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Sleepyhead: first foray
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AfibApnea Offline

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Posts: 16
Joined: Dec 2013

Machine: REMstar Auto A-Flex
Mask Type: Nasal mask
Mask Make & Model: Mirage FX
Humidifier: System One Heated Humidifier
CPAP Pressure: Unsure
CPAP Software: Not using software

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Sex: Male
Location:

Post: #1
Sleepyhead: first foray
Thanks very much for Sleepyhead!

I have been using CPAP since early September when I was diagnosed with Atrial Fibrillation/sleep apnea. I took to CPAP immediately, and initial results were impressive (I felt more rested, invigorated, etc.). I am otherwise healthy (low blood pressure, not overweight, moderate exerciser) and my apnea is minimal (AHI = 5).

In the beginning of December I stopped taking heart medication (Afib) at my cardiologist’s recommendation. I’d discovered (by forgetting to take my pills for a few days!) that without the pills I no longer gasped for breath (climbing staircases; doing exercise) and that my mood was much better.

So far so good.

For the last three weeks (since early December) my CPAP experience has deteriorated. I no longer am able to use the CPAP unit for sustained periods longer than 1-2 hours. My nostrils clog and I find myself throwing off the (nasal or pillows) mask and gasping for air (one night I described to my wife how I felt as “having forgotten how to breath”). I have tried: hydration (set unit up and down the range—I don’t particularly like the hydrated/heated approach); (based on Internet searches) lowering the unit relative to my head; covering the mask hose so as to help w. hydration; using nasal gels; etc.

…and now looking at the data through Sleepyhead. I have perused the Users Guide; FAQ; and the Sleep Disorder Term Glossary.

Observing the Sleepyhead/Overview\, immediately I notice an order --> disorder difference between the data accumulated from September to November and the data collected in December. [Examples: AHI: 3, 1,5… --> 13, 22, 35; Usage: 6,8 --> 3, 2, 3; Flow limit: 1, .2, .3 --> No Data, .1, etc.; Session Times: tight --> scattered; % PB: .3, .5 -->19, 22, 15; ] etc. etc.

I don’t want to bother anyone with particular questions about the data until I can learn to read/understand that data better myself.

Is there any documentation (or does someone have a recommendation) outlining how—given the problem I’ve outlined above—I should methodically approach the data and intelligently phrase my questions about that data.

Thanks
01-02-2014 07:40 AM
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drgrimes Offline

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Posts: 235
Joined: Sep 2013

Machine: S9 Resmed Autoset
Mask Type: Nasal pillows
Mask Make & Model: Philips Dreamwear
Humidifier: resmed
CPAP Pressure: 5-15
CPAP Software: ResScan

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Sex: Male
Location: Texas

Post: #2
RE: Sleepyhead: first foray
Afib I tend to have a stuffy nose also. Nasal masks and pillows are superior in regard to controlling leaks, but if you can't breathe free through your nose, they don't work. A couple of things that have helped me greatly.

I tried the nasal mask and could not continue with it. My observation is that the nasal mask applies pressure inside and outside the nose, thus pushing air through the nostrils, IF they are open. The nasal pillows, seal at the nostril and inflates your passages. I have noticed that with prolonged use of the pillows, I breathe easier all the time. So try pillows and see if you notice a difference like I did.

Also sometimes I have really stuffed up nose. Two things have really helped. I never thought I would do this but I now regularly do the saline nasal flush before bedtime. Not fun but really works. The second thing I do when really stuffy, is use an RX steroidal nose spray. Do not use Afrin. It will eventually make you worse. Ask your MD for an RX for a good nasal decongestant spray.

AND YES, learn how to interpret the data in the software. It will be much easier for you identify problems.

I hope my suggestions help. Good luck!!!

PS. i'm not sure how Sleepyhead would recognize when your nose is clogged. I don't know if that would show as an apnea event or what. I am sure some of the more experienced members will give you advice in that area.
(This post was last modified: 01-02-2014 11:13 AM by drgrimes.)
01-02-2014 11:08 AM
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AfibApnea Offline

Members

Posts: 16
Joined: Dec 2013

Machine: REMstar Auto A-Flex
Mask Type: Nasal mask
Mask Make & Model: Mirage FX
Humidifier: System One Heated Humidifier
CPAP Pressure: Unsure
CPAP Software: Not using software

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Sex: Male
Location:

Post: #3
RE: Sleepyhead: first foray
Truth be told, though the stuffy nose syndrome is annoying (since my nasal passages are clear until the CPAP unit does its thing) I think it’s something else I’m trying to get out of the data. After giving up on last night’s sleepless night (after posting this at 4AM) the only way I could get some semblance of rest was to a) lie down; b) hyperventilate for 30 seconds; and then c) breath normally (without the CPAP) for a few minutes, just to have to go through the procedure again.

Regardless, there must be ways the pros inspect the data… A “data diagnostic” flowchart of sorts would be a great addition to the documentation surrounding Sleepyhead.
01-02-2014 02:19 PM
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zonk Offline

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Posts: 7,908
Joined: Feb 2012

Machine: A10 AutoSet
Mask Type: Nasal mask
Mask Make & Model: Activa LT
Humidifier: Integrated /ClimateLineAir
CPAP Pressure: 9/13
CPAP Software: ResScan

Other Comments: CPAP since Nov 2010

Sex: Male
Location: Australia

Post: #4
RE: Sleepyhead: first foray
As you,re using nasal mask, whenever the nose clogged-up, its an automatic reaction to breath through your mouth. Many people find full face mask works better for them, full face mask allows you to breathe through your nose or mouth without any compromise
First and foremost, see ENT doctor to see if there is an underlying condition. Saline sinus rinse does help (as drgrimes mentioned), I use the bottle and also if happen to getup during the night with stuffy nose

Humidity play a big part, figure out what setting works better for you. Everyone is different, some find their nose stuffed up on lower setting and for others the opposite is true. Important to wash everything thoroughly and change the filer more often

I recommend "Nasal Breathing Video Series" by Barry Krakow MD (see Commercial Posts for the link)

Un-stuffing Your Stuffy Nose by Steven Y. Park, M.D
http://www.apneaboard.com/forums/Thread-Un-stuffing-Your-Stuffy-Nose
01-02-2014 03:51 PM
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AfibApnea Offline

Members

Posts: 16
Joined: Dec 2013

Machine: REMstar Auto A-Flex
Mask Type: Nasal mask
Mask Make & Model: Mirage FX
Humidifier: System One Heated Humidifier
CPAP Pressure: Unsure
CPAP Software: Not using software

Other Comments:

Sex: Male
Location:

Post: #5
RE: Sleepyhead: first foray
A full facial mask is not a good idea in situations where the power can unexpectedly go out (as it does around here during rainy season). I don't have a problem with occasionally breathing through my mouth anyway. For a person with minimal sleep apnea who's had such good experiences with CPAP a full mask seems a bit drastic. (Also I have little problem with using a NettiPot... And I'm getting back into the didge--though it's not my instrument of choice.)

And this having to breath rapidly (kinda like hyperventilating) for a few go-arounds before I can stabilize my breath enough to breath normally is happening regardless of nasal cavity stuffiness--and that new behavior is disturbing.

One thing I've wondered from the beginning that no doctor has been able to answer is whether or not using a CPAP machine causes one to get lazy about breathing (and thereby build up a dependence on the machine).

Still I'd like to find better ways of translating all that wonderful data Sleepyhead is exposing.
01-02-2014 07:01 PM
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drgrimes Offline

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Posts: 235
Joined: Sep 2013

Machine: S9 Resmed Autoset
Mask Type: Nasal pillows
Mask Make & Model: Philips Dreamwear
Humidifier: resmed
CPAP Pressure: 5-15
CPAP Software: ResScan

Other Comments:

Sex: Male
Location: Texas

Post: #6
RE: Sleepyhead: first foray
Afib, I find myself actually breathing better now even during the daytime. Even on nights when I get p!ssed off and take the mask off,I still breathe better the rest of the night. My wife listens and reports to me when start making death rattles and such. AND now I hardly snore, choke or sputter.

So, I think cpap has helped expand my narrowed breathing passages. As far as your hyperventilating to get going on the machine, sometimes I get out of breath just getting hooked up and going. I find myself out of breath, so I lift the nasal pillows off, and breathe pretty hard just to catch my breath. Then I try to relax, put it back on and get into the rhythm of breathing on the machine.

Back to the analysis of data. Don't over-analyze it in the beginning. Some of it I still don't understand. Start with understanding the basic things first. I mainly look at my AHI, leakage and air flow/pressure. The AHI is a composite score of all of your types of apneas. Don't get alarmed when you see them. They are often related to leaks, and maybe in your case, nose stopped up.

Everyone says if your AHI is less than 5 you are doing well. You want your 95% leak level to be less than 24. If your machine is an auto adjusting type, you will have a range, mine is 5-15. That allows my machine to make adjustments within that range to compensate for my breathing. I notice that when I am doing well, my air pressure softly undulates (sounds sexy) in the lower ranges. When I have a crappy night, I can see it going higher to help me breathe again.

Your data will be unique to you and whatever problems you may have but when you look at it over a period of time it starts to create trend that you will understand.

PS, I use Rescan but have Sleepyhead installed and I play with it from time to time. Sleepyhead give you more graphs than Rescan, which might be good. I find a lot of data in there that I do not use or understand. Early on I started fretting over minute ventilation, tidal volume and respiratory rate. Someone explained them to me, but I still can't tell you if mine look normal or not.
(This post was last modified: 01-02-2014 07:29 PM by drgrimes.)
01-02-2014 07:23 PM
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DeepBreathing Offline
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Posts: 2,294
Joined: Sep 2013

Machine: Resmed S9 VPAP Adapt
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: Resmed H5i
CPAP Pressure: EPAP: 9 - 15 PS: 3 - 10
CPAP Software: ResScan SleepyHead

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Sex: Male
Location: Perth, Western Australia

Post: #7
RE: Sleepyhead: first foray
Hi AfibApnea, welcome to the forum

Sleepyhead doesn't do a lot of interpretation - it basically decodes and displays the data captured by your machine. The key things that I look for are:
  • Leaks
  • AHI (just the number, not the graph)
  • Events
  • Flow
  • Mask pressure
  • Pressure
  • Flow limitation

Some people will add or subtract from this list, but these are the ones I find useful. First, look at the leaks. On a Resmed machine, these should be below 24. Philips does it somewhat differently, so I don't know what the limiting number is for any given mask - I'm sure somebody will chime in. If your leaks are out of control, all the other data is suspect, so taking care of leaks is the first priority.

The AHI score gives you a potted summary of apneas and hypopneas over the night. AHI = (total apnea + total hypopnea) / hours. The target is five or below.

"Events" will show you the individual apneas and hypopneas. It should also distinguish between central and obstructive apneas. A lot of people get hypopneas and central apneas during the transition in /out of sleep. These can be pretty much ignored. Events once you are properly asleep need to be treated. Central apneas are just as important as obstructive - they are a cessation of breathing. (There is a tendency for people to write off centrals as unimportant - this is not the case).

The flow graph shows your breathing pattern on a breath by breath basis. Zoom in and you can readily see times with nice smooth regular breathing and times of irregular breathing. Apneas will show up as flatlines, and hypopneas as periods of reduced flow.

Pressure and mask pressure show how the machine is responding to events in your breathing. Depending on your settings, pressure should start to increase when an event occurs, and drop down again once stable breathing is resumed. Different machines have different algorithms for handling this process.

Flow limitations occur when the shape of your airway changes - ie when it's starting to collapse but isn't yet obstructed. This will normally trigger an increase in pressure to maintain the patency of the airway.

Having got all this data, the trick is to look at how the traces interact with each other. You can often see ragged breathing and flow limitation as a precursor to an obstructive apnea. You can also see that centrals usually occur with no precursor - they just happen. But see if these events are occuring with major leaks - in that case you can't really trust the data.

More important than the nightly detailed readings are the trends. In your case you have a pretty negative trend going on, so it's necessary to identify the underlying problem. Perhaps you could do a screen dump of some of your graphs and we'll be able to advise you further.

DeepBreathing
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01-02-2014 08:17 PM
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AfibApnea Offline

Members

Posts: 16
Joined: Dec 2013

Machine: REMstar Auto A-Flex
Mask Type: Nasal mask
Mask Make & Model: Mirage FX
Humidifier: System One Heated Humidifier
CPAP Pressure: Unsure
CPAP Software: Not using software

Other Comments:

Sex: Male
Location:

Post: #8
RE: Sleepyhead: first foray
Thank you. This is a good start. When I see data, I want to understand and do something with it, and this is a great way to begin understanding (as you might have guessed I do have a tendency to over-analyze).

The hyperventilation thing is a bit more troublesome. It’s not “to get going on the machine”. It’s become a sleep-directed behavior on its own that I sometimes need to employ whether I am on the machine or not. I’m thinking it is not directly related to the CPAP [unless, of course, CPAP encourages lazy breathing habits]. I just talked to an older (CPAP) person who (going in to see about a breathing problem) had a liter of water removed from her lungs. I’m wondering if it is due to something of this sort (water in lungs; collapsed lung; etc.).

(My apologies: One thing I’m not is a hypochondriac. Talking like one is out of character and embarrassing.)
01-02-2014 08:27 PM
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Cicero Offline

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Posts: 33
Joined: Dec 2013

Machine: ResMed Elite
Mask Type: Nasal pillows
Mask Make & Model: Nasal pillow, make unsure.
Humidifier: ResMed Elite
CPAP Pressure: 5 to 15
CPAP Software: Other Software

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Sex: Male
Location: Christchurch New Zealand

Post: #9
RE: Sleepyhead: first foray
(01-02-2014 07:23 PM)drgrimes Wrote:  Afib, I find myself actually breathing better now even during the daytime. Even on nights when I get p!ssed off and take the mask off,I still breathe better the rest of the night. My wife listens and reports to me when start making death rattles and such. AND now I hardly snore, choke or sputter.

So, I think cpap has helped expand my narrowed breathing passages. As far as your hyperventilating to get going on the machine, sometimes I get out of breath just getting hooked up and going. I find myself out of breath, so I lift the nasal pillows off, and breathe pretty hard just to catch my breath. Then I try to relax, put it back on and get into the rhythm of breathing on the machine.

Back to the analysis of data. Don't over-analyze it in the beginning. Some of it I still don't understand. Start with understanding the basic things first. I mainly look at my AHI, leakage and air flow/pressure. The AHI is a composite score of all of your types of apneas. Don't get alarmed when you see them. They are often related to leaks, and maybe in your case, nose stopped up.

Everyone says if your AHI is less than 5 you are doing well. You want your 95% leak level to be less than 24. If your machine is an auto adjusting type, you will have a range, mine is 5-15. That allows my machine to make adjustments within that range to compensate for my breathing. I notice that when I am doing well, my air pressure softly undulates (sounds sexy) in the lower ranges. When I have a crappy night, I can see it going higher to help me breathe again.

Your data will be unique to you and whatever problems you may have but when you look at it over a period of time it starts to create trend that you will understand.

PS, I use Rescan but have Sleepyhead installed and I play with it from time to time. Sleepyhead give you more graphs than Rescan, which might be good. I find a lot of data in there that I do not use or understand. Early on I started fretting over minute ventilation, tidal volume and respiratory rate. Someone explained them to me, but I still can't tell you if mine look normal or not.
Your problems are likely to do with your mask, sexy it might be, but I would lose the goggles.Laugh-a-lot

At the evening service tonight, the sermon topic will be 'What Is Hell?' Come early and listen to our choir practice.
01-02-2014 09:14 PM
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Redonthehead Offline

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Posts: 7
Joined: Dec 2013

Machine: PR System One 560 APAP
Mask Type: Full face mask
Mask Make & Model: Quattro FX
Humidifier: Unheated PR
CPAP Pressure: 10-15
CPAP Software: SleepyHead

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Sex: Male
Location: USA

Post: #10
RE: Sleepyhead: first foray
(01-02-2014 07:01 PM)AfibApnea Wrote:  A full facial mask is not a good idea in situations where the power can unexpectedly go out (as it does around here during rainy season).

Are you under the impression you would suffocate if the power went out with a full face mask? On the contrary, my mask (Quattro FX), and I would assume all other face masks, are designed with a "safety value" to allow free breathing if the machine looses power.



Quote:
ADMIN NOTE:
This thread is now closed. If you have a question regarding the SleepyHead software package, please go HERE.

To download the SleepyHead software, go here:
http://www.SleepFiles.com/SH/
01-02-2014 09:57 PM
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