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Need help with snoring and sleep
#1
Need help with snoring and sleep
Hi,

I had posted another thread on AHI improvement couple of months ago. While the AHI has lowered since then, I do see that snoring has increased quite a bit and I started feeling tired again for last few weeks. I feel like I am dealing with fragmented sleep despite low AHI. Need your help and advice.

Please see my latest charts and let me know if anythings else is needed.

http://imgur.com/a/seZuE

http://imgur.com/a/HPaDl
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#2
RE: Need help with snoring and sleep
Ravik,


The snores showing under VS2 are meaningless.  I suggest you turn off the VS2 flag under preferences in Sleeyhead.  The snores under VS are what you want to look at and they are pretty low.  Your numbers look good but you say you feel tired.  Is there any reason why you have your pressure fixed at 8.5?  I didn't look at your past posts but is there any reason you can't open up your pressure?  A little more pressure may help clean up the snores and flow limitations you have.
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#3
RE: Need help with snoring and sleep
Ok, I just read your previous posts and I see you went through quite the process and I see why you are at fixed pressure.  You may need more time to start feeling better as it takes some longer than others.  But don't worry about the VS2 flags.  I get tons of those every night and I know I don't snore when I'm on CPAP.
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#4
RE: Need help with snoring and sleep
If the stats in the left hand column are correct and aren't a result of mouth breathing giving false readings or something. Your tidal volume seems low, the resp rate is high and the 2.6 sec insp 0.8 exp time is unusual. It would be worth bring to your doctors attention, were you titrated on the machine? you may do better on a BPAP, if that data is right.
new http://www.apneaboard.com/wiki/index.php...re_success
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
From machine or charts for auto-cpap, set the min at 'med' median pressure, or 2cm below 90/95%. max at 20cm for now. Forum will help you fine tune settings
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#5
RE: Need help with snoring and sleep
Thank you for your feedback. I did not go for titration as I was put on APAP 5-12. That did not work well for me. CPAP pressure at 8 seems to work better but I am still not feeling fully rested. Something is still missing. As this is full face mask mouth breathing should not matter right?
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#6
RE: Need help with snoring and sleep
(06-20-2017, 04:02 PM)Fedman Wrote: The snores showing under VS2 are meaningless.  I suggest you turn off the VS2 flag under preferences in Sleeyhead.  The snores under VS are what you want to look at and they are pretty low.
I beg to differ with this opinion. Both the VS and VS2 snores are important in looking at PR data.

But I will admit that the statistical data in the left sidebar and the "Snore graph" in SleepyHead probably are pretty meaningless since SH uses the VS2 data in a way that Encore does not. Encore is the official PR software for looking at data on their machines, and we should assume that Encore's use of the VS2 data gives a more complete picture of the importance of that data.

Encore uses the VS2 data to compute the Encore Vibratory Snore Index (Encore VSI). The Encore VSI is computed by adding all of the individual VS2 numbers (which you see under the individual events) and then dividing by the usage time. I suspect, but cannot confirm, that each VS2 number is the number of individual breaths that have some kind of evidence of snoring; in that case the Encore VSI would be the average number of snores per hour.

Interestingly, the Encore software does not use the VS data to compute any of the statistical data about snoring. And the VS data shows up as tick marks only on the Encore Flow Rate data; they do NOT appear in the Encore table of events.

It remains a mystery what causes a PR machine to score a VS rather than a VS2. What is known is that pressure increases are done only for VS snores rather than VS2 snores.
Questions about SleepyHead?  
See my Guide to SleepyHead
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#7
RE: Need help with snoring and sleep
Ravik,

I understand that you sleep better on straight CPAP than APAP. That's as good of a reason as any to keep running with a fixed pressure or a very, very tight pressure range.

Unlike ajack and Fedman, I don't think you can just dismiss the VS2 data. Yes, sometimes PR machines mis-score a lot of things as VS2s. On another forum there's a long term poster who has strong evidence that when her pug is sleeping in the bed, her PR machine picks up the dog's snoring. Others have sleuthed that sometimes their PR machines will pick up the hose scraping against the side of the bed as snoring. But the fact remains that if you are snoring, then it's likely to be flagged as VS2s as well as VSs. My own hypothesis is that snoring has to have certain characteristics to be flagged as a VS rather than a VS2 and those characteristics are something the machine is using to decide the snoring really is a sign that the airway is in danger of collapsing, so a pressure increase is warranted. (It is worth noting that VS snores are NOT recorded in CPAP mode on the PR machines.)

So I think it's well worth testing the hypothesis that you could be snoring and that the snoring could be responsible for the fact that you feeling tired again. You could try bumping the pressure up by 0.5-1.0 cm to see if that does anything. Or you could try running in a really tight APAP mode for a week or two to see if the machine wants to give you more pressure. In other words, you could try min pressure = 8 and max pressure = 9 for a week just to see how often the machine increases the pressure for things other than clusters of OAs and Hs.

As for the leak numbers: In my opinion, they are not high enough to worry about in the sense of adversely affecting the quality of your data or the efficacy of your therapy: Except for obvious leak problem that you fixed at the beginning of the night on June 19, none of the leaks are flagged as official Large Leaks by your machine. The PR machines do not have a "fixed" value for determining a Large Leak, but at 8cm, they are usually quite capable of dealing with a Total Leak Rate of 60-70 L/min before flagging an official Large Leak. (Remember that Total Leak Rate includes the intended leak for your mask; also remember that Total Leak Rate is the TOP graph in SleepyHead.) Your 95% Total Leak Rate numbers are well below that.

That said: The leaks might still be disrupting your sleep even if they're not large enough to adversely affect the data or the efficacy of your therapy. And if they're disrupting your sleep, then that could be what's causing you to feel tired during the day: A night of pulling at the mask all night to readjust it to fix leaks is not particularly restful. And it is possible to do a lot of pulling at the mask while you're in very light sleep.

You ask:
Quote:As this is full face mask mouth breathing should not matter right?
In theory you're right: Mouth breathing in a full face mask should not increase the leak rate.

But full face masks are prone to "springing leaks" because the seal has a much larger footprint on the face. When your face relaxes in deep sleep that can cause the jaw to pull away from the mask in such a way as to trigger a leak. When the mask is pushed against your pillow when you turn over, that can disrupt the seal and cause a leak. And, unfortunately, when you fit the mask with a closed mouth at the beginning of the night and then later on your mouth opens wide, that can cause the mask to shift enough on your face to cause a leak. A mask liner might help if the leak problem is caused by any of these things. But you really only need to worry about the leaks if you think they might be disrupting your sleep.
Questions about SleepyHead?  
See my Guide to SleepyHead
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#8
RE: Need help with snoring and sleep
@ravic, If you had the FFM, there is a good chance that the statistic column is accurate. I would take your SD card and a print/photo of those numbers into your lung doctor/pulmonologist/respiratory specialist, or what they are called where you live. I really think you need a review of your treatment with an expert in the field. I wouldn't be happy with those stat numbers on insp/exp time, breathing in is nearly 3 times longer than breathing out, good is the other way around. I would also ask about the tidal volume and resp rate .


@ roby, Slight misunderstanding, I said nothing about V2, or made any suggestions about CPAP adjustment.
new http://www.apneaboard.com/wiki/index.php...re_success
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
From machine or charts for auto-cpap, set the min at 'med' median pressure, or 2cm below 90/95%. max at 20cm for now. Forum will help you fine tune settings
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#9
RE: Need help with snoring and sleep
Thanks for your response.
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#10
RE: Need help with snoring and sleep
(06-21-2017, 04:24 AM)ajack Wrote: @ravic, If you had the FFM, there is a good chance that the statistic column is accurate. I would take your SD card and a print/photo of those numbers into your lung doctor/pulmonologist/respiratory specialist, or what they are called where you live. I really think you need a review of your treatment with an expert in the field. I wouldn't be happy with those stat numbers on  insp/exp time, breathing in is nearly 3 times longer than breathing out, good is the other way around. I would also ask about the tidal volume and resp rate .


@ roby, Slight misunderstanding, I said nothing about V2, or made any suggestions about CPAP adjustment.

I have upcoming sleep doctor's appointment and I will bring this up. My current doctor is ENT/sleep Dr, I think I may have to see a lung doctor.
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