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Trying to make sense of SleepyHead

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Joined: Wed Nov 09, 2011 5:16 pm
Posts: 9
Machine: REMstar Pro C-Flex+
Mask: Mirage FX for Her
Humidifier: Yes/?
Year Diagnosed: 2011
Profile 
Thu Nov 17, 2011 11:17 pm Post
I downloaded the SleepyHead software and uploaded my 6 days of data from my c-pap. It looks like loads of good information and I am trying to understand what it all says.
Here is the gist of it:
AHI 2.05
Hypopnea 0.51
Obstructive 0.17
Clear Airway 1.36
RERA 0.17
FlowLimit 0.00
Vsnore 0.00
PB/CSB 0.81%

So what is RERA, and what is 'normal' or good values for each of these. How do they interrelate? I have a few weeks til my first follow-up with my sleep doc and I want to be able to talk with her intelligently about my treatment. She said I do not have OSA, I am almost exclusively a nose breather, I use a chin strap as the pressure causes my mouth to open. BTW my pressure is 11, ramp starts at 4. Except that I am more tired now than ever, and that I try to turn my face into the pillow when I sleep effectively causing leak, I am doing ok on my c-pap, not a lot of complaints. Just want to know what all this means! Thanks, this board is a god-send!
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Re: Trying to make sense of SleepyHead

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Joined: Tue Aug 24, 2010 6:47 pm
Posts: 1326
Location: Buffalo, NY
Machine: PR System One BiPAP Auto
Mask: Swift FX for Her
Humidifier: System One Heated Humidif
Year Diagnosed: 2010
Profile 
Fri Nov 18, 2011 7:26 pm Post
GypsyGirl wrote
I downloaded the SleepyHead software and uploaded my 6 days of data from my c-pap. It looks like loads of good information and I am trying to understand what it all says.
Here is the gist of it:
AHI 2.05
Hypopnea 0.51
Obstructive 0.17
Clear Airway 1.36
RERA 0.17
FlowLimit 0.00
Vsnore 0.00
PB/CSB 0.81%

Are these summary data or daily data?

At any rate, All of these numbers except for the PB/CSB are indices---in other words, they give the average number of events of the particular type that occur in an average hour of sleep.

AHI = (total number of apneas and hypopneas)/(total time the machine was running)
Hypopnea = (total number of hypopneans)/(total time the machine was running)
Obstructive = (total number of obstructive apneas)/(total time the machine was running)
Clear Airway = (total number of clear airway apneas)/(total time the machine was running)
RERA = (total number of RERAs)/(total time the machine was running)
FlowLimit = (total number of Flow Limitations)/(total time the machine was running) [SEE NOTE BELOW]
Vsnore = (total number of vibratory snores that show up as tick marks in the wave flow)/(total time the machine was running) [SEE NOTE BELOW]

PB/CSB = the percentage of time your breathing pattern was flagged a "periodic breathing" or "Cheney-Stokes breathing."

Notes:

An apnea is scored when the machine detects no air moving in or out of your nose for at least 10 seconds. On an in-lab sleep study (NPSG), apneas are classified as obstructive, where there's no air moving in/out, but you continue to attempt to breathe and central, where the belts show no effort to breath. The assumptions about apneas scored in NPSGs is that if the belts show effort to breath, the upper airway must have collapsed. If you don't show any effort to breath, the problem lies with your brain failing to send the signal to breath. On a CPAP machine, the classification of an apnea as obstructive or clear airway depends on a proprietary algorithm that sends either puffs or pulses of pressurized air down your airway. Depending on what happens to the back pressure at the machine end of the hose, the machine concludes either that the airway is blocked and scores an OA or that the airway is open and scores a CA. The presumption on the machines' manufacturers is that there's a high probability that machine scored CAs are probably central apneas.

A hypopnea is scored by your machine when the amount of air moving in and out of your nose significantly drops from the baseline volume for at least 10 seconds. How much it has to drop depends on the manufacturer. How the baseline for airflow into/out of your lungs is determined also depends on the manufacturer. But basically you can think of the machine scored hypopneas as 10 second plus long intervals where you are breathing, but not enough air is getting into your lungs.

A RERA is a respiratory effort related arousal. On an NPSG, scoring of RERAs requires an arousal in the EEG along with some kind of evidence of increasing respiratory effort. Think of RERAs as wannabe hypopneas if you want to. Since your System One clearly does not have an EEG to measure the arousals, you have to understand that the RERAs are being detected by a proprietary algorithm that is based on identifying certain wave form patterns as having a high probability of being caused by a real RERA as scored on an NPSG.

Vibratory Snores are scored in two fashions on the System One machines. One kind pops up in the table of "events" in Encore Viewer, but does not show up in the wave form. SleepyHead does not display those vibratory snores for some reason. The other kind of vibratory snore shows up in the wave form but is recorded ONLY when you are using a System One AUTO and the machine is running in AUTO mode. Since you are using a straight CPAP, this number will always be 0.0.

A Flow limitation is one of a number of characteristic changes in the shape of the inspiratory part of the wave flow that are known to indicate that the upper airway is compromised---i.e. the upper airway is beginning to collapse but is not yet restricted enough to trigger a hypopnea or apnea. Vibratory Snores are recorded ONLY when you are using a System One AUTO and the machine is running in AUTO mode. Since you are using a straight CPAP, this number will always be 0.0.

Periodic Breathing or Cheney-Stokes Breathing is a periodic pattern where the size of your inhalations first increases, then decreases, and then increases again----often with a central apnea at the end of where the inhalations are decreasing. A minute or two of this kind of breathing here and there is not uncommon. But substantial chunks of PB can be a symptom of serious heart disease and substantial chunks of PB can also lead to problems with oxygen levels during the central apnea in the middle. PB is usually thought to be a result of the patient's body not managing the CO2 cycle well enough to breathe normally---either while asleep or, in extreme cases, even while a wake. With PB/CSB = 0.81%, that's an average of less than a half of a minute of PB for each hour the machine was running. Most likely not something to worry about unless you already know you've got heart disease.

Quote
So what is RERA, and what is 'normal' or good values for each of these. How do they interrelate?

For folks with OSA, we want the treated AHI to be less than 5. And the smaller the better is the usual rule. If RERAs are significant problem that too can lead to daytime sleepiness and exhaustion, so many people would say they want AHI + RERA < 5 if they're using a System One machine.

Quote
I have a few weeks til my first follow-up with my sleep doc and I want to be able to talk with her intelligently about my treatment. She said I do not have OSA
So what IS your diagnosis? And why did the sleep doc put you on a CPAP if you don't have OSA?


Re: Trying to make sense of SleepyHead

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Joined: Wed Nov 09, 2011 5:16 pm
Posts: 9
Machine: REMstar Pro C-Flex+
Mask: Mirage FX for Her
Humidifier: Yes/?
Year Diagnosed: 2011
Profile 
Fri Nov 18, 2011 8:53 pm Post
"So what IS your diagnosis? And why did the sleep doc put you on a CPAP if you don't have OSA?"
very good question Robysue. I have been asking myself that. During my sleep study I had 4 <30 min episodes of REM in which I quit breathing, sat dropped to 89%, I have said and said I am never going into deep sleep. This has been going on for about 20 years and I am exhausted. If they tell me to try cpap I will try cpap, I need something! My AHI as a result of my sleep study was 4, from what I understand that is not even considered mild apnea? I am just really tired of being tired and this is the first attempt to do something. Thanks so much for all the wonderful information! Wow! And after I posted this I found that this is 1 day's results, this machine/program really gives a ton of information.
Thanks again, Connie


Re: Trying to make sense of SleepyHead

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Joined: Wed Nov 09, 2011 5:16 pm
Posts: 9
Machine: REMstar Pro C-Flex+
Mask: Mirage FX for Her
Humidifier: Yes/?
Year Diagnosed: 2011
Profile 
Fri Nov 18, 2011 10:50 pm Post
those were <30 second episodes of REM! Oops!


Re: Trying to make sense of SleepyHead

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Joined: Tue Aug 24, 2010 6:47 pm
Posts: 1326
Location: Buffalo, NY
Machine: PR System One BiPAP Auto
Mask: Swift FX for Her
Humidifier: System One Heated Humidif
Year Diagnosed: 2010
Profile 
Sun Nov 20, 2011 10:35 pm Post
So every time you went into REM, you had an episode with a desat and then immediately left REM? Hence you had 4 episodes of SDB in a grand total of no more than 2 minutes of REM?

Did your sleep study calculate a REM AHI? If it did, it would have been ridiculously high if you had 4 episodes, but each one was in a <30 second REM episode and you had a grand total of no more than 2 minutes of REM.

Did you have a titration study done? And if so, did you get and stay in REM at all during that study?

Has there been any other investigative work on testing you for other conditions that can lead to limited time in REM?


Re: Trying to make sense of SleepyHead

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Joined: Wed Nov 09, 2011 5:16 pm
Posts: 9
Machine: REMstar Pro C-Flex+
Mask: Mirage FX for Her
Humidifier: Yes/?
Year Diagnosed: 2011
Profile 
Mon Nov 21, 2011 6:02 pm Post
I'm assuming that a titration study is the sleep study with the c-pap, yes I had one. They titrated me at 11 and said I did better, however it was undoubtedly the WORSE night's sleep I have ever had. I have had no more testing done and I have been willing to keep sleeping with the c-pap until my doctor appt on Dec 13, but today (17 nights with c-pap) I feel worse than ever. I am so exhausted I feel as if I am going to die! The only AHI number that they told me was that my AHI was 4. I am going to ask for copies of both my sleep study results when I go back. I am sorry if I sound whiny I am so tired and so tired of being tired and was sure hoping that this was the answer, though I never believed that I have apnea, I think something is wrong that prevents me from sleeping deeply.
Thanks so much for your time!


Re: Trying to make sense of SleepyHead

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Joined: Tue Jul 15, 2008 6:41 am
Posts: 685
Location: Seattle, WA
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Mon Nov 21, 2011 6:19 pm Post
GypsyGirl wrote
I downloaded the SleepyHead software and uploaded my 6 days of data from my c-pap. It looks like loads of good information and I am trying to understand what it all says.
Here is the gist of it:
AHI 2.05
Hypopnea 0.51
Obstructive 0.17
Clear Airway 1.36
RERA 0.17
FlowLimit 0.00
Vsnore 0.00
PB/CSB 0.81%

So what is RERA, and what is 'normal' or good values for each of these. How do they interrelate? I have a few weeks til my first follow-up with my sleep doc and I want to be able to talk with her intelligently about my treatment. She said I do not have OSA, I am almost exclusively a nose breather, I use a chin strap as the pressure causes my mouth to open. BTW my pressure is 11, ramp starts at 4. Except that I am more tired now than ever, and that I try to turn my face into the pillow when I sleep effectively causing leak, I am doing ok on my c-pap, not a lot of complaints. Just want to know what all this means! Thanks, this board is a god-send!


Hi

First of all, please consider that the CPAP has ONLY flow data with which to determine what happened. There is a lot of conclusions here and very little information to work with. Take the readings with a grain of salt. RERA in particular!

AHI 2.05 = Apnea Hypopnea Index = (Apneas + Hypopneas) / Hours -- < 5 =Reasonable < 2 = Good
Hypopnea 0.51 = 0.51 Hypopneas per hour
Obstructive 0.17 = 0.17 Obstructive Apneas per hour
Clear Airway 1.36 = 1.36 Clear Airway Apneas per hour (probably noise).
RERA 0.17 = Respiratory Effort Related Arousals per hour
FlowLimit 0.00 = (probably) flow limited breathing
Vsnore 0.00 = Vibratory Snoring
PB/CSB 0.81% = Periodic Breathing / cheyne stokes breathing - per hour

Most sleep study terms available here: http://www.ucmc150.uchicago.edu/sleep/terms.html (Note: Hypopnea is normally considered >50% reduction in airflow)
Other terms available on Wikipedia or similar.

Respiratory Effort Related Arousal (RERA) can be part of Upper Airway Resistance Syndrome (UARS).

May you and your Doctor communicate well!!

Todzo


Re: Trying to make sense of SleepyHead

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Joined: Wed Nov 09, 2011 5:16 pm
Posts: 9
Machine: REMstar Pro C-Flex+
Mask: Mirage FX for Her
Humidifier: Yes/?
Year Diagnosed: 2011
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Fri Nov 25, 2011 10:11 pm Post
Thank you again for your information and encouraging words. However, last night I decided that perhaps I should go to bed earlier, try to get more than 6.5 hours sleep, so about 930 i'm in bed, mind you I have to be up at 430 so this is giving me 7 full hours. by 130 i have fought with trying to sleep with the mask, i turn it leaks, I adjust it, I sweat, I adjust it, my nose itches, I adjust it, it goes on and on and about 2am I take the d... thing off and throw it. I have got to get some sleep! I am exhausted here, I was so hoping this would be the answer to my fatigue, but it has set off another whole set of problems. My chest hurts in the morning, I wake up take off the mask and feel as if "yes! i can finally take a deep breath!". I can't concentrate at work, my coworkers are getting worried about me, I'm not my usual happy self. I am tireder than I have ever been. It's been just short of 3 weeks and I'm just not able to take it anymore. I have a nasal mask, it is very comfortable, my DME loaned me a full mask as I was getting a cold and my nose was stuffy, so I am trying both, both are comfortable and only leak when I turn my face toward the pillow while I am sleeping. I sleep on my side and as I go to sleep I tend to turn my face into the pillow. I bought a foam pillow and cut a 'notch' in it for the mask so I would quit knocking it off. It's just not working. Anymore suggestions out there? I am really at the end of my rope. Thanks, Connie


Re: Trying to make sense of SleepyHead

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Joined: Sun Nov 20, 2011 3:50 pm
Posts: 138
Location: Houston, Texas
Machine: PR System One BiPAP Pro
Mask: ComfortLite2 Nasal Pillows
Humidifier: PR System One
Year Diagnosed: 2011
Profile 
Fri Nov 25, 2011 11:02 pm Post
GypsyGirl, I understand what you're going through, because I am, too. Call up your doctor's ofice and tell them that the CPAP treament is not working for you, that you're more tired than you were when it started, and that you need help.

I, too, hoped CPAP would finally get me a good night's sleep, but alas, it wasn't to be. Yet. I went back to the doctor and some changes were made.

I'm just learning SleepHead, too. Look on the "Overview" to see the big picture.


Re: Trying to make sense of SleepyHead

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Joined: Wed Nov 09, 2011 5:16 pm
Posts: 9
Machine: REMstar Pro C-Flex+
Mask: Mirage FX for Her
Humidifier: Yes/?
Year Diagnosed: 2011
Profile 
Sun Nov 27, 2011 12:00 pm Post
Ok because of the holiday weekend haven't been able to call the doctor. So, Thursday night I slept without cpap. Friday night I put it on and went to sleep, woke up with first leak after about an hour and a half and took it off. Then last night, I went to sleep with it on and slept about 2 hours before I knocked it sideways and it leaked, so I took it off. Both nights I slept through the rest of the night and dreamed and awoke feeling as if I had slept, not rested, but I have slept. I'm gonna keep trying it like that. I have also discovered that I am fine without the ramp, as a matter of fact better as the low pressure the machine starts with... i believe 4... makes me feel as if I am suffocating. My pressure is at 11 and it seems not to be too much. My AHI is staying under 1.5 consistently usually it's about .5, so I guess that is good. Thanks for all the encouragement and the SleepyHead program is wonderful, allowing me to see that something is actually happening!


Re: Trying to make sense of SleepyHead

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Sun Jan 22, 2012 10:10 pm Post
GypsyGirl - I had a hard time getting started with the CPAP after getting my deviated septum fixed. My machine was changed from CPAP at 11 to AUTO at 6 - 12. The 6-12 AUTO didn't cut it for therapy. I was able to sleep through the night with it. Then once a week the bottom of range was brought up a notch. 7-12, then 8-12, etc. After 6 weeks or so it was switched back to straight CPAP at 11 and I was sleeping through the night with the mask just fine. One doesn't run a marathon without working up to it.

Just another thought ....
When you get your sleep study results take a look at your PLMs index. If its greater than 5 you may have Willis-Ekbom Disease (Restless Leg Syndrome). My CPAP data shows good results but I still feel like a zombie. My Zeo data shows 10 to 14 awakens a night. Started meds this week for the WED/RLS.

It's been a bit since the last post on this thread. Hope things are going better for you.

Sniezka
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