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mike5775
Unread post  Post subject: Sleep Report question  |  Posted: Sat Jun 27, 2020 10:07 am

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I have added 2 pictures from my sleepyhead report from last night. I have 2 questions.
1. On my hypopneas, are they really hypopneas or is the machine incorrect in labeling them hypopneas?
2. Everytime I have a clear airway it has a flat line in my flow rate. Does that really mean it's a clear airway? It looks to me like I'm not breathing right before it tells me it's a clear airway.

Thanks for the help


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Respirator99
Unread post  Post subject: Re: Sleep Report question  |  Posted: Sat Jun 27, 2020 7:39 pm
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G'day Mike. Can I suggest you keep all your stuff together in one thread - that way we'll have your full story in a nice linear narrative. If you start a new thread each time you post, stuff will get lost, people will get confused and you might end up with wrong or misleading advice.

Could I also suggest you update your software from SleepyHead to Oscar. Superficially the two programs are the same, but Oscar is more advanced and has corrected a lot of the bugs in SleepyHead. You can get it here: https://www.sleepfiles.com/OSCAR/

Final suggestion before I get to your questions :) please format the SH/Oscar output according to the "Organise your charts" link in my signature below. That will give us a lot more useful information to base our advice.

OK, on to your questions:

Quote:
1. On my hypopneas, are they really hypopneas or is the machine incorrect in labeling them hypopneas?


Looking at the event commencing at 01:51 that is definitively an hypopnea. There is a very clear reduction in flow, which is what an hypopnea is.

Quote:
2. Everytime I have a clear airway it has a flat line in my flow rate. Does that really mean it's a clear airway? It looks to me like I'm not breathing right before it tells me it's a clear airway.


You're missing a very important word - "event". The machine is flagging a clear airway event, which in the great majority of cases is a central apnea. And an apnea is the loss of airflow for 10 seconds or more - which means you're not breathing, which is why you get the flat line. That particular event probably took place while you were still awake, so you can safely ignore it. The total number and duration of central apneas is OK, but once we get your hypopneas under control you might like to come back and revisit these.

Now looking again at the hypopneas. They occur in clusters. Also, the close-up you gave us shows significant flow limitations. This is indicated by the ragged flat-topped wave flow. Ideally, your flow curve should look something like this:

Attachment:
File comment: Idealised flow curve
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The fact they occur in clusters might indicate that your sleeping position is to blame - your chin could be tucking down to your chest, which compromises the airway and makes it more susceptible to partial collapse. This can be overcome by adopting a sleeping position so that your head is very slightly tilted back to ensure the neck is straight and the airway is likewise nice and straight. Consider getting an orthopeadic pillow or a buckwheat hull pillow which can support your head and neck in the desired position. You could also consider a soft cervical collar to help keep your chin up.

I'd like to have a further look at the flow limitations, so please post again following the "Organise your charts" instructions, making sure that the flow limitations graph is included.

_________________
Regards from Australia

* Download Oscar
* Oscar help
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Pugsy
Unread post  Post subject: Re: Sleep Report question  |  Posted: Sat Jun 27, 2020 8:22 pm
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Those hyponea clusters might also be related to REM stage sleep.
Do you know if your sleep study happens to mention your OSA being worse in REM or not?


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mike5775
Unread post  Post subject: Re: Sleep Report question  |  Posted: Sun Jun 28, 2020 9:20 am

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Repirator99, I did what you said and downloaded OSCAR.
I have attached 2 pictures, one has the flow limitation and one that does not. I got rid of the calendar and pie chart view as well. I am new to all of this so I apologize for my ignorance in using this software. Thank you for taking the time to look over it. I am trying to learn how to read my own data.



Pugsy, I do not know much about my sleep study. It was done 3 years ago. The doctor basically told me that I had 16 ahi per hour so I have moderate sleep apnea.


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Pugsy
Unread post  Post subject: Re: Sleep Report question  |  Posted: Sun Jun 28, 2020 11:32 am
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I used to mention 2 main causes for dense clustering of either OAs or hyponeas....supine sleeping or REM stage sleep because both are well known to make OSA worse and cause a need for more pressure. I now will also add a third positional factor which is chin tuck which can alter the airway in a manner that can cause the need for either an airway position adjustment or more pressure being needed to hold the airway open.

Your clustering of dense hyponeas is very suspicious for a REM sleep stage pattern. There's really nothing available to us from the data the machine gathers to help us determine sleep stage but we can look at the pattern and the normal sleep stage progression hypnograms and get an educated estimation. Google "sleep stages" and take a look at the normal hypnograms to get an idea when and how often REM happens. Yours is a bit more difficult because you have so many awakenings that are disrupting the normal pattern or cycles of sleep. It wouldn't be impossible for the clustering of events (whatever the cause) to be waking you up to the point that your sleep architecture simply has to rest and you aren't getting into a nice normal sleep progression of stages throughout the night. This is what happened to me...my non REM OSA wasn't all that exciting but in REM my OSA was quite bad. Overall AHI wasn't absurdly high (around 12 I think it was) but in REM it was well over 50 events per hour. Probably being every time I hit REM the OSA would wake me up and I kept having to start the sleep cycle progression repeatedly and I simply never really got the normal progression nor the amount of deep sleep or REM sleep that the body needs.

What I did was just increase the minimum pressure to a point that the dense clusters that were showing in probable REM were broken up. I never worried too much about totally eliminating the clusters but I wanted the number of events to be reduced and not have the chance of having so many apnea events back to back and on top of each other.

So...IMHO...you need more minimum pressure to better hold the airway open and prevent the airway from collapsing and stop the dense clusters.
It might be supine related...but the fix is the same unless you can figure out someway to stay off your back IF (big if) they are supine related.
You could try wearing a soft cervical collar to hold the chin up and prevent chin tuck but it might not be something you want to be wearing.


If your reports were my reports....More minimum pressure is what I would try first. It's hard to get a feel for how much more because the segments are so short but if it were me I would start with 1 cm more minimum for a few nights and watch the clustering...then again another 1 cm more for a few nights...up to where the clustering wasn't so dense.
The goal being to break up the clusters no matter what is causing them.

More minimum pressure or baseline pressure will do a better job of holding the airway open in the first place and a better job of preventing the airway from collapsing. The machine will try to fix thing with increasing the pressure (which you can obviously see on the pressure graphs) but it won't increase at all DURING the apnea event and when you have so many happening back to back the machine sits by twiddling its little thumbs until the airway opens.. You end up with a segment essentially with the machine not being able to respond fast enough.

Better fix is just have the baseline pressure higher to start with and prevent the collapses instead of trying to fix them after they happened.
The machine simply can't respond fast enough to do that.

None of the apap capable machines will try to respond to the airway collapse with more pressure DURING the collapse. They can't blow through the event or blow the airway open. Simply not possible to generate that much air pressure or fast enough. Pressure increase come about AFTER the airway has returned to normal and the machine evaluates the recent past history and decides it doesn't like what happened so then it tried more pressure

Prevention is a better option.....more minimum pressure.


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mike5775
Unread post  Post subject: Re: Sleep Report question  |  Posted: Sun Jun 28, 2020 12:18 pm

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Pugsy,
Thank you for your input. I am a little frustrated because my sleep is very inconsistent. I am attaching pictures from my sleep report from last night. Unlike the night before, the clusters started happening around 6am which later than what it did the night before.
Why are my clusters so inconsistent?
Also, I am a stomach/side sleeper. I'm in between the two. I don't sleep fully on my stomach and I am not perfectly on my side if that makes sense.


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Pugsy
Unread post  Post subject: Re: Sleep Report question  |  Posted: Sun Jun 28, 2020 2:26 pm
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REM is inconsistent for one thing.
Another thing is we simply don't sleep the same each night...heck we don't sleep the same hour to hour during a night.
If you look at the graphs of normal hypnograms we normally get the most REM in the wee hours of the morning so it doesn't surprise me one bit that you get clusters in those wee hours....that's when REM comes more frequently and lasts longer.

If I was a betting person I would be laying a lot of money on your OSA simply being worse in REM and you just need more baseline pressure during REM only. The machine tries its best but it just needs a better head start on things to get the job done.

Increase your minimum to 7 cm....for one night....see what happens.


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mike5775
Unread post  Post subject: Re: Sleep Report question  |  Posted: Sun Jun 28, 2020 2:57 pm

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Ok I will try tonight and let you know tomorrow


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mike5775
Unread post  Post subject: Re: Sleep Report question  |  Posted: Mon Jun 29, 2020 8:06 am

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Here is my sleep report from last night. I changed my minimum pressure to 7 and it doesn't look like the clusters went away. My mask did leak a little more than usual too and I woke up with a little bit of a dry mouth which I NEVER have even when my mask does leak. I woke up twice last night which seems to be common these days. I did start out really well, I wonder if I didn't have the leaks if my hypopneas and clear airway events would have been less? What do you think? I'll take feedback from anyone. Thanks for all of your help!


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Pugsy
Unread post  Post subject: Re: Sleep Report question  |  Posted: Mon Jun 29, 2020 8:31 am
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You can zoom in on those flagged events and figure out if you were awake or not when they got flagged.
http://freecpapadvice.com/sleepyhead-free-software
Just because you don't remember an arousal/awakening doesn't mean it didn't happen.
And while the above link videos are talking mainly about central apneas being false positives....it's not limited to centrals. Any event category can have a false positive or arousal related flagged event.

My AHI usually runs between 1 and 2 with 75% being arousal related.
It's because I don't sleep so great from back pain issues.

If you are awake....those events don't count.


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mike5775
Unread post  Post subject: Re: Sleep Report question  |  Posted: Mon Jun 29, 2020 8:57 am

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Here are my first 2 hypopneas. I am pretty sure I was asleep. It's within the first hour to hour and a half of me falling asleep. I'm guessing by my flow rate that I am asleep.


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mike5775
Unread post  Post subject: Re: Sleep Report question  |  Posted: Tue Jun 30, 2020 9:03 am

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I have recently increased my minimum pressure to 7 to see if it would help break up the clusters of hypopneas that I seem to have. It does not seem to be working so I'm wondering if increasing to 8 should be the next step? Any advice would be appreciated. I did have more than normal mask leakage last night. I wear a nasal mask (Phillips Respironics Dream Wear) because whenever I wear a full face mask the leaks are very bad and I am a stomach/side sleeper.


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mike5775
Unread post  Post subject: Re: Sleep Report question  |  Posted: Tue Jun 30, 2020 9:15 am

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Here is the full night screen shot. 1 has flow limitation and one does not


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Pugsy
Unread post  Post subject: Re: Sleep Report question  |  Posted: Tue Jun 30, 2020 11:49 am
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The zoomed in snap shot showing the CA/central then UA (leak caused it to not be able to be identified) and then another CA/central flag....all that breathing appears to be awake/arousal breathing. Those event flags aren't asleep flags.

If you are sleeping soundly (as much as you can tell) then you need more minimum pressure still.
If you are waking often and spending much time awake with mask and machine on....then the flagging of events may be mistaking awake breathing irregularities as some sort of apnea event when it really isn't.
The machine doesn't know if you are awake or not...all it measures is air flow.

Central/clear airway apnea flags.....more pressure won't fix those.
More pressure only fixes OAs and hyponeas (assuming we are asleep).

The image you posted yesterday with the 2 hyponeas...not really zoomed in enough to optimally evaluate them but off hand they did NOT look like asleep flagging to my eye.

When you evaluate a flagged event you have to look at the breathing prior to the flag...

Asleep breathing is circled in red. Obviously nice regular pattern....Awake arousal breathing is very irregular. If we aren't asleep the flagging doesn't count.

Image

Image


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mike5775
Unread post  Post subject: Re: Sleep Report question  |  Posted: Tue Jun 30, 2020 11:53 am

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Thank you for that information Pugsy!


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mike5775
Unread post  Post subject: Re: Sleep Report question  |  Posted: Thu Jul 02, 2020 11:05 am

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I have attached a video of my entire sleep report from last night. It looks to me like most of my clear airway events took place while I was awake and some of my hypopneas. Does anyone else see that? If you click on the link below you can view the video. Please someone let me know if you interpret the same thing as I do. Thanks

https://screencast-o-matic.com/watch/cYinb85O6z


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Pugsy
Unread post  Post subject: Re: Sleep Report question  |  Posted: Thu Jul 02, 2020 1:11 pm
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Yes. I agree...the centrals/CAs are pretty much all arousal/awake related and some of the other flagged events as well.
From a rough eyeballing...looks like about 75% of that AHI is arousal/awake related. Pretty much like I see every night.

In my case I know what my sleep is less than optimal...and it's not from the cpap therapy. It's from other reasons. I do the best I can though...that's all anyone can do. The best cpap therapy in the world doesn't do a darn thing for a bad back. Sure wish it did.

Your machine and settings are doing a good job....your body isn't cooperating very well in terms of getting good sleep in general...as to why??? That's the million dollar question isn't it?

Part of it might simply be to the newness to all this therapy. It took me a full 3 months to have any semblance of decent sleep when I first started therapy. Let's face it....sleeping will all this stuff attached isn't exactly normal or conducive to good sleep. It's been over 11 years now that I have been on cpap....my apnea is well treated but my sleep quality leaves a lot to be desired because my pain meds wear off mid way through the night and I am getting older and sometimes it just sucks.


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mike5775
Unread post  Post subject: Re: Sleep Report question  |  Posted: Thu Jul 02, 2020 6:39 pm

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Possibly. I have been on CPAP for about three years now so I guess my body is adjusting to the new pressure changes.


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mike5775
Unread post  Post subject: Re: Sleep Report question  |  Posted: Fri Jul 03, 2020 10:25 am

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Last night I had 7 clear airway events. All but 2 of them had a big spike in my flow rate. I was wondering what the spike in my flow rate means before I have the clear airway event? I have attached pictures to show and I also attached the 1 that didn't have a spike. I was curious if the one that didnt have the spike was a real clear airway event?


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Pugsy
Unread post  Post subject: Re: Sleep Report question  |  Posted: Fri Jul 03, 2020 12:06 pm
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The breathing pattern prior to the central without a spike/gulp of air doesn't appear to be asleep breathing to me.

If those were mine...they would all be put in the SWJ sleep/wake/junk trash can and ignored.

The "spike" is nothing more than a big gulp of air.


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