Please help me interpret my Sleepyhead Data

[Happiest]

I certainly feel worse with my APAP than without, and can barely think.
Would you kindly help me with these data?

AHIApnea Hypopnea Index 6.82
Philips Respironics System One (60 Series) RemStar Auto with A-FlexModel 560P - P073933223C43
PAP Mode: APAP (Variable) Min 4 Max 20 (cmH2O)
Date Sleep Wake Hours 7/1/2015 22:48:43 07:01:33 08:12:50
Cheyne Stokes Respiration 0.32%
Large Leak 0.00%
Clear Airway 2.31
Obstructive 1.22
Hypopnea 3.29
Flow Limitation 1.58
RERA 0.24
Vibratory Snore 0.00
Vibratory Snore (VS2) 0.24
Pressure Pulse 8.52

Statistics
Channel Min Med 95% Max
PressureTherapy Pressure (cmH2O)
W-Avg: 7.37 4.00 7.00 9.80 10.80
Minute Vent.Amount of air displaced per minute (L/min)
W-Avg: 4.15 0.12 3.50 8.00 73.50
Resp. RateRate of breaths per minute (Breaths/min)
W-Avg: 13.47 1.64 13.80 16.20 21.00
Leak RateRate of detected mask leakage (L/min)
W-Avg: 5.16 0.00 0.00 91.00 91.00
Total Leaks Detected mask leakage including natural Mask leakages (L/min)
W-Avg: 27.24 16.00 22.00 121.00 121.00
SnoreGraph displaying snore volume (?)
W-Avg: 0.01 0.00 0.00 0.00 1.00
Insp. TimeTime taken to breathe in (Seconds)
W-Avg: 2.97 0.50 2.80 4.50 29.80
Exp. TimeTime taken to breathe out (Seconds)
W-Avg: 1.66 0.30 1.44 3.00 5.24
Tidal VolumeAmount of air displaced per breath (ml)
W-Avg: 308.95 13.33 260.00 600.00 5986.67
Time over leak redline 5.884%

Machine Settings
PAP ModePAP Device Mode APAP (Variable)
Pressure MinMinimum Therapy Pressure 4 cmH2O
Pressure MaxMaximum Therapy Pressure 20 cmH2O
Flex LevelPRS1 pressure relief setting. x3
Flex ModePRS1 pressure relief mode. A-Flex
Headed Tubing Heated Tubing Connected No
Humid. Lvl.PRS1 Humidification level x2
Humidifier StatusPRS1 humidifier connected? Connected
Ramp PressureStarting Ramp Pressure 4 cmH2O
Ramp TimeRamp Delay Period 5 Minutes

And do you have any recommendations for me?
Big thanks in advance!

[quiescence at last]

your reading look fine, settings are not bad, your therapy is adequate. Even though Sir SleepyHead might alert you to the crappiness of your results, this should be for the most part ignored. although you did not get a score of AHI under 5, you are getting good therapy.

you should look (and are looking) at other parts of your health and sleep conditions. Fibro and medications for relief may be influencing the perceived quality of sleep based on potential negative feelings upon wakening. Ambien use especially can indirectly cause or reinforce emotional memory about the pain or dissatisfaction during sleep onset. While it may help reduce the pain, and enable sleep, it is also likely you'll remember the difficulty more (and this stimulates the negativity).

QAL

[Happiest]

Thanks, QAL.
I'm concerned because I feel so much better with just my Mandibular Advancement Device than with MAD+CPAP. I was wondering if my CPAP might be inducing CA or something else that's making me feel worse.

[AlanE]

Pressure induced CA is a possibility. Were you prescribed a min pressure of 4?

[Happiest]

Pressure induced CA is a possibility. Were you prescribed a min pressure of 4?

Hi AlanE.
Yes, my minimum pressure was prescribed at 4. I really feel awful when I use my MAD+CPAP.
My husband says that when I don't use Ambien and just use my MAD, he hears no gasping from me... just occasional soft snoring. (When I had my sleep study, they gave me TEN mg of Ambien... no wonder I had an AHI of 72!)
Is there anything on my Sleepyhead results that might suggest CA? Thanks for any advice you can give.

[trish6hundred]

Hi Happiest,
WELCOME! to the forum.!
You said your min pressure is at 4, what is your max pressure?
The reason I ask about your min pressure is that a pressure of 4 might be a bit low, it makes some people feel like they can't get enough air and sometimes people have to raise their min pressure up a bit.
I don't know anything about using MADs with CPAP so I can't help you with that, but hang in there for more suggestions and answers to your questions.
Much success to you with your CPAP therapy.

[Happiest]

Thanks, Trish, for your input.
My max pressure is set at 20.
If I'm reading SleepyHead correctly:
My Minimum was 4.0
Med: 7.00
95%: 9.80
Max: 10.80
W-Avg: 7.37

[vsheline]

Is there anything on my Sleepyhead results that might suggest CA?

Hi Happiest,

In the SH results the two numbers which are related to CA are:

Cheyne Stokes Respiration (CSR) 0.32%
Clear Airway (CA) 2.31

Keep an eye on these numbers to see if the Last Week average is lower than the Last Month average. (Don't pay much too attention to the daily averages.)

CSR of 0.32% and CA of 2.31 are fairly small numbers, and for most patients these numbers tend to get smaller during the first few weeks or months of CPAP therapy as our bodies become used to the therapy.

Since you are feeling miserable with CPAP therapy, I suggest raising the Min Pressure to 5 or 6 to see if it would make CPAP therapy more comfortable and help you feel better.

The Min Pressure is partly a comfort setting which for most patients should not be set as low as 4 for longer than the first few days or weeks of therapy, until the chest muscles gain strength from the exercise of breathing against pressure. After this short adaptation time for the muscles to get stronger most patients find it is easier to inhale if the Min Pressure is 6 or 7 or higher.

Also, A-Flex, which makes it easier to breathe out, will not work fully unless the pressure during inhalation is 6 or higher.

A-Flex settings of 1 or 2 or 3 all add 2 cmH2O of pressure relief during exhalation. Additionally, a setting of 3 gives the highest amount of Flow based pressure relief, which during the start of exhalation adds even more pressure relief based on the rate which the air is being exhaled. But also, the higher the setting for A-Flex, the sooner the pressure starts dropping before the end of inhalation, based on the reduction in the rate of airflow being inhaled toward the end of inhalation. So the A-Flex setting affects the shape of the pressure curve both during exhalation and during inhalation.

[AlanE]

How long have you been on PAP therapy?
Your humidity setting may be a little on the low side. Do you wake with dry mouth or nose?

[OpalRose]

Thanks, Trish, for your input.
My max pressure is set at 20.
If I'm reading SleepyHead correctly:
My Minimum was 4.0
Med: 7.00
95%: 9.80
Max: 10.80
W-Avg: 7.37

Happiest,
Looking at these numbers, you may want to bump up your minimum starting pressure to 5 for now. If the numbers stay close to above, then within a week or two move it to 6. This will help you to breath easier. The max number should be
brought down to 14.

The other thing I see is you are using ramp. I don't think that is benefiting you, since your start pressure is low. You may do better if you turn it off.

The CSR in sleepyhead is actually mislabeled and should read Periodic Breathing.
You will need to watch the Clear Airway numbers. They should go down in time.

Get the Clinical manual for your machine. (See top of page)

Just want to add that the Flex setting of 3 could be turned back to 2. Then in time, you can try a setting of 1. My Clear Airway events pretty much took a nose dive when I changed mine to 1.