Unusual Sleepyhead Data

[JohnLL]

This is a brief reintroduction. I have used cpat over a year and was happy until 3 months ago when I started having air blowing into OR out of my left eye. I tried a full face ( Fitlife ) mask but I cannot live with it and have gone back to a nasal mash (Mirage FX).
I learned that if I apply a slight pressure on the left edge of the FX with my finger near the corner of my eye the fluttering sensation stops. I now wear a regular bandage, with the cotton part near the corner of my eye, underneath the mask. This creates a little bump, and so greater pressure there, and it makes the issue tolerable.
I am very happy to have discovered this forum and Sleepyhead last month. I am running a 60 series C flex at 15 pressure, and the mask has a designed leak rate of 40. My raw data (rough numbers) looks good. AHI is typically 1.25-2, average CA 2, PB 1, 95% leaks 75, and average leaks 55. If I reduce the pressure to 14, to help with the left eye issue, AHI is 1.75- 2.5 and the leaks are somewhat less.
It is not the raw data, but the data pattern I wish to discuss. Often an inordinate percentage of my AH events occur during the last half hour of sleep. This is not every night and the screenshot of December 25 below is more dramatic than typical. The 14 pressure AHI is 2.7, but of the total 15 AH events, 9 (1 CA) occurred between 6:43 and 6:48 AM. It appears to not to be correlated with masks leaks so pressure cannot be an issue. There seems to be a correlation with a declining respiration rate (breaths per minute) over the entire night but particularly at the end. The December 24 numbers are AHI 2.4 with 8 (no CA) of the 15 AH events occurring between 7:28 and 7:40 am. I want to repeat it is not every night but if pressure is not the issue then what? THX

PS
Ok the software will not allow a link to photobucket and the attachment is too large to copy from my desktop. All is not lost as what you would have seen is there is no indication leaks are causing a decline in pressure and there is a gradual decline in respiration rate that peaks in the last half hour .

[trish6hundred]

Hi JohnLL,
I don't use software but hang in there and someone will help you with your data question soon.
Best of luck to you.

[robysue]

It is not the raw data, but the data pattern I wish to discuss. Often an inordinate percentage of my AH events occur during the last half hour of sleep. This is not every night and the screenshot of December 25 below is more dramatic than typical. The 14 pressure AHI is 2.7, but of the total 15 AH events, 9 (1 CA) occurred between 6:43 and 6:48 AM. It appears to not to be correlated with masks leaks so pressure cannot be an issue. There seems to be a correlation with a declining respiration rate (breaths per minute) over the entire night but particularly at the end. The December 24 numbers are AHI 2.4 with 8 (no CA) of the 15 AH events occurring between 7:28 and 7:40 am. I want to repeat it is not every night but if pressure is not the issue then what? THX (emphasis added)

Any chance you are very lightly dozing during this last half hour of "sleep" on the nights where this data pattern happens? As in, are you in that half asleep, half awake state that some of us go through before we decide to get out of bed in the morning?

If so, it may be that the machine is just misreading some of your normal wake breathing patterns that are present when you are more "awake" than "asleep" in this dozing period. Wake breathing is a lot less regular than sleep breathing, and the transition to wake breathing from sleep breathing when you're taking a long time to wake up is also kind of ragged compared to real sleep breathing. And so the machine may be misreading this transition breathing pattern as sleep disturbed breathing. And contrary to common assumption, when a machine is misreading normal wake breathing patterns, the ragged parts of the wake breathing can be scored as Hs and OAs as well as CAs.

Heck, when I've run the "hold your breath as long a possible" experiment, it typically shows up as an OA on my machine rather than a CA. Maybe it has to do with what I do with my tongue when holding my breath ...

Ok the software will not allow a link to photobucket and the attachment is too large to copy from my desktop.

I've not had any problem putting in image links to particular jpg images I have stored on PhotoBucket. Can you describe how you're trying to link to the image stored on PhotBucket?

[zonk]

Often an inordinate percentage of my AH events occur during the last half hour of sleep.

If both leak or/and lying in bed awake at the time been ruled out, my guess is that in deeper sleep or if rolled on your back, the set pressure is not high enough to deal with those cluster events
First would try avoid sleeping in supine position, placing a tennis ball in a sock attached at the back of pajama top/shirt would do the trick and if you can do without pressure relief (FLEX), turn it off. If that does not makes any difference, then increase set pressure by a small increment might works and at times only slight increase in pressure is all that needed. AutoPAP with minimum pressure set at CPAP pressure and allow the machine to go bit higher when needed can works too but we have to manage with whats available

[JohnLL]

"Any chance you are very lightly dozing during this last half hour of "sleep" on the nights where this data pattern happens? As in, are you in that half asleep, half awake state that some of us go through before we decide to get out of bed in the morning?

If so, it may be that the machine is just misreading some of your normal wake breathing patterns that are present when you are more "awake" than "asleep" in this dozing period. Wake breathing is a lot less regular than sleep breathing, and the transition to wake breathing from sleep breathing when you're taking a long time to wake up is also kind of ragged compared to real sleep breathing. And so the machine may be misreading this transition breathing pattern as sleep disturbed breathing. And contrary to common assumption, when a machine is misreading normal wake breathing patterns, the ragged parts of the wake breathing can be scored as Hs and OAs as well as CAs."

I think that might be the answer. It assumes the report is the chicken and not the egg. Often I am semi-awake and perhaps the machine is reading it wrong. I find it difficult to make sense of the report in other ways as if you remove the early morning events the AHI is very low. Last night I did not have a early morning "spike" and my AHI was 1.3.
I have to believe the pressure is fine but perhaps apap would help in some way I do not understand now.
The forum software would not allow me the link an outside source as I do not have enough posts. No problem or great loss. Thanks all.

[eviltim]

John, that sounds like its almost definitely the cause. But your AHI is actually excellent either way.

[vsheline]

… was happy until 3 months ago when I started having air blowing into OR out of my left eye. … I learned that if I apply a slight pressure on the left edge of the FX with my finger near the corner of my eye the fluttering sensation stops. I now wear a regular bandage, with the cotton part near the corner of my eye, underneath the mask. This creates a little bump, and so greater pressure there, and it makes the issue tolerable.

Hi JohnLL,

A bi-level Auto machine would very likely eliminate or mostly eliminate the problem of air leaking in/out of your eye socket.

A bi-level machine will allow a lower exhale pressure, and an Auto machine will allow the pressure to be lower most of the time (whenever higher pressures are not needed).

Don't neglect to address this problem with your doctor(s) further now, or in future you may get serious eye infections from germs from the nasal cavity (where sometimes there are lots of germs and infection) getting pushed into your eye cavity.

I really advise you to push your doctor toward prescribing a bi-level Auto machine like the Philips Respironics System One BiPAP Auto or the ResMed S9 VPAP Auto. Either machine would reduce the potentially dangerous leaking into your eye socket.

Take care,
--- Vaughn

[JohnLL]

Hi JohnLL,

A bi-level Auto machine would very likely eliminate or mostly eliminate the problem of air leaking in/out of your eye socket.

A bi-level machine will allow a lower exhale pressure, and an Auto machine will allow the pressure to be lower most of the time (whenever higher pressures are not needed).

Don't neglect to address this problem with your doctor(s) further now, or in future you may get serious eye infections from germs from the nasal cavity (where sometimes there are lots of germs and infection) getting pushed into your eye cavity.

I really advise you to push your doctor toward prescribing a bi-level Auto machine like the Philips Respironics System One BiPAP Auto or the ResMed S9 VPAP Auto. Either machine would reduce the potentially dangerous leaking into your eye socket.

That’s an interesting possibility. I do use a C Flex + machine which I understand is a limited bipap. I am going to see if I notice a difference in the fluttering on the exhale cycle. I wonder if I can rent a bipap to try.
The bone in my nose became infected when I was a child (60 years ago) and was removed. It was replaced with a silicone substitute in my teen years and so my sinuses are not normal.
I visited with my optimists (a fellow hosehead) to discuss closing the tear duct with punctual plugs. He is willing to do it but suggested exhausting the other possibilities starting first with reducing the pressure. His comment to me is that some people at my age have trouble keeping the plugs in place. If he did it he would begin with a temporary plug (it dissolves in a week) to see if it is effective.
Remember I am not certain the fluttering is air comes out of the eye. I appreciate all the suggestions!

[me50]

I have plugs in 4 of my tear ducts and I am glad I have them. They can put in a bigger size to keep them from falling out

[JohnLL]

I have plugs in 4 of my tear ducts and I am glad I have them. They can put in a bigger size to keep them from falling out

May I ask if you did this because of cpat issues or were there other reasons. I have read it helps with dry eye and my left eye is always redder than the right. I have not discounted this option entirely. If I need it at all it would probably be only my left lower duct. Thanks.