed and shows a vertical line marked CA. So how do I know how long the event occurred? Beside each event is a number in parenthases. Is that the length of time event lasted? If not, how do I determine duration of each event?

hueyville wrote:I am right now looking at last night in sleepyhead. I opened the events tab and it tells me that I had 42 centrals. When I expand that it shows each event numbered #001 through #042. Beside each event is the time it was recorded. If I click on any event it moves my graphs to that time. I compress the view size slider and the graph gets more detailed and shows a vertical line marked CA. So how do I know how long the event occurred? Beside each event is a number in parenthases. Is that the length of time event lasted? If not, how do I determine duration of each event?

Yeah, that number in the parenthesis is a decent approximation for the length of the event as measured in seconds. (That's true for OAs, CAs, Hs for sure. Probably true for FL. And definitely NOT true for VS2's or PP's.)

Just for kicks went back several weeks to look for nights with excessive centrals.
Aug 23. 71 events (99 obstructive)
Aug 25. 121 events (6 obstructive)
Aug 26. 68 events (257 obstructive)
Aug 27. 76 events (174 obstructive)
Aug 28. 79 events (164 obstructive)
Aug 31. 48 events (287 obstructive)
Sep 02. 79 events (258 obstructive)
Sep 03. 78 events (112 obstructive)
Sep 09. 64 events (70 obstructive)
Sep 12. 70 events (71 obstructive)
Sep 18. 55 events (407 obstructive)
Sep 19. 81 events (212 obstructive)
Sep 20. 76 events (81 obstructive)
Oct 16. 42 events (67 obstructive)

Have a lot more bad nights and high numbers like Sep 29 were 444 pressure pulse events and Sep 09 were 721 pressure pulse events. Hypopneas often in the 40 to 80 event range. All this after years of treatment and the past three months having best help yet. 3 studies in 3 months with 2 more scheduled. So one of you gurus tell me if this is as bad as my imagination can conjure up. My docs seem to be sugar coating it to try and keep me calm. Or is it really not that bad? Its all new to me and dont know where the line between bad and messed up really bad lies.

Thanx robysue. My C.A.'s are based on that mostly in the 30 to 60 second range with them going over a minute not uncommon.

When are they thinking of bringing in the ASV type of machine? Any discussion on that yet?

That will probably be what we try next trip to the lab. Gotta get it done before Dec 31....

So I sat down and went through the last couple of months of sleepyhead data. I pulled a representative sampling of reports and will be adding more as time allows. I am hoping someone will see soething in these reports that fires a brain cell or two just enough to point me toward some out of the box ways o treating my issues.

These screen captures are not anomalies. I have one to two nights a week where my centrals hover in the 200 range. Most in a single night has been 212 centrals.



From the same night a sampling of the length of time the obstructives last. Once again these are just a capture of average times. I do have both centrals and obstructives that last well over a full minute. One sleep lab study reported an apnea event of over three minutes. That is the lab that made me go home and told to not come back and the doctor that sent me cancelled my follow up visit with him and never would find the time to reschedule.





Here are a couple of those nights that scares the cr@p out of me.





These next two screen captures are from what I consider an average night. AHI of 53 and considering have had nights of AHI's in the 120 to 140 range this is not only average, but actually pretty darn good.





Then out of the blue I have a couple of nights like this each week. Thus the confuzion. My numbers are bouncing all over the place with no rhyme or reason.



So a good night sneaks in and then bounce goes the ball and we have another one of these. Notice 396 obstructive events on this report.



I am in process of working on screen captures for an entire average month. I want to be able to have info ready in the event some apnea guru asks for something specific. Meantime, any of you folk who get all weirded out and upset if your AHI sips up above 1 or 2 at some point just flip back to this thread and maybe it will make you feel better about your numbers. While I am still too ignorant to understand all of this I do know it scares the cr@p out of sleep doctors to the point they refuse to see me again after my first visit. I feel lucky to have one now that has stuck with me for three months and says he isn't going to quit until he exhausts everything he knows or can guess to do.

hueyville wrote:it scares the cr@p out of sleep doctors to the point they refuse to see me again after my first visit.

What scares me even more about that first doctor is that he is practicing medicine and doesn't know how to deal with central apnea.
If he specializes in sleep...he's a sorry excuse for a sleep doctor and would make me question anything that moron did/does.
He wasn't even smart enough to admit he didn't know what to do and that's scarier than hell to me.
They should have put you on the fast track for a ASV machine but I guess just as well since he wouldn't have had a clue how to use/prescribe it anyway.

New doctor started off treating me like revular patient till 2nd sleep study. After the 2nd study he scheduled me for weekly clinical visits. Had 3rd sleep study in 8 weeks last Tues. In follow up clinical this morning had PA get resp tech schedule and fold PA to cancel patient "x" Sunday night and puf me in that slot for ASV study. She was stunned. When doc left room ask hed whats up? She said they are fully booked till Thanksgiving and he almost never bumps a new patient. While my motive was to get this done before end of year, he apparently wants to make progress immediately. He also told her to get me a machine that does bipap with backup rate & ASV. He said find one and have it ovennight shipped so they could program it and give to me at next Mondays appointment. This will be 4 sleep studies and 7 clinical visits in 3 months. More than the other 2 docs did in 2.5.years. I like that get things done instead of looking at the floor and then referring to someone else like an old testement leper style of medicine. When new machine arrives he wants me to do a month of home study using his professional dial winging then 1 more trip to the lab. If he can get insurance to approve 6 sleep studies in 4 months why did the others just do one and tell me to pack my bags?