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Need help evaluating SleepyHead graphs - AHI, RDI, Leaks?
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green wings Offline

Advisory Members

Posts: 547
Joined: Feb 2016

Machine: Respironics System One RemStar Pro (460)
Mask Type: Nasal pillows
Mask Make & Model: AirFit P10
Humidifier: integrated humidifier
CPAP Pressure: 13.0 cm
CPAP Software: SleepyHead

Other Comments: using CPAP since Jan. 2016

Sex: Undisclosed
Location: US

Post: #1
Need help evaluating SleepyHead graphs - AHI, RDI, Leaks?
I have been using CPAP therapy for 2 months plus now. My average AHI is usually 3-5. When I look at my graphs, though, I see a lot of stuff going on in the 5-6 am period. Not sure how to evaluate it.

In my sleep study a few months ago, my untreated AHI was low 30s, RDI low 50s.

I'm wondering if I need APAP rather than CPAP, and I don't have a good handle on what the significance of RERAs are - if I'm having a lot of them and they're lasting 20-30 seconds, but CPAP doesn't do anything about them, what, if anything, should I do?

Image 1: Overview from last night - wondering if leak rate is high?
Image 2: 3 month overview
Image 3: Selected periods from 5-7 am today with flow rate & events shown.

I'm still new enough to using SleepyHead that I don't have a really good understanding of what graphs I should be looking at. The ones I chose may be entirely the wrong ones.

[Image: 2Xyp0Dw.png]
[Image: DCHHIiz.png]
[Image: AldfJZr.png]

Since starting CPAP therapy, my morning headaches are either gone or lots less severe than they used to be. I still feel tired in the mornings, but I have fibromyalgia and autoimmune arthritis, so I'm not sure what kind of improvement I can expect.

I did have a few days in early February where I would wake up with energy in the mornings but those have been rare.

I am still periodically having "freak-out" periods where I'm not using the machine for days in a row due to anxiety/claustrophobia issues, so those are the gaps you see after Feb 1. Before Feb 1, I was having issues with a reaction to the first mask I had and then nasal congestion (and anxiety/claustrophobia).

Thanks.
03-21-2016 10:13 AM
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PoolQ Offline

Advisory Members

Posts: 986
Joined: Jul 2015

Machine: AirCurve 10 VAUTO
Mask Type: Full face mask
Mask Make & Model: Amara View
Humidifier: Integrated
CPAP Pressure: 6.2, 15, PS4.0
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Sillicon Valley

Post: #2
RE: Need help evaluating SleepyHead graphs - AHI, RDI, Leaks?
There will be more input from people with more experience than I, but what I see tells me that your pressure is not high enough -too many events and very few CA's. Would APAP help, my guess is yes.

your anxiety/claustrophobia issues may be caused by a need to tweak the settings, If you ever feel like you are not getting enough air it can case anxiety/claustrophobia issues. If you have never adjusted any comfort settings then my guess is that you should look into it, there are very few "typical" "default" people in this world.
03-21-2016 10:42 AM
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OpalRose Offline

Monitors

Posts: 3,180
Joined: Nov 2014

Machine: PR System One REMstar Auto 560 with A Flex
Mask Type: Nasal pillows
Mask Make & Model: AirFit P10 For Her
Humidifier: REMStar heated humidifier with heated hose
CPAP Pressure: Auto Cpap 10-13 AFLEX 1
CPAP Software: SleepyHead EncoreBasic

Other Comments: Started CPAP Therapy October 23, 2014

Sex: Female
Location: Northeast Ohio, USA

Post: #3
RE: Need help evaluating SleepyHead graphs - AHI, RDI, Leaks?
Do you have the option of exchanging the Cpap for an APAP? Talk to your doctor about this. You would be more comfortable using an APAP since it looks like you need a higher pressure.

Does your machine have an Auto Trial option? That may be something to try with a range of pressure. It will reset your Cpap at an optimal pressure.

You obviously need a higher pressure to combat the Obstructives and hypopneas.

Leak rate is fine, you had one small time period with leak rate rising, you were probably adjusting mask or turning.

OpalRose
(This post was last modified: 03-21-2016 12:04 PM by OpalRose.)
03-21-2016 11:41 AM
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green wings Offline

Advisory Members

Posts: 547
Joined: Feb 2016

Machine: Respironics System One RemStar Pro (460)
Mask Type: Nasal pillows
Mask Make & Model: AirFit P10
Humidifier: integrated humidifier
CPAP Pressure: 13.0 cm
CPAP Software: SleepyHead

Other Comments: using CPAP since Jan. 2016

Sex: Undisclosed
Location: US

Post: #4
RE: Need help evaluating SleepyHead graphs - AHI, RDI, Leaks?
Thanks so much, PoolQ. Smile

I did have problems with feeling like I couldn't get enough air or that I couldn't exhale comfortably back when I first started using the therapy. I worked through those issues by adjusting settings with advice from people after I joined this board in late January.

The last two times I have had anxiety issues and didn't use CPAP (once for two nights, once for five nights), I've really been having no comfort issues at all (at least not conscious ones - I'm aware of a general resentment of being attached to a hose.)

The one issue that I still haven't solved is that it's easier for me to sleep on my back while using CPAP, but I am naturally a side sleeper. When I lie on my side (while awake) with the mask on, I tend to get little mask leaks which bother my eyes and then I become aware of the mask straps pressing into my face, etc, then it just all gets uncomfortable then I shift back to my back.

This is leading to my waking up with lower back pain and generally feeling like I've been sleeping in one position all night.

Thanks for the opinion about APAP. I guess I just need to get up the courage to ask my doctor about it. I saw him for my initial 90-day follow-up appointment about a month ago.

As far as I could tell, all he did was to print out the basic report from ReScan and point out that my AHI was about 5, compared to the 50+ RDI from my sleep study. That was all. He is a sleep medicine specialist with neurology and internal medicine subspecialties, so I'm sure he can take a closer look, if he will.

Are the graphs that I attached sufficient evidence to ask for APAP? How does one go about making that request if treated AHI is near 5?

Thanks so much again for your input.

(03-21-2016 10:42 AM)PoolQ Wrote:  There will be more input from people with more experience than I, but what I see tells me that your pressure is not high enough -too many events and very few CA's. Would APAP help, my guess is yes.

your anxiety/claustrophobia issues may be caused by a need to tweak the settings, If you ever feel like you are not getting enough air it can case anxiety/claustrophobia issues. If you have never adjusted any comfort settings then my guess is that you should look into it, there are very few "typical" "default" people in this world.
03-21-2016 12:09 PM
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green wings Offline

Advisory Members

Posts: 547
Joined: Feb 2016

Machine: Respironics System One RemStar Pro (460)
Mask Type: Nasal pillows
Mask Make & Model: AirFit P10
Humidifier: integrated humidifier
CPAP Pressure: 13.0 cm
CPAP Software: SleepyHead

Other Comments: using CPAP since Jan. 2016

Sex: Undisclosed
Location: US

Post: #5
RE: Need help evaluating SleepyHead graphs - AHI, RDI, Leaks?
Thank you, Opal Rose! I'll have to contact my sleep medicine doctor or nurse practitioner to find out about whether I can get an APAP machine.

I did not see the option for an Auto trial when I went into my machine settings to take a look around. (I started at 7.0 cm H2O initially.) At 9.0 cm H2O, I seem to be having slightly fewer obstructive events but more hypopneas, which I suppose makes sense.

Thanks for the comment about leak rate. I do think I'm getting some leaks with my nasal mask when I move away from sleeping on my back. The ones that happen when I'm awake feel very small.

I'm prone to delayed-onset insomnia, so even taking mirtazapine for sleep, it usually takes me 45-90 minutes to fall asleep, so I have plenty of time to notice this kind of thing. Thank goodness for my iPod, which I set to shut off after about 90 minutes, otherwise I'd probably get really bored listening to myself breathe for an hour or more.

If you have any suggestions about what to say to the doctor or what graphs/data to present in order to get the best shot at switching to an APAP or getting an auto-CPAP trial, I'd welcome them.

Thanks again!

(03-21-2016 11:41 AM)OpalRose Wrote:  Do you have the option of exchanging the Cpap for an APAP? Talk to your doctor about this. You would be more comfortable using an APAP since it looks like you need a higher pressure.

Does your machine have an Auto Trial option? That may be something to try with a range of pressure. It will reset your Cpap at an optimal pressure.

You obviously need a higher pressure to combat the Obstructives and hypopneas.

Leak rate is fine, you had one small time period with leak rate rising, you were probably adjusting mask or turning.
03-21-2016 12:19 PM
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