Are these good numbers for a beginner?

[PopIsGettingGrumpy]

My father finally made it through the entire night the last two nights. I'm trying to learn to interpret the data as quickly as possible, but I don't feel very confident yet and could use some help while we begin this journey.

Background:
68 years old male, 145lbs, in good health but having memory and cognition concerns. General daily fatigue and an overnight oximetry test led our doctor to recommend a sleep study.

In-lab Sleep Study Results:
Diagnosed with AHI 54.5/hr and quoted "Respiratory events were characterized primarily as frequent obstructive apneas and mixed apneas. Desaturations were generally mild. Obstructive respiratory events were well controlled on all tested pressures. Snoring persisted throughout the night despite pressure increases. Oral leak became problematic at 11cmH20 and was not completely controlled with a chin strap. Recommendation to start trial of AutoCPAP 5-9cmH20 (pressure corrected for use of F&P filter during study"

My Questions:

• Does his data from last night look good? I'm still not confident at identifying real events vs arousals vs him being awake. Any general guidance or input based on the below?
• Is his leak rate too high for the Dreamware Mask/Nasal Cushion? He likes it, but sometimes snores and I can hear leaking when he opens his mouth slightly. He doesn't remember mouth leaks bothering or waking him though.

Here is one large leak with event flags - are these real events or false positives either due to the leak or the flow pattern (perhaps he was awake)?



And do these look like real events, or do they look more like he was awake?

[Deborah K.]

I am not one of the experts, but his AHI looks really good for someone who has had only two full nights on the machine, especially with his high untreated AHI numbers.

He would probably do better yet if you increase his minimum pressure up to 7 or so. Most folks feel pretty air starved when starting at 4 or 5.

I'm sure the experts will be along soon to offer more help.

[Pugsy]

don't change anything just yet.
we can't fix CAs/centrals with more pressure for one thing and second thing most look arousal related anyway.

good enough for now.

concentrate on sleep.

sorry...no novels for a while...had surgery on hand 3 days ago.....splint on for 3 months

[Julie]

Oh wow, 3 months? Hope it helps whatever needed help, but don't kill yourself here - others will take a lot of the load I'm sure, but what will you do to keep busy?

Don't feel you need to reply to this one!

[PopIsGettingGrumpy]

Much appreciated. We certainly don't need any novels, just the thumbs up on his current data is very much appreciated at this point. I feel like the blind leading the blind.

Yes, I honestly feel a bit skeptical that his AHI would already be so low from a 54 AHI at diagnosis. So far, none of his Oscar data has exceeded a 6 AHI and most were CA's. I did request a complete copy of his sleep study, but what I was sent did not include the summary graphs nor the breakdown of the exact counts for apnea, hypopnea, obstructive, etc. Although they were an accredited facility, I would like to see those numbers for myself so I guess I'll have to send a certified request in writing for the full study, reports and graphs.

@Pugsy: Wishing you a speedy and uneventful recovery from surgery.

[Pugsy]

I actually expected good results (like the above) right off the bat. The eternal optimist.

Anyway 3 or 4 more nights at these settings....let him get more/better sleep in general and then maybe some minor tweaks based on reports.

[PopIsGettingGrumpy]

Oh good! So it's not completely uncommon then, even with the higher AHI?

[Pugsy]

Oh wow, 3 months? Hope it helps whatever needed help, but don't kill yourself here - others will take a lot of the load I'm sure, but what will you do to keep busy?

Don't feel you need to reply to this one!

splint 3 months in total per my doc and the mess my joint was in and what he did

this procedure...though not my doc
https://www.schimizzimd.com/lrti-ligame ... as-tx.html

OMG does this hurt...so not bored yet

i spend a lot of time napping.

try tearing off a piece of toilet paper with one hand.....it sucks

[Pugsy]

Oh good! So it's not completely uncommon then, even with the higher AHI?

I have see numbers a lot worse than your dads go down to next to nothing.
immediately.

[PopIsGettingGrumpy]

@Pugsy - that's very encouraging. thanks again. Very sorry to hear about your thumb though, and that surgery sounds rough. Too much typing out helpful advice on the internet, I'd wager.

try tearing off a piece of toilet paper with one hand.....it sucks

... time to go hands free?

[Miss Emerita]

Don't be skeptical because his AHI is so much better -- that's PAP therapy working!

The first zoomed-in view looks to me like an obstructive apnea event occurring sleep. True, there's a little arousal beforehand, but this may not involve an actual awakening. Meanwhile, we see dwindling flow rates, indicating that obstruction is setting in, and then after the event, we see recovery breathing. I wouldn't be surprised if that involved a wake-up, so the central event that followed the recovery breathing might not be an event that occurred during sleep. Honestly, it can sometimes be hard or impossible to be sure what's going on.

In the second zoomed-in view, there seems to be a clearer picture of post-arousal waxing/waning breathing. (Deeper breathing may wash out some CO2, which means the brain isn't getting its "breath now" signal on the usual schedule. A central may follow, and then some catch-up breathing, which washes out some CO2.... Rinse and repeat until things settle down again.)

It would be nice if we could tell what causes the arousals -- that's what Pugsy calls the million dollar question. But we usually can't.

I'm going to guess that as your father gets used to the set-up, he'll have fewer arousals and fewer centrals. My own rule of thumb is that an AHI under 2 is very good and under 1 is excellent. But your father is doing well, especially for someone new to the whole thing.

See if you can get a sense of how he's feeling during the day -- more rested? A little better memory or mood? Those "subjective" indicators are especially important when things look generally good by the numbers.

[Julie]

Yeah, thumbs (and arthritis) are weird... that little joint near the bottom (don't know if it applies to yours) can cause so much trouble.

[Pugsy]

I'm going to guess that as your father gets used to the set-up, he'll have fewer arousals and fewer centrals. My own rule of thumb is that an AHI under 2 is very good and under 1 is excellent. But your father is doing well, especially for someone new to the whole thing.

I suspect that with a bit of time and better sleep things will settle down and then we will have less chance of arousal stuff muddying up the evaluation. Right now there is a real good chance that arousal stuff is even messing with the pressures as well.

[musculus]

His flow limitations at 3 and 4am (REM sleep periods) looks like what I saw in my data. I bet the REM sleep were still interrupted. How was his subjective feeling about sleep quality?

[PopIsGettingGrumpy]

He's not totally sure, to be honest. And unfortunately, the last few nights of data have been poor with the dreamwear nasal cushion mask. We're seeing higher AHI (though I think he's awake during many of the flags), higher leak data, some larger gaps in data, and it doesn't look (to me) like he was sleeping as well. Last night he remembered a few times where the mask was leaking/misaligned - though the data looks like a full hour for one gap. My hunch is that this mask doesn't fit him as well as the nasal mask he hates (n20 airfit), and also that he has a lot of mouth leaks.