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My 1st post of SleepyHead data
#11
RE: My 1st post of SleepyHead data
June 28 data (http://imgur.com/a/yKdPR)

Again, the data is broken over numerous sessions. So clearly you are not yet sleeping well with your PAP. But you know that already.

Lots of snores (VS2s) are scored during those first two sessions. The PR machine's scoring of snoring is not well understood and there's a lot of anecdotal evidence that VS2s can be scored by things that are definitely not snoring by the patient. (A friend on another forum used to swear that anytime her pug was in bed with her when she used a PR System One, her VS2 snores skyrocketed; when the pug wasn't in bed, it registered no snoring.) But it does raise the question: Do you ever catch yourself snorting or sort of snoring while you are drifting off to sleep?

There's an interesting cluster of mixed OAs and CAs that starts around 23:47. This looks a lot like the stuff I talked about in regards to the June 27 data, but this time it doesn't last very long. In other words, it looks like this cluster is scored just as you are drifting off to sleep. So the CAs could be normal sleep transitional CAs, but the OAs would indicate that you need a higher min pressure. The rest of that session looks to be pretty normal sleep breathing, with just a couple of Hs scored between 23:10 and 23:25. There's a clear arousal at the end of this session, and that arousal does NOT seem to be associated with any sleep disordered breathing events: The CA scored at the end of the session is most likely mis-scored wake breathing or a transitional CA. At any rate, it looks like it is scored after the wake has occurred in this screen shot. (It could be worth zooming in on that CA at the end of the session that ends at around 0:05.)

After a two hour gap in the CPAP data, you put the mask back on a little after 2:10. What happened between 0:05 and 2:10?

The last session is similar to the pattern we've seen before: Lots of events just as it looks like you're drifting off to sleep. Some of them are CAs. Some are OAs. That "sleep initialization cluster" (for lack of better words) clears up about 2:25 and then all the data looks pretty good (and indicates you are most likely asleep) from about 2:25 until 3:50. It looks to me like you aroused around 3:50 and never really got back to sleep soundly after that arousal.

Issues this raises, particularly in light of my previous posts:
1) Do you have trouble falling asleep in general?

2) Is it harder for you to fall asleep with the mask on?

3) Do you ever catch yourself startling yourself awake just after you feel like you are falling to sleep?

4) Where did your events occur on your diagnostic study? Did you have a lot of events just as you were transitioning to sleep? We'd need the sleep study results with the summary graphs to answer that question.
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#12
RE: My 1st post of SleepyHead data
July 1 data (http://imgur.com/a/EgztM)
Usage is MUCH improved on this night!

You turned the machine on the first time at 1:06am (on July 2) and turned the machine off at 9:09am. So that's a "time in bed" of right around 8 hours, and you wound up having almost 7.25 hours of usage in those 8 hours.

But this bed time is much later than the previous nights. Did you simply stay up? Or did you go to bed at a more usual time for you, and then woke up and put the mask on in the middle of the night?

Your transition to sleep during the first session appears to be just before 1:20. And things are a lot less "noisy" before you fall asleep on this night than they were on the other nights. There is some clustering of Hs along with a Large Leak in that first session. But you've got bigger problems than those to deal with first, in my opinion.

In the second session, you again get to sleep rather quickly. Look at the drop off in the flow rate graph that occurs at about 2:50: That's what the transition to sleep breathing often looks like. And things stay relatively calm until all hell breaks loose around 3:45. The timing is not quite right for a REM cycle, since this starts only about 50-60 minutes after you turned the machine back on, but my guess is that it most likely is a REM cycle. And that your apnea is much worse in REM than non-REM.

Interestingly, the cluster of events shortly before the end of the first CPAP session is timed about right for a REM cycle, and if we go back to the fact that you fell asleep around 1:20, the nasty cluster that starts around 3:45 would be pretty close to the idea that the start of REM cycles usually occur about 90 minutes apart. In other words, the first time you woke up and turned the machine off and back on, could very well have been a normal post-REM wake.

If the cluster that starts around 3:45 is REM-related, then your min pressure setting definitely needs to be increased: At the start of that cluster, the machine is at your minimum pressure and it just takes too long for the machine to respond to prevent this cluster from getting started.

The third session starts with another long cluster of events---OAs mixed with CAs. And given what I can see of the Flow Rate curve itself, I don't think you are soundly asleep when the CAs are happening. But you probably are asleep by the time the cluster switches over to only OAs around 5:40. Once you are past that nasty "sleep onset cluster", things look decent enough for the rest of the session. Since the third session lasts just about 90 minutes, I think that the wake at the end of it is just a normal post-REM wake.

The fourth session has the same kind of real nastiness at the beginning and end with cleaner data in between. My guess is you had trouble getting back to sleep after the normal post-REM wake, and then again had a nasty "sleep onset cluster" that made it even harder to transition to real sleep.

Observations and comments that come out of this night's data:

1) What is your desired sleep schedule? When would you like bedtime to be? When do you need to wake up in the morning?

2) Do you sleep in on Sundays? Do you stay up later on Saturday nights?

3) There is evidence that you need a higher minimum pressure to try to prevent those clusters of "sleep onset OAs" from occurring. A higher minimum pressure may also make it easier for the machine to prevent REM-based obstructive clusters from occurring.

4) This is your worst night in terms of Official Large Leaks, but you were in Large Leak territory only 8% of the night. Given the clustering of events, I think you need to work on fine tuning the pressure and learning how to sleep with the machine more than you need to work on leaks right now.

5) A caveat to #4: If you are keenly aware of your mask leaking and the mask leaks themselves are keeping you from getting to sleep, then you need to work on the leaks as well as bump the min pressure up by 1-2 cm. If you can eliminate the leaks as one of the issues that is preventing you from falling totally asleep, that may help eliminate some of the nasty clusters of CAs that occur just as you are drifting off to sleep.
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See my Guide to SleepyHead
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#13
RE: My 1st post of SleepyHead data
July 2 data (http://imgur.com/a/eMW9B)

Usage is not as good as July 1 mainly because you turn the machine off for good at 4:07. Did you have to get up to go to work this morning?

But on the other hand, you turned the machine on at 11:36, turned it off at 4:06, and got almost 4.5 hours of usage in a 4.5 hour "time in bed". That's really good. How much sleep do you think you got with the mask on this night?

The first session is pretty good in terms of the data. Even the leak data is decent enough. The Flow Rate is a bit choppy, so my guess is that you were not sleeping very soundly, but I do think you were sleeping.

The second session has a nasty "double cluster" between 2:15 and 2:45, with a possible arousal/wake (based on the size of the Flow Rate data) between them. Again, the clusters are a mess of OAs, CAs, and Hs all mixed together, and it's not clear whether these things are happening when you are sound asleep, dozing, or awake and fighting to get back to sleep.

The smaller cluster around 3:20 that is made up primarily of Hs looks to me to be REM-related. I don't think the two monster clusters are REM-related.

Observations and questions:

On the plus side, there are no hour long gaps in the data any more. But bed time is later than it was on the first several nights so that brings us back to these questions:

1) What is your desired sleep schedule? Bedtime? Wake up time? Do you have a very different sleep schedule on weekends?

2) How long does it take you to get to sleep with the mask? How long did it take you to get to sleep before you started CPAP?

3) How many wakes do you remember in the morning? One or two? 3-5? A whole lot, as in too many to count?
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See my Guide to SleepyHead
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#14
RE: My 1st post of SleepyHead data
Final post for now:

Where to go from here?
1) I think a modest 1 cm increase in your minimum pressure for a week or so is worth trying. After a week if you are still having lots of clusters with tons of OAs and Hs mixed with CAs that occur shortly after turning the machine on while using a min pressure of 9, increase the min pressure again.

2) It is worth increasing the max pressure from 13 to 15 (or higher) if you can get those clusters of events when you are trying to get to sleep or back to sleep under control. But until you find a min pressure that is high enough to prevent those clusters, increasing the max pressure is not really going to do much to change your data.

3) But the thing I think you need to really work on is learning how to sleep with the mask on your face.

For many of us, it takes some getting used to the mask when we start. For some of us, it takes some real work in trouble shooting why we have trouble getting to sleep or staying asleep with the mask.

In your case, you seem to have some real problems with clusters of events just as you are drifting off to sleep. But it is not clear to me whether these event clusters are so-called sleep-wake-junk (SWJ) or are real events. If they are SWJ, then they will clear up only after you are spending less time awake in bed fighting for sleep. And tweaking the CPAP pressure settings is not likely to help you fall asleep faster if the problem is discomfort from the whole "I have to sleep with this mask on my nose" thing.

So you also need to do some self analysis: Are there specific things about the mask that make it harder for you to fall asleep? And what do you do when you find that you've woken up and are struggling to get back to sleep?

Finally, I'll say this about the leaks: If you don't think the leaks are waking you up or keeping you awake, then your leaks are not yet serious enough to spend a lot of time and effort on. You need to put your effort into (1) getting the pressure settings set so that those clusters don't happen and (2) getting to where you can fall asleep and get back to sleep fast enough to prevent SWJ "fake events" from causing enough pressure increases to wake you further up.
Questions about SleepyHead?  
See my Guide to SleepyHead
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#15
RE: My 1st post of SleepyHead data
(07-03-2017, 05:44 PM)trickyneedsleep Wrote:
(07-03-2017, 05:22 PM)robysue Wrote: 1) What was your diagnostic AHI? And how many of the events were listed as Central or Mixed Apneas instead of obstructive apneas?

2) Did you have a formal titration study? If so, what pressure setting was recommended after the study?

3) How uncomfortable are you when you are first trying to get to sleep with the mask on? What makes you uncomfortable? Be as specific as possible.

1 - AHI diagnostic was 38.4. I posted my sleep study in a previous post.
2 - I did not hav a titration study becasue once I heard how much it would cost, i just pursued my own machine.
So you were diagnosed with severe sleep apnea.  Can you tell me if the problem was mainly OAs, Hs, or CAs on that diagnostic study?  I will go back and look for that post, but you could save me a bit of time by catching me up.

Was the diagnosis a surprise to either you or your wife?

Quote:3 - Actually Im getting more and more comfortable each day. I admit I probably do not wear it all night most of the time.
      What makes me uncomfortable wearing it? I think I wake up because Im afraid it came off
Trying to wrap my head around this: You are uncomfortable because you think you wake up because you are afraid the mask came off, but you also admit you're not using the mask most all night most of the time.

Let's start with baby steps:

1) Do you put the mask on when you first go to bed every single night? If not, why do you choose to not put it on some nights?

2) Have you woken up only to find that you have taken the mask off in your sleep?  (It's actually a pretty common problem for newbies.)  If so, what do you do when you wake up and find that the mask is no longer on your nose?

3) Do you ever consciously take the mask off after a middle of the night wake and allow yourself to go back to sleep?  (This is also a common newbie problem.)

(07-03-2017, 05:49 PM)trickyneedsleep Wrote: Inital diagnostic is OSA.
With a diagnostic AHI of 38, you've got severe OSA.  Did that surprise you when you got the results?

Quote:I got the Dreamwear, it's very comfortable but I move alot. Probably need to tighten the straps. Mouth breath? Maybe.
Personally, I wouldn't worry a whole lot about tightening the mask straps (yet).  It is quite possible to over tighten straps and that can lead to both discomfort and additional leaking.

Any problems with waking up with a very dry mouth?

Quote:Yes, my usage is a big issue I know. Without the mask. my wife tells me I sleep like a baby, no grasping for air, a little snoring maybe and she says some nights I don't snore at all.
Unless your wife is awake all night long, she may very well be sound asleep when the worst of your events happen. Was your wife surprised at the results of your sleep test?

Also out of curiosity: What lead to the sleep test? If it wasn't your wife saying you snore loudly and sometimes quite breathing at night, what made you or your doctor think that a sleep test was a good idea?

And any chance your apnea is worse in REM?
Questions about SleepyHead?  
See my Guide to SleepyHead
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#16
RE: My 1st post of SleepyHead data
Just went back and looked at what you posted about the home sleep study. It's a shame that the study did not include anything to try to infer (or better yet measure) actual sleep stages. So we really don't know if your events are worse in REM. Or if they're worse when you are just falling asleep. Nor is there any way to tell whether the CAs and mixed apneas found on the study were sleep transitional ones (that would probably have NOT been counted with EEG data to stage the sleep) or real one (that would have been counted with EEG data to stage the sleep.)

Even more puzzling is the stuff that is said about sleep architecture: (see http://www.apneaboard.com/forums/Thread-Charts)

Quote:The patient recorded the study on 3/31/2016 at 11:00 PM and ended the recording at 5:59 AM for an overall recording time of 839.9 minutes. The total time in bed (TIB) was 396.6 minutes, the total estimated sleep time 420.0 minutes, with an estimated sleep efficiency of 61.1 %, and an estimated sleep latency of 0.0 mins. The patient slept in the supine position 161.8 minutes. There was 0.0 minutes of data that was deemed invalid or unreadable.

Those numbers are just plain funky.

839.9 minutes of recording time = 13.99 hours (call it 14 hours).

396.6 minutes of TIB = 6.61 hours.

11 pm to 5:59 AM = 420 minutes, which is listed as the "estimated sleep time". But "estimated sleep time" should be no longer than TIB in an overnight sleep study.

Based on the calculated indices, I think the transcriptionist transposed the TIB and estimated sleep time numbers: All the indices are based on using 396.6 = estimated sleep time in minutes (which equals 6.61 hours of estimated sleep time) rather than 420 minutes.

But if 396.6 was the estimated sleep time and 420 is the TIB, then sleep efficiency should be calculated as 94.4%

I haven't the foggiest idea of where they get that "sleep efficiency" number: It is usually calculated by dividing the estimated sleep time by the TIB. But that doesn't work in your case.
Questions about SleepyHead?  
See my Guide to SleepyHead
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#17
RE: My 1st post of SleepyHead data
(07-03-2017, 06:30 PM)robysue Wrote: June 27 data (http://imgur.com/a/DDuPI)

The data is broken into four sessions. The first one starts at 21:57 and the last one ends at 5:25.  That's about 7.5 hours "in bed", but only 5.333 hours of usage.  Lots of time between bedtime and wake up time where you either were not in bed or were in bed without the mask, and possibly sleeping without the mask.

The first two sessions are both short: The first one lasts about 30 minutes; the second lasts about 20 minutes. And then there's an almost 2 hour gap in the data.  My guess is that you tried to get to sleep, but couldn't. Took the mask off briefly and tried unsuccessfully to get to sleep a second time.  Then what happened? Did you take the mask off and sleep for two hours? Or get out of bed and do something for two hours?

Whichever it was, you had the good sense to try once more, and you put the mask back on about 0:50.  Again, it looks to me like you had a tough time falling asleep, but since it looks like sleep breathing has definitely kicked in by 1:05, an important question is whether that cluster of Hs scored just before 1:00 are sleep transitional junk, real events because you fell asleep right away, or a mixture of the two.  If you

Things stay quiet for a while, but they get very interesting by 2:20 and stay interesting all the way to the end of the session, which occurs about 2:40.  The size of the inhalations increases enough to be seen on this graph right around 2:20. That can indicate an arousal or wake. Or it can indicate REM sleep.  Too hard to see what's going on for me to speculate here.  But CAs start mixing in with the events by 2:30 and it looks like they make up a significant portion of the events scored between 2:30 and 2:40.  Because you turn the machine off and back on at 2:40, my best guess is that you had an arousal and the CAs are sleep transitional, but you never make it back to full sleep.

That last session starts at about 2:43. And there are lots of events during the last session.  Interestingly, it looks to me like you successfully got to sleep this time: The Flow Rate data settles down substantially right between 2:45-2:50.  But it doesn't stay settled down for long: A whole cluster of CAs and OAs starts up right around  2:52 or 2:53.  And that first cluster lets up just a bit for about 7 or 8 minutes right around 3:00 and then another cluster of CAs mixed with OAs starts.  This pattern of repeated clusters of OAs and CAs separated by just a few minutes at a time continues all the way until around 4:45.  What the heck is going on here?

It could be that your pressure is just plain too low and every time you have some OAs, you arouse just enough to have a (normal) sleep transition CA as you get back to sleep. Or it could be that you're running into some problems with pressure induced CAs. Or it could be you might have complex sleep apnea.  Or it could just be that you are lightly dozing and there are numerous (non apnea related) arousals with lots of "sleep-wake-junk" breathing in between the arousals.  Whatever it is, it's a mess.  

Questions raised by this night's data:

1) What was the original diagnosis? Just OSA?  A mixture of OSA and CSA?

2) Was there a titration study? If so, did it show any CAs?

3) How awake were you between 2:50 and 4:40?

1 - Correct just OSA.
2 - Once I found out the insurance costs, I didn't follow through with a titration
3 - I haven't the slightest idea.

I admit Im not using ther machine consistently
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#18
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RE: My 1st post of SleepyHead data
Hi. My  post in the other thread mentions changing to 9 min, and 12 max, but meant to increase both min and max by one, so really 9 cm min and 14 cm max.

This is quite similar to RobySue and ajack suggestions. I do feel you may end up with a bit higher minimum in the long run, but we do all feel your first focus is on just being able to get consistent sleep. 

Good luck, 

QAL
Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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#19
RE: My 1st post of SleepyHead data
Ok changing to 9 min, and 12 max. Wish me a good night's sleep tonight
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#20
RE: My 1st post of SleepyHead data
(07-03-2017, 07:56 PM)robysue Wrote:
(07-03-2017, 05:44 PM)trickyneedsleep Wrote:
(07-03-2017, 05:22 PM)robysue Wrote: 1) What was your diagnostic AHI? And how many of the events were listed as Central or Mixed Apneas instead of obstructive apneas?

2) Did you have a formal titration study? If so, what pressure setting was recommended after the study?

3) How uncomfortable are you when you are first trying to get to sleep with the mask on? What makes you uncomfortable? Be as specific as possible.

1 - AHI diagnostic was 38.4. I posted my sleep study in a previous post.
2 - I did not hav a titration study becasue once I heard how much it would cost, i just pursued my own machine.
So you were diagnosed with severe sleep apnea.  Can you tell me if the problem was mainly OAs, Hs, or CAs on that diagnostic study?  I will go back and look for that post, but you could save me a bit of time by catching me up.

Was the diagnosis a surprise to either you or your wife?

Quote:3 - Actually Im getting more and more comfortable each day. I admit I probably do not wear it all night most of the time.
      What makes me uncomfortable wearing it? I think I wake up because Im afraid it came off
Trying to wrap my head around this: You are uncomfortable because you think you wake up because you are afraid the mask came off, but you also admit you're not using the mask most all night most of the time.

Let's start with baby steps:

1) Do you put the mask on when you first go to bed every single night? If not, why do you choose to not put it on some nights?

2) Have you woken up only to find that you have taken the mask off in your sleep?  (It's actually a pretty common problem for newbies.)  If so, what do you do when you wake up and find that the mask is no longer on your nose?

3) Do you ever consciously take the mask off after a middle of the night wake and allow yourself to go back to sleep?  (This is also a common newbie problem.)

(07-03-2017, 05:49 PM)trickyneedsleep Wrote: Inital diagnostic is OSA.
With a diagnostic AHI of 38, you've got severe OSA.  Did that surprise you when you got the results?

Quote:I got the Dreamwear, it's very comfortable but I move alot. Probably need to tighten the straps. Mouth breath? Maybe.
Personally, I wouldn't worry a whole lot about tightening the mask straps (yet).  It is quite possible to over tighten straps and that can lead to both discomfort and additional leaking.

Any problems with waking up with a very dry mouth?

Quote:Yes, my usage is a big issue I know. Without the mask. my wife tells me I sleep like a baby, no grasping for air, a little snoring maybe and she says some nights I don't snore at all.
Unless your wife is awake all night long, she may very well be sound asleep when the worst of your events happen. Was your wife surprised at the results of your sleep test?

Also out of curiosity: What lead to the sleep test? If it wasn't your wife saying you snore loudly and sometimes quite breathing at night, what made you or your doctor think that a sleep test was a good idea?

And any chance your apnea is worse in REM?



Was the diagnosis a surprise to either you or your wife?   Yes!!!! A BIG surprise!

1) Do you put the mask on when you first go to bed every single night? If not, why do you choose to not put it on some nights? Most nights I do. I say 4 out of 5. Sometimes Ill be too tired to take a chance on NOT getting a good nights sleep so I just keep it off.

2) Have you woken up only to find that you have taken the mask off in your sleep?  (It's actually a pretty common problem for newbies.)  If so, what do you do when you wake up and find that the mask is no longer on your nose? Yes, I have woke up to find it off. Most of the time I put it back on and if I don't go to sleep soon I take it off.

3) Do you ever consciously take the mask off after a middle of the night wake and allow yourself to go back to sleep?  (This is also a common newbie problem.) YES!!!

Any problems with waking up with a very dry mouth? Never! I make sure the humidifier on my Dreamstation is on.

Was your wife surprised at the results of your sleep test? Yes!! She says I snore a little and never grasp for air (when she's awake of course).

What lead to the sleep test? High blood pressure
If it wasn't your wife saying you snore loudly and sometimes quite breathing at night, what made you or your doctor think that a sleep test was a good idea? High blood pressure
And any chance your apnea is worse in REM? I don't know but last night at a setting of 9cmH20 and 12cmH20 I slept VERY well. Only woke up cause nature was calling. AHI was 12.3.
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