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Home Sleep study questions
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(05-17-2016, 03:47 PM)richb Wrote: You will need to have 8 posts in order to add an attachment to one of your posts. You are getting there.


Thanks! I hadnt realized that. Ill try to post some of the data I am seeing until I can provide a chart..

Some of the last nights I wore the cpap, I got some decent AHI's, in the 2-4 AHI range, with these being the machine settings:

Machine Settings

ModeCPAP Mode VPAPauto
Min EPAPLower Expiratory Pressure 9 cmH2O
Max IPAPHigher Inspiratory Pressure 18 cmH2O
PSPressure Support 0 cmH2O

I was having more clear airway incidents it seems with all those days..
ahi 3.21
Date Sleep Wake Hours
8/10/2015 23:09:19 05:04:20 05:55:01
Large Leak 2.54%
Clear Airway 2.37
Unclassified Apnea 0.00
Obstructive 0.00
Hypopnea 0.85

ahi 3.68
Date Sleep Wake Hours
8/12/2015 23:37:25 05:36:26 05:59:01
Large Leak 3.00%
Clear Airway 3.18
Unclassified Apnea 0.00
Obstructive 0.00
Hypopnea 0.50

this was my best one with AHI 1.44
Date Sleep Wake Hours
8/9/2015 22:48:32 02:58:33 04:10:01
Large Leak 0.03%
Clear Airway 0.96
Unclassified Apnea 0.00
Obstructive 0.00
Hypopnea 0.48

Here was my worst one...It did have different machine settings though.
ahi 50.29
Date Sleep Wake Hours
8/6/2015 23:44:28 03:45:29 04:01:01
Large Leak 1.55%
Clear Airway 45.31
Unclassified Apnea 0.50
Obstructive 0.00
Hypopnea 4.48

machine settings for that "bad" night were:
ModeCPAP Mode VPAPauto
Min EPAPLower Expiratory Pressure 10 cmH2O
Max IPAPHigher Inspiratory Pressure 18 cmH2O
PSPressure Support 4 cmH2O

When I had higher PS settings my AHI seem to shoot up, when I lowered to 0 it was much better.

Hopefully this helps a bit...
Thanks again!
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Thanks for posting the data.

That awful night with the CAI = 45+ and a PS = 4 gives some reason for caution: You may be in the small group of PAPers who have problems with pressure induced central apneas. Sometimes a larger PS makes the problem worse.

The other nights with the following settings were not too bad:
  • ModeCPAP Mode VPAPauto
    Min EPAPLower Expiratory Pressure 9 cmH2O
    Max IPAPHigher Inspiratory Pressure 18 cmH2O
    PSPressure Support 0 cmH2O

But even with these settings, your CAI > 3.0, while your OAI and HI were negligible: The OAI+HI < 1.0 on all three nights.

Given all of that, since you're game to try the VPAP again to see if it does you some good, I'd suggest that you use a lower pressure range quite a bit and keep the PS = 0. I'd suggest that you try using settings that look like this for at least a day or two:

Min EPAP = 4 cmH2O (but see the NOTE below)
Max IPAP = 10 cmH2O
PS = 0 cmH2O

NOTE: Some people are uncomfortable when the pressure is as low as 4cm because they feel that there's not enough air coming through the mask to inhale comfortably. If you feel "air starved" with a min EPAP = 4, then increase the EPAP up to 6cm and see if that's enough pressure to prevent the "air starved" feeling.

Also note that with PS=0 you are effectively turning your VPAP into a APAP with EPR turned OFF. And that's ok.

The idea of using much, much less pressure for a couple of days is two-fold:

1) It would be useful to see if the CAs disappear when the pressure stays below 10cm. Some people with pressure-induced CAs only get them when the pressure is above 10cm.

2) Given how low your OAI+HI is when the min EPAP = 9, there's a good chance that you need less pressure than that to manage the obstructive stuff. A pressure range of minEPAP=4 to maxIPAP=10 will allow the machine to respond to any obstructive events. And if too many of them get through the PAP defenses, you can take that as evidence that you do still have some obstructive sleep apnea problems going on and you can increase the pressure(s) based on what the data shows. If your OAI+HI < 5.0 at this pressure range, then you'll know that you don't need particularly high pressure to control whatever OSA you happen to have.

Finally, I've noticed you are also posting on the other board. (It is a good board and you may have noticed that I'm active over there too.) If you want advice from the other forum as well as this one, I'd suggest that you post the same data over there. While I'm active on both boards, I tend to stick with the first board I responded on when replying to a given poster. So in your case that means I'll mainly be posting over here. It helps me keep straight what I and the other board members happen to know about the situation straight.
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See my Guide to SleepyHead
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Thanks! I will try these settings over the next several nights and see what happens, than post some of that data.
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Good news! My AHI was 2.3 last night, and I was able to keep my mask on all night, which has been a huge problem for me in the past. I was using the Quattro air for the first time , along with a pad-a-cheek liner, so maybe that had something to do with it, or my new settings I tried last night. Either way, very encouraging! I did find myself waking up multiple times throughout the night though, so maybe that will get better with time. I'll look at the sleepyhead data later today when I'm home from work and post those results. Thanks
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Here are the statistics from last night from sleepyhead:

AHIApnea Hypopnea Index 2.33
ResMed S9
VPAP AutoModel 36006 -
PAP Mode: VPAPauto
PS 0.0 over 4.0-10.0 (cmH2O)
Date Sleep Wake Hours
5/17/2016 22:51:48 05:43:49 06:52:01
Large Leak 5.33%
Clear Airway 1.89
Unclassified Apnea 0.00
Obstructive 0.00
Hypopnea 0.44


Channel Min Med 95% Max
EPAPExpiratory Pressure (cmH2O)
W-Avg: 4.49 4.02 4.38 5.24 6.20
IPAPInspiratory Pressure (cmH2O)
W-Avg: 4.49 4.02 4.38 5.24 6.20
Minute Vent.Amount of air displaced per minute (L/min)
W-Avg: 6.73 2.25 6.62 9.12 15.62
Resp. RateRate of breaths per minute (Breaths/min)
W-Avg: 16.76 6.40 16.80 20.40 33.80
Resp. EventA ResMed data source showing Respiratory Events (Events/hr) 0.00 0.00 0.00 7.00
Flow Limit.Graph showing severity of flow limitations (Severity (0-1))
W-Avg: 0.00 0.00 0.00 0.01 0.23
Leak RateRate of detected mask leakage (L/min)
W-Avg: 17.10 0.00 16.80 25.20 36.00
SnoreGraph displaying snore volume (?)
W-Avg: 0.05 0.00 0.04 0.10 0.20
I:E RatioRatio between Inspiratory and Expiratory time (ratio)
W-Avg: 51.65 13.00 51.00 67.00 123.00
Insp. TimeTime taken to breathe in (Seconds)
W-Avg: 1.22 0.60 1.20 1.46 2.00
Exp. TimeTime taken to breathe out (Seconds)
W-Avg: 2.42 0.86 2.34 3.30 7.90
Tidal VolumeAmount of air displaced per breath (ml)
W-Avg: 404.31 80.00 380.00 620.00 1360.00

Total time in apnea 00:03:44
Time over leak redline 5.331%
Machine Settings

ModeCPAP Mode VPAPauto
Min EPAPLower Expiratory Pressure 4 cmH2O
Max IPAPHigher Inspiratory Pressure 10 cmH2O
PSPressure Support 0 cmH2O

It said I had a large leak rate, but I dont recall any bad leaking those times when I did wake up over the night. I should be able to attach the graphs, etc from sleepy head in my next post or two I think..
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I got a copy of my past sleep study today. I dont have a scanner, so not sure if I take pictures of the study on my phone if that might work. If not, are there any particular parts of the sleep study that you wanted to see? Basically its saying I have severe obstructive apnea ( I had thought they told me moderate) with excessive sleep fragmentation. My AHI was 33.6 per hour. The apneas were not associated with significant oxyhemoglobin desaturation as evidenced by a low oxygen saturation of 90%. There were no EKG abnormalities and no significant limb movements.
This was from March of 2010 when I had this done.
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Here is a copy of the sleep study that I broke into 2 parts so hopefully it is ok to view...The whole study is just on one page, and the only information not shown in the pics is my name, dr name, etc.


Thanks again for all the information you have given me thus far!!
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Scientific Investigations

Accuracy of Automatic Polysomnography Scoring Using Frontal Electrodes -1Sleep Disorders Centre, University of Manitoba, Winnipeg, Manitoba, Canada; 2YRT Ltd, Winnipeg, Canada

Study Objectives
The economic cost of performing sleep monitoring at home is a major deterrent to adding sleep data during home studies for investigation of sleep apnea and to investigating non-respiratory sleep complaints. Michele Sleep Scoring System (MSS) is a validated automatic system that utilizes central electroencephalography (EEG) derivations and requires minimal editing. We wished to determine if MSS' accuracy is maintained if frontal derivations are used instead. If confirmed, home sleep monitoring would not require home setup or lengthy manual scoring by technologists.

One hundred two polysomnograms (PSGs) previously recorded from patients with assorted sleep disorders were scored using MSS once with central and once with frontal derivations. Total sleep time, sleep/stage R sleep onset latencies, awake time, time in different sleep stages, arousal/awakening index and apnea-hypopnea index were compared. In addition, odds ratio product (ORP), a continuous index of sleep depth/quality (Sleep 2015;38:641–54), was generated for every 30-sec epoch in each PSG and epoch-by-epoch comparison of ORP was performed.

Intraclass correlation coefficients (ICCs) ranged from 0.89 to 1.0 for the various sleep variables (0.96 ± 0.03). For epoch-by-epoch comparisons of ORP, ICC was > 0.85 in 96 PSGs. Lower values in the other six PSGs were related to signal artifacts in either derivation. ICC for whole-record average ORP was 0.98.

MSS is as accurate with frontal as with central EEG derivations. The use of frontal electrodes along with MSS should make it possible to obtain high-quality sleep data without requiring home setup or lengthy scoring time by expert technologists.

Younes M, Younes M, Giannouli E. Accuracy of automatic polysomnography scoring using frontal electrodes. J Clin Sleep Med 2016;12(5):735–746.
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