My 1st post of SleepyHead data

[trickyneedsleep]

Ok, here is my chart!

http://imgur.com/ugHql7M

[DavePaulson]

Post a couple of the daily graphs at your current settings as well. Read THIS on how to organize your chart.

Dave

Edited to fix the link.

[trickyneedsleep]

Here's some daily reports:

http://imgur.com/a/EgztM
http://imgur.com/a/eMW9B
http://imgur.com/a/ZbgkV
http://imgur.com/a/iRRf0
http://imgur.com/a/DDuPI
http://imgur.com/a/yKdPR

[robysue]

First comment: Why no daily data from June 29 and June 30?

Now for the stuff you're really wanting:

Overall comments
1) The overall AHIs are too high, but you knew this already.

2) There are a bunch of things that stand out, and not in a good way, in your data. Lots of CAs on some nights. Lots of OAs or Hs on other nights. What was your original diagnosis? Simple OSA? Or did you have clinically significant numbers of CAs on your diagnostic and/or titration studies? It makes a big difference in trying to evaluate your daily data.

3) Leaks appear to be a real problem on some nights. Leaks need to be investigated. What mask are you using? And do you think you mouth breath at night?

4) Usage is appears to be a huge issue. Best night has just over 7 hours of mask time, but there is a 50 minute gap in the middle of the night on that night. So you're obviously NOT sleeping much with the mask. So that begs the question: How much sleep are you getting without the mask each night?

5) Bedtimes are drifting. You started out with three nights where you went to bed between 9pm and 10pm. The other three nights show bedtimes of 11pm, 1am, and 11:30.

6) Mask off times are very erratic: It seems like you are taking the mask off and presumably returning to sleep without it on many of these nights.

So you're not off to a great start. Lots of folks have rough starts, and we can help you sort it all out.

I will post more impressions on each night's data separately.

[robysue]

June 25 data (http://imgur.com/a/ZbgkV)

My first guess is that you never really got to sleep during that third session (the one from 23:50 to 0:55). And that you finally gave up, threw the mask off, and went to sleep without it. If that's the case, then all those events scored during that session probably are not real, and there's no need to jump immediately to the You Need More Pressure bandwagon.

The flow rate on the first session has rather large spikes and it would not surprise me if you were awake fighting for sleep during this entire 30 minute session.

So that's my first question: How much of the first and third sessions represent "I was awake, but fighting to get to sleep" breathing?

The second session is the interesting one: It looks to me like your breathing might be settling down into sleep breathing around 22:50 and I think there probably is some real sleep breathing 22:30 and 23:30. The reason I think that is that there is a whole lot less "spiky-ness" to the graph in that period. The flow rate in high quality sleep breathing has very few spikes in it and the numbers for the peak inhalations and exhalations are not as large as those of wake breathing.

The leaks during this second session are good, but not great. And I mean "good enough to not worry about" if that's what most of your leaks look like.

But something went badly wrong after you put the mask back on at a bit before 23:50. My guess is that you just could not get back to sleep, possibly because of a leak that you just could not seem to fix. And in all that tossing and turning, you were partially holding your breath or simply doing a lot of wake breathing that got mis-scored as Hs. Which increased the pressure, which in turn increased your discomfort and also made the leak get worse. All of which made it even more difficult to get back to sleep.

Now there's also just a chance that cluster of CAs right at 0:00 are an indication that you finally fell asleep HARD. And then started having a ton of obstructive events as well as either mouth breathing or a mask leak caused by a combination of facial relaxation and increased pressure. In that case, your min pressure may be too low.

This day's data leads to these questions:

1) What was your diagnostic AHI? And how many of the events were listed as Central or Mixed Apneas instead of obstructive apneas?

2) Did you have a formal titration study? If so, what pressure setting was recommended after the study?

3) How uncomfortable are you when you are first trying to get to sleep with the mask on? What makes you uncomfortable? Be as specific as possible.

[trickyneedsleep]

June 25 data (http://imgur.com/a/ZbgkV)

My first guess is that you never really got to sleep during that third session (the one from 23:50 to 0:55).  And that you finally gave up, threw the mask off, and went to sleep without it.  If that's the case, then all those events scored during that session probably are not real, and there's no need to jump immediately to the You Need More Pressure bandwagon.

The flow rate on the first session has rather large spikes and it would not surprise me if you were awake fighting for sleep during this entire 30 minute session.

So that's my first question: How much of the first and third sessions represent "I was awake, but fighting to get to sleep" breathing?

The second session is the interesting one: It looks to me like your breathing might be settling down into sleep breathing around 22:50 and I think there probably is some real sleep breathing 22:30 and 23:30.  The reason I think that is that there is a whole lot less "spiky-ness" to the graph in that period.  The flow rate in high quality sleep breathing has very few spikes in it and the numbers for the peak inhalations and exhalations are not as large as those of wake breathing.

The leaks during this second session are good, but not great.  And I mean "good enough to not worry about" if that's what most of your leaks look like.

But something went badly wrong after you put the mask back on at a bit before 23:50.  My guess is that you just could not get back to sleep, possibly because of a leak that you just could not seem to fix.  And in all that tossing and turning, you were partially holding your breath or simply doing a lot of wake breathing that got mis-scored as Hs. Which increased the pressure, which in turn increased your discomfort and also made the leak get worse. All of which made it even more difficult to get back to sleep.

Now there's also just a chance that cluster of CAs right at 0:00 are an indication that you finally fell asleep HARD. And then started having a ton of obstructive events as well as either mouth breathing or a mask leak caused by a combination of facial relaxation and increased pressure.  In that case, your min pressure may be too low.

This day's data leads to these questions:

1) What was your diagnostic AHI? And how many of the events were listed as Central or Mixed Apneas instead of obstructive apneas?

2) Did you have a formal titration study? If so, what pressure setting was recommended after the study?

3) How uncomfortable are you when you are first trying to get to sleep with the mask on? What makes you uncomfortable? Be as specific as possible.

1 - AHI diagnostic was 38.4. I posted my sleep study in a previous post.
2 - I did not hav a titration study becasue once I heard how much it would cost, i just pursued my own machine.
3 - Actually Im getting more and more comfortable each day. I admit I probably do not wear it all night most of the time.
      What makes me uncomfortable wearing it? I think I wake up because Im afraid it came off

[trickyneedsleep]

First comment: Why no daily data from June 29 and June 30?

Now for the stuff you're really wanting:

Overall comments
1) The overall AHIs are too high, but you knew this already.  

2) There are a bunch of things that stand out, and not in a good way, in your data.  Lots of CAs on some nights. Lots of OAs or Hs on other nights.  What was your original diagnosis? Simple OSA? Or did you have clinically significant numbers of CAs on your diagnostic and/or titration studies? It makes a big difference in trying to evaluate your daily data.

3) Leaks appear to be a real problem on some nights.  Leaks need to be investigated. What mask are you using? And do you think you mouth breath at night?

4) Usage is appears to be a huge issue. Best night has just over 7 hours of mask time, but there is a 50 minute gap in the middle of the night on that night.  So you're obviously NOT sleeping much with the mask. So that begs the question: How much sleep are you getting without the mask each night?  

5) Bedtimes are drifting. You started out with three nights where you went to bed between 9pm and 10pm. The other three nights show bedtimes of 11pm, 1am, and 11:30.  

6) Mask off times are very erratic: It seems like you are taking the mask off and presumably returning to sleep without it on many of these nights.

So you're not off to a great start.  Lots of folks have rough starts, and we can help you sort it all out.

I will post more impressions on each night's data separately.

Inital diagnostic is OSA. I got the Dreamwear, it's very comfortable but I move alot. Probably need to tighten the straps. Mouth breath? Maybe. Yes, my usage is a big issue I know. Without the mask. my wife tells me I sleep like a baby, no grasping for air, a little snoring maybe and she says some nights I don't snore at all.

[robysue]

June 26 data (http://imgur.com/a/iRRf0)

There is a huge break in the data between 23:30 and 3:00. Care to tell us if you were sleeping without the mask? Or were you out of bed trying to regroup?

Leaks are so-so. Outside of a large peak on the leak graph centered at 23:00, the leaks for the first session look ok. The leaks on the second session are problematic because they continue to grow for the whole session.

Again, it's not clear how much sleep you actually got in either session. Hence it's hard to say how much to worry about the high AHI here.

In the first session, there is a cluster of Hs scored between 21:20 and 21:40. This cluster causes a significant pressure increase, but not an increase in the leak rate (which is good). If you fell asleep around 21:20, that would be evidence that you need a higher min pressure setting. If you were awake when that cluster got going, the pressure increase may have made you more miserable and kept you from getting to sleep. At this scale, it's tough to try to figure out if you are awake or asleep when that first cluster happens.

Notably it definitely looks like you were asleep between 21:40 and 22:10. Looking very closely at the what is visible in the flow rate through the forest of scored events that start at 22:20, it's clear something has happened. It could be you woke up and had trouble getting back to sleep. (Any memory of that?) The CAs mixed with the Hs would be consistent with a wake of some sort followed by trouble getting soundly back to sleep. Or this second cluster of events could be indicate that you hit a REM cycle and the pressure was not high enough to prevent your events. If that second cluster of events is REM-related, you likely need a higher max pressure.

The second session this night is an hour long, but again, it looks to me like you never got back to sleep. My guess is that the increasing excess leak may have figured into your discomfort. Unless you know for sure that you were asleep during this session, I think I'd ignore the data from it.

Questions/comments raised by this night's data:

1) If you were asleep 22:10 and 22:40, you clearly need to raise the pressure. My guess is that you need to increase both the min and max pressure settings. How much? That requires more information.

2) When you put the mask back on after a longish wake in the middle of the night, does it seem like you never get back to sleep? Do you spend an hour or so trying to get back to sleep and then just rip the mask off?

3) Are you aware of either growing leaks and/or increasing pressure when you are lying in bed with the mask on trying (perhaps unsuccessfully) to get to sleep?

[robysue]

June 27 data (http://imgur.com/a/DDuPI)

The data is broken into four sessions. The first one starts at 21:57 and the last one ends at 5:25. That's about 7.5 hours "in bed", but only 5.333 hours of usage. Lots of time between bedtime and wake up time where you either were not in bed or were in bed without the mask, and possibly sleeping without the mask.

The first two sessions are both short: The first one lasts about 30 minutes; the second lasts about 20 minutes. And then there's an almost 2 hour gap in the data. My guess is that you tried to get to sleep, but couldn't. Took the mask off briefly and tried unsuccessfully to get to sleep a second time. Then what happened? Did you take the mask off and sleep for two hours? Or get out of bed and do something for two hours?

Whichever it was, you had the good sense to try once more, and you put the mask back on about 0:50. Again, it looks to me like you had a tough time falling asleep, but since it looks like sleep breathing has definitely kicked in by 1:05, an important question is whether that cluster of Hs scored just before 1:00 are sleep transitional junk, real events because you fell asleep right away, or a mixture of the two. If you

Things stay quiet for a while, but they get very interesting by 2:20 and stay interesting all the way to the end of the session, which occurs about 2:40. The size of the inhalations increases enough to be seen on this graph right around 2:20. That can indicate an arousal or wake. Or it can indicate REM sleep. Too hard to see what's going on for me to speculate here. But CAs start mixing in with the events by 2:30 and it looks like they make up a significant portion of the events scored between 2:30 and 2:40. Because you turn the machine off and back on at 2:40, my best guess is that you had an arousal and the CAs are sleep transitional, but you never make it back to full sleep.

That last session starts at about 2:43. And there are lots of events during the last session. Interestingly, it looks to me like you successfully got to sleep this time: The Flow Rate data settles down substantially right between 2:45-2:50. But it doesn't stay settled down for long: A whole cluster of CAs and OAs starts up right around 2:52 or 2:53. And that first cluster lets up just a bit for about 7 or 8 minutes right around 3:00 and then another cluster of CAs mixed with OAs starts. This pattern of repeated clusters of OAs and CAs separated by just a few minutes at a time continues all the way until around 4:45. What the heck is going on here?

It could be that your pressure is just plain too low and every time you have some OAs, you arouse just enough to have a (normal) sleep transition CA as you get back to sleep. Or it could be that you're running into some problems with pressure induced CAs. Or it could be you might have complex sleep apnea. Or it could just be that you are lightly dozing and there are numerous (non apnea related) arousals with lots of "sleep-wake-junk" breathing in between the arousals. Whatever it is, it's a mess.

Questions raised by this night's data:

1) What was the original diagnosis? Just OSA? A mixture of OSA and CSA?

2) Was there a titration study? If so, did it show any CAs?

3) How awake were you between 2:50 and 4:40?

[ajack]

with a DS, with those numbers 90% 11.8
I'd set min 10 max 14 which should put you in the ballpark. when you get the full charts up it will help. you may need to reduce the flex for the CA