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Graph interpreters.... do your worst!
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sonicboom Offline

Advisory Members

Posts: 547
Joined: May 2015

Machine: Airsense 10 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: ResMed AirFit P10, Dreamwear
Humidifier: Integrated
CPAP Pressure: 4.6-7.6
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Washington

Post: #11
RE: Graph interpreters.... do your worst!
(06-24-2016 10:16 PM)shawn42 Wrote:  Anyway, I recall my doc saying he wanted to raise my pressure after the first 30 days, and he said he'd do that remotely. In my Statistics tab, there's only 1 line under Changes to Prescription Settings. Do you think that means the change never occurred? I should give the office a call and see if they recorded what my latest settings should be. Then I can verify them.

It looks like your settings have not been changed. Double check with your doctor. While you're at it ask for a copy of your prescription settings if you don't already have them.

06-25-2016 10:54 AM
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shawn42 Offline

Preferred Members

Posts: 36
Joined: Jun 2016

Machine: Philips DreamStation AutoBiPAP
Mask Type: Nasal mask
Mask Make & Model: Philips DreamWear
Humidifier: detachable-- currently not using this
CPAP Pressure: 4-10 EP/IP, 2-4 PS, 3 BiFlex
CPAP Software: SleepyHead

Other Comments: Using CMS50IW Pulse Oximeter; Diagnosis AHI 60.2 with 74% O2 Desaturation Nadir

Sex: Male
Location: US

Post: #12
RE: Graph interpreters.... do your worst!
Thanks, everyone, for chiming in! Without any other symptoms to address, I feel like I'm going to be one of the ones attempting to get my AHI as close to 0 as possible with a soon-to-be focus on my oxygen levels (pulse-ox in the mail).

(06-24-2016 10:29 PM)chill Wrote:  You say that you awoke naturally around 5:15. Your graphs show two hypopneas and a flow limitation at 5:08 - 5:10 followed by a spike in pressure and mask leak. I think it is likely that this is what woke you up, though you were probably not aware of it.

You bring up a very good point. Even before diagnosis/treatment, I always considered my frequent wakings as natural. I use that to describe the feeling-- it's not a jolt or a shock or caused by anything obvious. I just open my eyes, and I'm there. I can't sense any cause for it, and it's peaceful, so I just call it natural. It was kind of funny that a week or so before my first sleep study, I woke horrendously in the night choking & coughing, gasping for air. It was the only time I can recall going through such a thing. Once in a blue moon, I get rudely awoken by a charlie horse in my leg. Other than that, waking up always just happens on its own and feels natural.

My circadian rhythm is actually pretty hardcore. I have an adverse reaction to waking up to loud alarms. They startle me too much, yet I'm too focused on being punctual to leave them off in the first place. So I inadvertently became conditioned to wake up mere moments/seconds before my regular alarm each day. That eventually grew into being able to maintain the wake-before-alarm phenomenon even after changing time zones and thus sleep/wake times. A couple months ago, I was on travel in CA (from MD), and I maintained this experience throughout the week. I even topped it off by waking up a minute before my 3am alarm clock to catch my flight home. I didn't even go to bed early. It wasn't the first time that had happened, but it was the first time I had the chance to experience these phenomena since starting my treatment. I was uncertain if my new sleep experience would change my extreme sleep-time-keeping abilities. Now I believe it probably isn't related.

All that said, the 5:15 statement was really a guess. I glanced at the clock, and it was in the early 5's somewhere. I've attached a zoomed view of that period for reference. One of the things I'm curious about is trying to figure out where I'm awake in these graphs. I feel like I take deep breaths when I'm awake with the mask, especially since waking up can sometimes result in me holding my breath for a moment while I sit up a bit to check the clock. Does 5:18 look like that?

I also attached a second zoom around 3am of a scary looking 30-second OA preceded by some funky looking breathing patterns =( I don't like that at all!

(06-25-2016 09:41 AM)green wings Wrote:  Hi, Shawn. I think it's great that you're using SleepyHead and looking at your data, in spite of not having any detectable symptoms of apnea.

Re your graph, I do see that you're having some obstructive events that would possibly respond better if your starting pressure was higher. (That's not a recommendation to change your settings based on just one night's data, though.)

If your doctor gave you a copy of your initial sleep study, you can look at it to see if your apnea is worse when you are sleeping on your back or during REM sleep (or both). I'm guessing that it probably is, since your pressure graph shows hills and valleys.

If your apnea is indeed both positional and REM-related, I think it's good to know that if you are going to be looking at your SleepyHead data regularly.

I didn't have any daytime sleepiness before I was diagnosed with sleep apnea (and still don't, no matter what sort of sleep I get).

I think that you'll just have to ignore it when someone tells you that your data is "good enough and what really matters is how you feel". Just know that the "how you feel" part doesn't apply to you. The data is "good enough" part probably still applies. If you want to pursue a super low AHI, though, I don't see any reason why you shouldn't.

If you decide to get into analyzing your sleep, you may want to buy additional monitoring equipment like something to estimate the amount of time you spend in each sleep stage, and maybe a pulse oximeter, too, if you had any oxygen desaturations during your sleep study.

If you monitor your sleep stages (sleep architecture), you may discover that you get enough REM and N3 (slow-wave) sleep but have less lighter (N1 and N2) sleep than most people. That would explain how you can sleep fewer hours and still wake up feeling refreshed.

Article for you about REM-related OSA, should you want to read it.

I'm glad you bring all this up. Prior to my diagnosis, I was a belly-sleeper mostly for comfort, but also due to my wife's complaints whenever I was on my back and snoring loudly. Now that I'm being treated, I started trying to sleep on my back more after reading some articles about which sleep positions were the most healthy. They all frowned on stomach sleeping, which I still desire, but can rarely pull off anymore unless I turn my head to the side just right. I used to sleep a lot with my forehead resting on my forearm, but I can't do this anymore because of the noise of the mask vent air hitting my bed/pillow. I am usually comfortable sleeping on my sides, but I've noticed I sometimes get bad pain in one or the other of my shoulder joints lasting days/weeks, and I suspect the side sleeping could be a cause. With all this, I figured if the apnea is treated then I should be focusing on sleeping on my back. Yet I find it difficult to relax my muscles in that position, and I often feel antsy and start flopping around anyway. It's almost like my hip joints get "itchy" or irritated if I don't switch positions enough.

To insert some numbers from my studies, my initial study had me supine for 87% of sleep and it also gave me a 64.4 AHI, as opposed to my non-supine 31.6 AHI. My sleep stages were 4.3% N1, 81.9% N2, 2.6% N3 and 11.2% REM. My REM AHI was 12.6 with 66.1 NREM AHI. I slept 427 minutes that night with 91.8% sleep efficiency. During that time, I experienced 315 obstructive, 46 mixed & 0 central apneas with an overall AHI of 60.2 and an arousal index of 33.4/hr. My oxygen nadir was 74% with an average of 93% and 37 minutes were spent under 88%. Other than all the wires & being on my back, my sleep was normal and expectedly light. I awoke feeling refreshed and normal with no fatigue during the day.

My second study with CPAP was reported a little differently. They only mentioned that I was supine 100% during the period with my "most appropriate" pressure setting of 7. That had me down to 1.1 AHI with 0 central events, though an overall AHI of 2.9 for the night with a 0.6 central apnea index. My sleep stages were 3% N1, 51.8% N2, 20.7% N3 and 24.5% REM. They didn't give a REM/NREM AHI. I slept 415 minutes that night with 78.6% sleep efficiency. They didn't give a number/type of events, though my arousal index was 6.7/hr. My oxygen nadir was 91%. During that study, I had a very hard time breathing comfortably while awake since I found it difficult to exhale under the constant pressure. It aggravated me and likely contributed to my lower sleep efficiency. I remember waking in the night and feeling stiffness/irritation in my hip joints, so I tried to sort of sleep on one side or the other despite the wires, but I could only turn a little each time. I woke in the morning feeling groggy and annoyed. I felt fatigued & yawned a lot throughout the day. It was very uncharacteristic of me.

So does not everyone with apnea experience oxygen desaturation? From my experience (including my pre-diagnosis experience through my father), this is the most significant part of living with sleep apnea.

I'm not sure how much I would benefit from monitoring my sleep stages since my numbers appear to contradict the accepted logic of how I should be feeling. I wish I had a 3rd study with my APAP to see if I continue to see good N3/REM numbers.

(06-25-2016 10:54 AM)sonicboom Wrote:  It looks like your settings have not been changed. Double check with your doctor. While you're at it ask for a copy of your prescription settings if you don't already have them.

Definitely-- I'm already awaiting a response from them. Thanks for confirming my suspicions on the prescription settings display!
(This post was last modified: 06-25-2016 07:56 PM by shawn42.)
06-25-2016 07:51 PM
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