Newbie wanting starter advice!

[Pugsy]

The SleepyHead software mentioned above will give more details.
See this thread for some examples
viewtopic/t103468/Need-help-with-screen-shots.html

How to use imgur to embed the images if you want to share them with us
https://sleep.tnet.com/reference/tips/imgur
How to organize the graphs...3 pages so be sure to read all 3 pages
https://sleep.tnet.com/resources/sleepyhead/shorganize

Unfortunately none of these machines actually measure sleep quality or sleep stages or even if you slept at all.
They measure air flow/breathing and can't tell if you are awake or not.
We can make educated guesses based on the pattern of the air flow/flow rate but there's nothing on the machine that can tell you about sleep itself.

[OkyDoky]

Yes Sleepyhead gives you much more information. It gives you breath by breath detail if needed. Look at the graphs people have posted here and see the detail. My Air is very basic info but it does tell us you have improved from your study AHI. Your pressure settings are wide open and will need adjusting to bring the AHI down further. In the case of OA and Hypopneas raising the minimum pressure is what is needed to keep them from happening. Not sure how pressure changes work in the UK with them monitoring for your driving, but keep this in mind. And get Sleepyhead where you can learn and know what you need when you discuss it with them.

[mattshaw]

Unfortunately none of these machines actually measure sleep quality or sleep stages or even if you slept at all.

Thanks for that. So when the DVLA look at the results to assess driving licence reinstatement is it assessed on treatment hours per night and the AHI?

[OkyDoky]

What I'm about to say is ... an interpretation. An interpretation because in its official publications and on its website, the DVLA does not say precisely what the 'levels' are. But the conditions that the medical profession seem to agree on as qualifying are:

a. that you get at least four hours of sleep a night;

b. that - in your case, with an untreated AHI of 50, and your doctors going by what the medical journals said six years ago - your AHI comes down to under 10;

(Most people on this forum would say under 5 is even better. And you'll find that many routinely come in under 2.)

c. that you don't give up treatment after a few weeks or months - so that the SD card in your machine shows you using the machine long term; and

d. your scores on a questionnaire called the Epworth Sleepiness Scale come down to the 'normal' level. (The sleep service staff are usually the ones who ask you to fill this in.)

I don't know how soon after your initial mask-fitting session your first follow-up will be. That too varies from area to area. Here in Gloucestershire, the first follow-up is at three months. Thereafter, it's once a year. You would need to ask what it is in your area.

But if you meet these four conditions by the time of that first follow-up, you should be clear to go.

Rick Blaine from your area posted this for you earlier. Here in the US it is use of the machine for at least 4 hours for 70% of the time.

[Pugsy]

So when the DVLA look at the results to assess driving licence reinstatement is it assessed on treatment hours per night and the AHI?

Correct.
I guess it's sort of assumed that if the AHI is acceptable and the machine is used for X numbers of hours that means things are all hunky dory. While it isn't necessarily true in all situations it is the best they can do with the information the machine gathers. They have to have a line in the sand somewhere.
Measuring sleep itself with any accuracy involves EEG leads and we simply can't be doing that every night.

We have something similar here in the US but so far it only involves truck drivers that require a special license. So far the general public doesn't have the same regulations about sleep apnea diagnosis.

[mattshaw]

Yes I did read that which is great information. I just wanted to know what if you struggle to sleep with Cpap but are still administering therapy for the required hours and getting an AHI of under 10 you will likely be given your licence back, ie. There is no way of them really knowing how tired you are or hat quality of sleep you are really getting?

Aha Pugsy - see you have just answered this as I type. So basically if I carry on how I have done then I don't need to worry about getting it back - just a bit less anxiety that is all!!!

[mattshaw]

Day 3 - more encouraging results,

AHI: 5.9
Useage 6.05 hrs
Clear Apneas: 2
Obstructive Apneas: 14
Hypopneas: 20

Are these results ok?

[Pugsy]

We usually like to see the AHI be less than 5 here in the US but I have read that in other areas of the world the line in the sand is AHI of below 10.

How are you feeling? How are you sleeping?
How many hours of sleep are you getting?
Are those flagged events showing up as dense clusters or spread out randomly through the night?

[mattshaw]

We usually like to see the AHI be less than 5 here in the US but I have read that in other areas of the world the line in the sand is AHI of below 10.

How are you feeling? How are you sleeping?
How many hours of sleep are you getting?
Are those flagged events showing up as dense clusters or spread out randomly through the night?

Thanks for the reply. I'm feeling much more awake. No sleepy period in the afternoon any more. I'm sleeping pretty well tbh once I get off. Moving around much less and no trips to the loo as before I could be going 4 times a night. Strangley my eyes hurt, like I've been hit! I'm getting 6-8 hours sleep/therapy. Not downloaded the results to sleepyhead yet so cannot determine any clusters etc but will do. Coming from an AHI of 50 to this is amazing and I feel so much more normal, not felt like this for years!!!!

[rick blaine]

Hi mattshaw,

You say: "There is no way of them really knowing how tired you are or what quality of sleep you are really getting."

The 'checksum' part of the 'fit-to-drive' assessment is - or used to be - the patient filling in the Epworth Sleepiness Scale.

I get one of those to fill in at every one of my annual follow-ups.

In addition to the questionnaire, the sleep service staff or sleep medicine staff - whatever your hospital calls them - also use their eyes and ears to form a clinical impression. If you look haggard and beat, and sound tired and dispirited, they're more likely ask a few questions.

Having said that, the situation in the UK is changing - one, because there are more patients coming forward now. Once GPs got the idea that there is a treatment, and that it is, in the main, highly effective, then they started referring more people to the sleep service clinics.

And two, at the same time as patient numbers have increased, the two major machine manufacturers have been busy. In addition to bringing out lighter, quieter models, they have included (in some models) a 'wireless card' - one that can connect up with the nearest mobile-phone mast, and through the mobile-phone network, with the sleep service staff at the hospital.

So far, this has only happened in some UK areas. But where it has, it means your doctor and specialist nurses and sleep physiologists can (a) see how you're doing, and (b) make changes to the machine's settings - all 'over the phone' - and without you having to go in for another appointment.

Now, as you've twigged, mattshaw, this new way of managing patients means less face-to-face contact. And less reliance on - and maybe even doing away with - the Epworth Sleepiness Scale.

And, as you've also twigged, what's to stop some deliberate faker (or hapless f***er) from just sticking the machine on and meditating for four hours? Or doing crosswords? Or staring at the walls, insomniac?

It's the 'ninety-nine times out of a hundred' argument.

If someone has a CPAP machine on and they're in bed and the lights are out, then the reasonable assumption is: they are sleeping. And if the SD card shows an AHI below 5, then the reasonable assumption is: they are sleeping 'soundly' and 'normally'.

Because the DVLA is making the same assumption - minus the machine bit - about the average Joe (or Josephine) who does not have sleep apnea.

Short of putting every driver in the land through a full-on sleep lab, wired up sixty ways from Sunday - ECG, EEG, trunk orientation, limb movement, blood gas analysis, and so on - the Agency assumes that, unless there is clear evidence to the contrary, you are getting enough rest and you are safe to drive.

And when your consultant says 'this person is good to go', then that's a legal statement - and that's all that the Agency wants and needs to know about you.

[mattshaw]

Thank's Rick, that all makes sense and is reassuring. The responsible ones like myself though would find it hard to drive when totally tired and wouldn't risk it. My car is parked up until I get the ok.
My machine is brand new with Modem and Card, and can be adjusted remotely, so will be expecting less appointments and remote adjustments!

[mattshaw]

OK, I'm 5 days in and the results are looking odd! Started off well then went up and now last night a massive increase in hypopneas and very low apneas, and higher leakage. Anyone any ideas - nothing has changed. The only thing I have done over the last couple of days was eat my dinner 2 hours earlier.

[rick blaine]

Well, it's not good, but it isn't the end of the world.

It's hard to know what to say - for several reasons. One is, it's only been five nights, and there are some who would wait for two week's worth of results before aiming to spot the patterns.

Two, this form of presentation doesn't give many clues. The software from Philips Respironics called Encore (which is presumably what your sleep medicine department uses) and the shareware called Sleepyhead both show more detail than this.

This is barely a summary.

The third thing that concerns me is: what's the protocol here? At what point is your consultant going to start making changes? Wouldn't it be better for you to wait and see what she has in mind?

[mattshaw]

Thanks. Yes it is early days but cannot see any real patterns myself. The specialist asked me to call her after a week when the results will have been downloaded and she can suggest any changes. I washed the mask and hose this morning and hoping to have a good night tonight. The graphic is just something I have put together myself from a spreadsheet so I can see all the data on one sheet and have yet to download the data from the SD.

[mattshaw]

Ok, downloaded last nights stats if anyone has any comment!!