Review first night values so I can learn to interpret my own data

[willo]

Last night was my first night using CPAP. My device is a Philips DreamStation AutoCPAP. I opted not to install the humidifier unit yet as I dislike breathing warm, moist air and wanted to try the unit as is first. (I am very concerned about traveling with this bulky, heavy equipment, and want very much to get therapeutic treatment with the bare minimum “stuff.”)

My mask is Nuance Pro Gel Pillows Mask, w/ HGR, DOM. The technician judged the size Small insert as the best fit, but took away the other parts.

I’m aware of the more detailed software popularly recommended here, but I haven’t installed it yet. I thought I’d need some data to make its use meaningful anyway. To start, I’d like to understand better what my machine’s simple data display is telling me.

Night one results:
Therapy hours: 8.0
AHI: 3.9
Mask fit: 100%
Periodic breathing: 0%
90% pressure: 7.5

So, if my admittedly limited understanding is correct, here’s what this tells me.

THERAPY HOURS:
Therapy hours is simply how long I wore the mask with the machine running. The CPAP doesn’t know that I was awake, reading for the first hour or so, right? This is ALL the time a masked human used the running machine.

AHI: 
AHI is a calculated summary of bad breathing incidents. This is the same measure my sleep test generated, and that value was used to diagnose me with moderate-to-severe sleep apnea. 3.9 is below the threshold of 5, which I believe is the value that triggers the diagnosis of apnea. Does this value represent a successful night of treatment since it is less than 5?

MASK FIT:
100% “minus large leaks” says the manual. This one is part of why I’m here asking. I know I had to shift the mask repeatedly overnight and lots of air whooshed out at those times. I had a disturbed night as I tried to adjust to wearing the mask. Where I pulled it away from my face to adjust the fit, did that make a “large leak,” hence the 100% result? I thought this would show issues since I definitely fiddled with the mask multiple times last night.

PERIODIC BREATHING:
I don’t know what this is, but I’m assuming it is good that I had zero because “periodic breathing” is a bad thing? If this shows zero, do I need to learn more about this problem?

90% PRESSURE:
Am I right that this is an average and suggestive of what my “typical” setting might want to be if I had a dumber machine that could only have pressure adjusted manually?

[Gideon]

Your numbers seem good, you have noted the likely issues.  So how do you feel?

Do please post nightly charts when you have them.

[Walla Walla]

A quick rundown.
Therapy Hours: Your correct the machine can't sense if your asleep.
AHI: is Apnea and Hypopnea events Avg per hour. Under 5 is considered treated. Most here try to get lower. (under 2 is a good target)
Mask fit: 100% means you had no large leaks. Your mask was sealed 100% of the time.
Periodic Breathing: No periodic breathing is good. From our wiki: Periodic breathing consists of clusters of breaths separated by intervals of apnea (no breathing) or near-apnea. As opposed to normal breathing which is usually regular.
Periodic breathing was originally thought to arise from serious neurological or cardiovascular disease and therefore to carry a poor outlook. It is now known that periodic breathing also tends to occur during sleep, it can occur in healthy persons, and the apnea in periodic breathing is usually central (without respiratory movements) rather than obstructive (caused by upper-airway blockage).

90% pressure. Is the pressures reached at or below 90% of the time for the night. It's useful for determining the minimum pressure to set on your machine. Normally as a rule of thumb the minimum pressure is set 1 to 2cm below the 90% pressure.

Below is a link to Beginner's guide to sleepyhead. It explains a lot in more detail on how to use sleepyhead when you start to use it.



Periodic breathing during sleep occurs typically in patients with congestive heart failure.

[OpalRose]

90% PRESSURE:
Am I right that this is an average and suggestive of what my “typical” setting might want to be if I had a dumber machine that could only have pressure adjusted manually?


willo,
Your profile suggests your machine is set to a default setting of 4cm minimum and 20cm maximum.  Your 90% pressure reading is 7.5.  (this means you were at that pressure for 90% of the night and below.)  An optimal pressure reading should be set at aprox. 2cm below the 90% reading, and 2 to 3cm above that reading.  

So based on a 90% reading of 7.5, change your setting to a minimum of 6cm and a max setting of 11cm.  This is just based on what you are telling us.  We may see something different after we see some data.  

Download the free #SleepyHead software.  Organize your data according to the directions below in my signature line.  Then post a Screenshot of your daily page here using the directions for posting attachments.    

Get your Clinicians manual here if you have not done so already.
https://www.apneaboard.com/adjust-cpap-p...tup-manual

[willo]

The "how do I feel" question is interesting. Short answer: okay today, not great. Thanks for asking. I hope my sleep tonight is less interrupted by the machine.

Longer answer:

I'm one of those women who didn't present the "usual" (defined by men's symptoms) way. Neither my husband, parents, or kids (with whom I've shared hotel rooms, tents, and cruise ship cabins in recent memory) report that I snore at all, except moderately when I have a cold. I've not had the daytime sleepiness, either.

After several years of suffering repeating flares of autoimmune disease symptoms (joint pain, flu like exhaustion and malaise, low fevers) as well as some stuff that seems more like fibromyalgia (muscle aches), earlier this year I encountered brain fog. I forgot how to sign my name one day. I keep forgetting my computer passwords. I started to feel downright stupid, and highly intelligent is one of the primary ways I've always defined myself. That hits me right in my self-worth. Vitamin B-12 seemed to help the worst of it, but I'm still forgetful.

I find it easier to accept living with physical infirmity than losing my mental faculties. I've always taken decent care of my body--non smoker, reasonable diet aiming for organic, whole foods, exercised regularly before I got sick--but I don't find that stuff interesting. It's just necessary.

I'm extraordinarily fortunate to have the privilege of adapting to my new reality by cutting back activity after ~4pm, hiring help for jobs I can't manage like heavy cleaning and grocery deliveries, etc. My family is both helpful and understanding, and my in laws live in an attached apartment downstairs in our home, so I get tons of help with the kids.

After a few years trying to get to the bottom of my joint pain and overall fatigue, my primary care doctor suggested the sleep study. Insurance pushed back and he had to justify it because I don't match most of the trigger symptoms. I'm in my early 40's, but height-weight proportionate, female, small neck size, not falling asleep during the day...

So I feel okay today, but not great. My joints ache, but it is raining, chilly autumn, and my symptoms come in flares that tend to persist for days or weeks. I have a slight headache, but my sleep was disturbed, so that's normal for me. My fatigue is better when I have a good sleep--go figure!--so I'm moderately tired today.

I've been prone to insomnia my entire adult life. I'm well aware of good sleep hygiene and attempt to practice it. Most of this is mental, "can't wind down my thoughts" insomnia of the "difficulty falling asleep" variety. In recent years, I've had more of the other, later, "can't get back to sleep" variety. Alcohol, in particular, triggers the latter if I have more than one drink.

What I now wonder about, thinking it was a symptom of apnea, is a pair of two episodes of waking at night into "panic attacks." Starting a few years ago, I've had a number of "waking up feeling panicky" experiences, but, recognizing that it was not a "real" threat, I got through them with deep breathing, relaxing eventually back to sleep. Both times they progressed to actual, diagnosed panic attacks, I tried to ignore them and got up (to go to the bathroom.) Taking physical action brought me literally to the ground, thinking I was dying of a heart attack. There was something PHYSICAL behind it, and activity ramped it up.

Those were a while ago, but I've also had nights this past summer where I wake from dreams and feel a sense of dread and horror, but the content of the dreams didn't match those feelings. It seems logical that could be a result of not breathing--a dreadful situation, in fact!

I've read that a "sense of being overwhelmed" is also a woman's apnea symptom. That fits my situation. Then again, I'm a mom to school aged children. The fact that being ill has made me worse at that job--which I take very seriously--is an obvious reason to feel overwhelmed. But I have described to my doctors that I feel like I have an anxiety that is being created by physical symptoms. I don't think this anxiety is psychological in origin. All of it is new, since I got sick with the original autoimmune condition. I think that's part of what prompted my GP to order the sleep test. I'm hopeful that treating the apnea will rid me of the anxiety.

You may have noticed by now that I'm wordy. Sorry for that! I do try to put the vital stuff at the top and then launch into my long-winded explanation for those, like me, who enjoy long form content...

[Sleeprider]

not sure where you live, but Lyme's matches these symptoms. If you live ore have visited a location where that is a risk, get checked. I have unfortunate first hand experience.

[willo]

Yeah, I got the test for that, though usually it is larger joints affected with Lyme, especially knees. Fingers and toes are my worst spots. Though I was asked often, I never had any skin rashes either. Also no headaches or neck aches. My symptoms began in January, and the likely season for ticks here is more like May-July for the invisible tiny ones.

There's tons of controversy about the Lyme blood test and whether it is accurate, too. I'm also not going to go on long term antibiotics against mainstream medical advice which is what the people who really distrust the test suggest. It is common around here, and we know many people with it, but they are folks who walk often in the woods.

I'm not very outdoorsy. I dress myself and my family in permethrin treated (insect repellent) clothing when we are outdoors because I was so paranoid about them getting ticks at nursery school. I did get one tick bite once that I'm aware of when I joined a school walk in those same damn woods, but I took prophylactic antibiotics the next day following the course of action for "people really anxious about Lyme disease," so my risk of getting sick from that event would be very low. Mailed it in for testing at a state lab at my own expense, too, and it did carry the bru*** disease, but not Lyme.

If my knees were more involved, or if I had ever exposed myself to the outdoors here before knowledge of Lyme made me paranoid, I'd be more likely to suspect it. I moved here from far away, though, and grew up somewhere that ticks and Lyme are still not endemic. It is one of the many, many, many things I've discussed with my PCP and my rheumatologist, however.

[Sleeprider]

What you think you know about Lyme is mostly wrong. I had Lyme meningitis which had mainly neurological symptoms and paralysis. It's as horrible as it sounds, and I'm here to tell you I was not aware of the bite, which was probably in April, but ticks are a risk all year. It can affect people in many ways, not just the large joints. Your concerns for antibiotics is fine, but I was on long term intravenous antibiotics, and needed those to recover. Testing has gotten better, but without a blood test you can't assume your somewhat classic symptoms are unrelated.