Should I be worried?

[dankoziolek]

I was diagnosed with obstructive sleep apnea 6 days ago. I started on a BIPAP machine that night. I have used it all night every night since. My 6 day average for AHI is 6.4, large leak is 3% and periodic breathing is 28%. I had 2 nights with an AHI<5. I started importing the data into SleepyHead and now my worry is about all of the Cheyne Stokes like breathing patterns I think I am seeing in my flow rate graphs. (I would upload a graph if I could figure out how.) My wife looked at the graphs and said this is what she has been trying to tell me about my breathing at night. This breathing pattern was repeated all night the first night. The second night was a significant improvement. Last night I had a 30 minute period of this pattern and several more 10 minute periods, except the periods with little to no flow have decreased from about 20 seconds to about 5 seconds. The periods of escalating then decreasing flow remain consistent at about 30 seconds each. All in all, I am quite encouraged to see this much improvement in six days time.

I had a physical exam a month ago with no identified health concerns except what I brought to the doctor; fatigue and frequent urgent urination which has not been a problem since I withdrew from caffeine 3 months ago. My sleep study showed no heart concerns, no Cheyne Stokes Respirations and normal sinus rhythm without ectopy throughout the entire study.

I have another appointment with my sleep doctor in 7 weeks. I can keep using the machine and see how things are then. I could see if I can go back to the sleep doctor sooner to get his opinion. I could ask the medical equipment provider, though I have not been impressed. They were picked by my doctor, had a copy of my sleep study which they didn't ask for, brought only the machine and mask they had picked out for me, fitted the mask while I was sitting upright in a chair, and billed me $1,500 for the first month's rent of the machine and the rest of the equipment. Or I could start listening more closely to my wife, who wanted me to get a sleep study for several years and go out of town to a new sleep doctor to get a second opinion. All advice is welcome at this point.

Since I don't know how to add my equipment to my message footer, I have a Phillips System One 760P REmstar BIPAP Auto with Bi-Flex. Mode APAP 9-13cmH2O, with humidifier, and a Mirage Quattro mask.

[Pugsy]

Welcome to the forum.

Here's how to add your equipment to your profile...Use mine as an example..I use the same machine as you.
wiki/index.php/Registering_Equipment_in_User_Profile

How to post images of your reports with examples of what we like to see is discussed in this thread.
viewtopic.php?f=1&t=81072&p=737779#p737779

How is your sleep quality been? Are you sleeping soundly or having quite a few wake ups during the night? It's common to have more awakenings than usual sometimes because it can take the body/brain time to get used to all this stuff being attached to us and blowing air up our nose or in our face.
When we have a lot of wake ups sometimes the machine mistakes awake/semi awake breathing irregularities (awake breathing is much more irregular than asleep breathing) for apnea events and flags the irregularities by mistake.
Also it is normal to have some centrals during sleep onset and when we have a lot of awakenings we have more chance for more sleep onsets. This may be what you are seeing right now.
Also the Periodic Breathing that gets flagged doesn't automatically equal Cheyenne Stokes Respiration. Periodic Breathing by definition is a waxing and waning of the air flow. CSR is a type of PB but not the only type.

If you tell your doctor about it right now he is just going to tell you to give it time. Time for the body to adjust and settle into the routine. While giving it time we can use that time to do some detective work and see if things are really as scarey as you might think.

Is your AHI mostly Clear Airway events or Obstructive in nature (OAs and hyponeas are obstructive in nature)?

So don't panic. There's no need at this point. AHI of 6 even if it were all centrals isn't a horrible thing where you just have to do something about it right this minute.

When you have time I have a little tutorial about understanding your data
viewtopic/t88983/Pugsys-PointersSleepyH ... nding.html
Read it and come back with questions that aren't covered there and post a couple of reports so we can see what you are seeing and we will try to alleviate some of your concerns.

[dankoziolek]

Thanks Pugsy,

Your reply did more to help me sleep than my machine!

My graph looks like this:



Aside from the first night, I generally wake up once or twice a night, most of the time fall back to sleep quickly, and wake up thinking I slept well. Except as I look back on the past 1 1/2 years I realize that I have been getting more and more tired until I began to worry that I would fall asleep during my commute to and especially from work. I have been less worried about this so far this week, so I am encouraged to think I am slowly doing better.

I will have to study your post about understanding my data to be able to answer your questions about the clear airway or obstructive. But I wanted to say thanks before putting on my machine tonight.

Dan

[dankoziolek]

I read through all of the definitions on SleepyHead a couple of times and believe I understand most of the terms. I am even more confused. This morning my BIPAP's readout said 3.9 AHI, 0% leaks, and 12% periodic breathing, which is about as good a night as I have had in the 8 nights I have been on the machine. In SleepyHead this same data looks like this:



The lowest SleepyHead AHI number I have had in a week is 142. The highest AHI number on my machine readout was the first night when it was 18. The sleep and wake times and session times seem accurate. But total leaks shown in SleepyHead is 0% every night while my machine readout shows a large leak average of 2%. What could be causing these discrepancies? I have SleepyHead version 0.9.2-3 running on a mid-2007 iMac and OS X Mavericks.

Thanks for any clarification anyone can provide.

Dan

[Bill44133]

Oh my goodness!! 4,873 AHI are you still alive??

[Pugsy]

What could be causing these discrepancies? I have SleepyHead version 0.9.2-3 running on a mid-2007 iMac and OS X Mavericks.

You have PR S1 60 series BiPap model 760 and you are using the SleepyHead version for Macs.
Did you get the Patch that is needed for SleepyHead Mac version to be compatible with your machine?
If you did...there's a bug and it simply is not compatible..the data is totally unreliable.
If you didn't ...let's see if the Patch will fix the issues with the whacko numbers.

An OSX version of the software is now available at:
https://s3.amazonaws.com/thefreemanclan ... pyHead.dmg
From this thread. You may need to back up and read about how to apply the Patch. We don't have to use the Patch file with the Windows version anymore but Mark hasn't got a new Mac version that includes the Patch so you have to do it manually.
viewtopic.php?f=1&t=83551&st=0&sk=t&sd=a&start=30

If you do/did the Patch...then it simply isn't working with your machine. Do you have access to a Windows OS computer? If not we are in trouble because Encore (Respironics software that works with your machine) doesn't have a Mac version. You would need a Windows environment on the Mac to use it...but then you could also use the Windows SH version 0.9.3 that already includes the Patch. I can get you set up with Encore too.

If we can't get you with some working software...send me a private message as I know how to have you send me your data and I will get you the reports and send them back to you.

[dankoziolek]

I have not been able to find anything more current than the Mac version of SleepyHead that I have. But I have been able to install the Windows version on an old XP machine and it works as expected. It is helpful to see that after the first night my obstructive AHI's have been .6 or less and that there is an inconsistent but persistent pattern in reductions in my clear airway AHI's and periodic breathing percentage.

While my pressure change: 13 Inhale and 9 exhale seems moderate compared to what my Remstar System One BiPap Auto is capable of, my Mirage Quattro mask seems to push against my face more tightly as I inhale, and then bump free as I begin to exhale. This happens even on the ramp setting and even when I slow my inhalation and beginning exhalation as much as I can. I am struggling to fall asleep against the repeated bump. Has anyone experienced this and found a solution?