First Night's Data

[Melman]

[attachment=3172]
Although I've had my new ResMed AirSense for two weeks I just tried Sleepyhead for the first time two nights ago. A screenshot is attached.  The data looks pretty good to me but I don't know how to interpret most of it and would appreciate any comments/suggestions. I have two specific questions:

1) what is the significance of the wider range of flow rate for some periods (e.g. 4:15 to 5:30) vs. the lower ranges (e.g. 6:15 to 6:30)?

2) What is a clear airway event? I has one that lasted 18sec. (Clear airway sounds like a good thing. )

I may have more questions later but will study the forum and SleepyHead guides first. Just hoped for some initial impressions right now. I've been on CPAP therapy on and off for about 10 years but this is the first machine that provides data.

Thanks in advance for any help and advice.

[Beej]

The AHI - Apnea/Hypopnea Index was 1.07. This means that the number of events / the time, in hours, was slightly above 1. At 5.0 or higher is the level they will say is not controlled.

Your total time in apnea, the time you weren't breathing, was 1 minute and 8 seconds (left panel, under the pie chart), which is good.

A Clear Airway event means the machine marked you as not breathing, and without an obvious indicator of obstruction. In great numbers, these can indicate central apnea, where the brain doesn't keep you breathing when you get deeply asleep. A couple over the night are no big deal.

The pressure was a steady 10.0 and it seems to be working OK for you.

Most importantly, how do you feel. The machine feels fine!

[DeepBreathing]

Lookin' pretty good! The lower flow rate at the start of the night corresponds with higher flow limitations. Resmed defines this as "any event that limits the flow of air into your body, due to a blockage or collapse of your upper airway". So your airway isn't fully open, but the restriction isn't enough to be flagged as an apnea or hypopnea. A common cause is sleeping with your head forward so that your chin is tucked down to your chest - you can easily try this just by tilting your head well forward and taking a deep breath, then raise your chin and take another breath. The difference is quite discernible. Have a look at your pillow - it should support your neck so that your head isn't tilted forward.

[OpalRose]

Melman, you may want to consider switching your machine to Auto Mode.  If it were me, I would set my range at 10 minimum and 13 maximum.  Watch where your 90% pressure falls, then we can help adjust if needed.  Ideally, a range should fall 2cm below the 90% reading and 2cm above.

That would help when you need a little more pressure to keep the airway open, and prevent the high Rera's, and keep you at a lower pressure when no apneas occur. Notice that the Rera's correlate with the flow limitations.

The Respiratory disturbance index (RDI) reading on SleepyHead includes Rera's.

A RERA is characterized by increasing respiratory effort for 10 seconds or more leading to an arousal from sleep.  You may or may not notice these arousals.

[Sleeprider]

I agree with Rose. You have an interesting pattern of increasing flow limitations which abruptly end at a RERA or hypopnea. I think these are arousals from the increasing flow limitation and impending apnea that would likely occur in the absence of the arousal. Allowing the machine to automatically increase pressure to counter these flow limits and breathing disturbances might improve the quality and continuity of your sleep. The CPAP pressure of 10 with EPR at 2 seems to be working pretty good for you otherwise. Other things that stand out that may not be significant is your leak rate looks pretty good, but maintains a steady low level like there may be facial hair. This does not affect therapy. Also you have a pretty high respiration rate and relatively low tidal volume for a male. Again, this is apparently normal for you, but it might be interesting for you to look at the respiration rate and minute vent graph vs flow limitation and see if these move inversely together. If so, that would be additional argument for the auto mode pressure increases.

Good luck.

[Melman]

Here is another night's data data. The reason for the two day gap is that on Feb, 8th, there was only summary data on my card and on Feb 9th I was trying a new mask and had a lot of leaks, so the data may not be worth much.  Here's my data from last night and my reaction is what the ...........happened?!   I have also reposted my data from Feb 7 for comparison.

The data from last night would have been great , if it weren't for the period from 4:30-5:16, during which 26 of my 27 events occurred. The only exception is the clear airway at 6:21.
Here's what was different:
1) I began sleeping on my side and believe I slept on my side for much of last night (more about that below). On Feb 7 I began on my back and believe I spent more of the time on my back, although I know I changed to side positions a couple of times.
2) Last night a was using an Amara View mask. On Feb 8th I was using a Quatro FX.  The Amara had a slightly higher leak rate but the highest leak rate was not during the 45 minute period of the 26 events. It's hard to believe the mask was a contributing factor.

The other thing that jumps out at me is the change in my respiratory rate graph following the 45 min period in which the 26 events occurred. It is pretty steady in the 14 to 16 range until about 4:30, has more frequents spikes to about 30 during the period of the events, and then continues in a range of 20 to 50 for the remainder of the night. Can anyone explain the significance of that?

Interestingly, my wife tells me that she got up briefly at 4:30 for about 5-10 minutes. (Do I blame her? ) I don't recall her getting up and she says I appeared to be asleep. She also says I was on my back so apparently I was on my back preceding and during the event period. It's hard to attribute it to the back position though, because I spent more time on my back on Feb 7 and didn't experience a similar cluster of events.

I'm puzzled and would appreciate input from more experienced/knowledgeable forum members.

OpalRose and Sleeprider; I haven't ignored your comments and suggestions. They are much appreciated and I will follow up on them in a subsequent post.

[OpalRose]

I'm puzzled and would appreciate input from more experienced/knowledgeable forum members.

OpalRose and Sleeprider; I haven't ignored your comments and suggestions. They are much appreciated and I will follow up on them in a subsequent post.

Good to know we aren't being ignored.     

Again, the high Rera's and Flow Limitation will improve with the proper settings.

[Melman]

Good to know we aren't being ignored.     

Again, the high Rera's and Flow Limitation will improve with the proper settings.

Hi, OpalRose,

Initially I was thinking I would wait to change the pressure settings until I spoke with my clinician but then decided the heck with that. I am going to wait a little, however, because my experience with troubleshooting most things is that changing too many variables at once often confuse the issue. So my plan is to get about a week's data sleeping more on my side with the new mask, and then try the change in pressure settings. I think there is some method to my madness and hope it makes some sense.

[Beej]

Makes sense to me. I slept on my back last night with an AHI of 5.78. The AHI on the previous night side sleeping was 1.24. It really makes a difference on the obstructive apneas and hypopneas for some of us.

[OpalRose]

Good to know we aren't being ignored.     

Again, the high Rera's and Flow Limitation will improve with the proper settings.

Hi, OpalRose,

Initially I was thinking I would wait to change the pressure settings until I spoke with my clinician but then decided the heck with that. I am going to wait a little, however, because my experience with troubleshooting most things is that changing too many variables at once often confuse the issue. So my plan is to get about a week's data sleeping more on my side with the new mask, and then try the change in pressure settings. I think there is some method to my madness and hope it makes some sense.

Yes, of course it makes sense to try one thing at a time.  And side sleeping does make a difference in some folk.  I recommend it quite alot here, even though I know it isn't always possible.  I do better on my side, but can't stay there all night due to hip pain.....so I roll onto my back for relief, knowing that my Apap is set with the range that works for me, and if needed while on my back, it will raise the pressure to keep my airway from collapsing.  And my AHI, while on my back doesn't end up any higher.  
 
That's the beauty of Apap, wheras cpap cannot rise above your setting to stop your airway from collapsing while you are on your back.