OSA is going well, overall things maybe not

[TheStamp]

So I have reached 3 weeks of CPAP. First two titration on an AirSense 10 AutoSet, last one on my 11 AutoSet. Which is overkill for the prescribed 12.2 but I wanted a machine before being left out, and just got the most flexible one. I’m seeing OSA have dropped off to near zero per night and that’s awesome! But the last… 3 days? The AHI has been creeping back up and it’s all CA events in OSCAR, it’s now at 12 AHI. I’m really not thrilled by this, what should I do?

[Pugsy]

How is your sleep quality??? Waking often during the night????

Read this thread.
viewtopic.php?f=1&t=190210&p=1469429&hi ... d#p1469429

Start from the top and read is all. If you aren't sleeping soundly, for the most part anyway, those centrals or anything else.....aren't real and no cause for worry.

Are you using EPR and sleeping soundly then we may need to look at EPR as a potential culprit.

You need to get OSCAR and use it.
http://www.cpaptalk.com/viewtopic/t1585 ... eview.html
viewtopic/t190188/OSCAR-201-is-available.html

how to post images so we can see what you are seeing or use SleepHQ
because forum member can zoom in on the flow rate
I don't have a link for SleepHQ handy but it has been mentioned and used a lot.

viewtopic/t190188/OSCAR-201-is-available.html

[Pugsy]

Found it

https://www.sleephq.com/

If you don't have a SD card in the machine you will need to get one. Any plain SD card will work....just don't go getting a huge capacity card....anything from 8 GB to 32 GB will work.

[TheStamp]

Thanks for the reply! I have OSCAR (albeit 1.7.2 because that's seemingly the latest .rpm available?) but the zooming in is probably more valuable in my case than the average as my sleeping patterns have decades of accumulated mess and... the graph takes 24 full hours because of the midday reset. Yeah, that bad. So here's yet another account lol https://sleephq.com/public/c5aa27d3-794 ... 8177ca82e5


A small side note, I'm kinda prone to anxiety and panic. Just... putting it there.

Edit: but you asked more questions, I should answer them. How did I sleep? I think I wake up a little from time to time, but it’s not “up to pee we go” as before the machine. It’s more along the lines of barely being conscious for a short time and back to sleep, often without opening my eyes. Tiredness: hard to tell. It’s easy to say better than before the machine, but as I learned, that was real bad. I have no clue where “good” stands. Subjectively, I didn’t feel the need of a nap after lunch, so uhhh… towards good? And all the settings are as per sleep study, that’s what the doctor ordered. Aside from auto start/stop/ramp

[Pugsy]

How is your sleep quality??? Waking often during the night????

I didn't see an answer to the above question...
Answer please... thank you..it's important because I think your problem is sleep and not all those false positives.

Do you take any medications of any kind (even OTC)? If so...what is it...dosage and time of dose as well as name.

The bulk of your flagged events seem to be post arousal which points to crappy sleep and a sleep problem.

EPR is during ramp only....so I don't think we can blame EPR.

Overall there is a large amount of arousal or post arousal breathing going on. Now to figure out how to improve your sleep quality in general.

[TheStamp]

Sorry! As you can see I evidently edited the answers in while you were typing an answer, my bad. I don’t take anything to sleep. The only unusual thing going on is a bit of a stuffy nose and a… thing to make mucus more liquid or something? Anyway it’s a tablet in a glass of water at dinner. Still! Question and answer: 1 tablet per day of Fluimucil 600mg. Should keep taking that terrible tasting thing for 10 days.

[Pugsy]

Question and answer: 1 tablet per day of Fluimucil 600mg. Should keep taking that terrible tasting thing for 10 days.

I don't know.
I don't know why you are taking it and has it helped whatever it is that you are taking it for.
I assume the stuffy nose but if it is nasty....maybe discontinue it for a week and see what happens to your data.
It is well known to cause sleep problems but that doesn't mean it doesn't for some people.
When did you start taking it? Was it about the time your number of central apneas starting increasing.

You may not remember all those arousals but you are sure having them.

Might want to alert your doctor.

[TheStamp]

As far as helping, it does: I went from having drip in my throat, like a constant something half stuck there, needing to spit all the time and nose more stuffy than normal, to essentially normal. I could technically stop, and I guess I’ll try tonight? But that graph is the 4th night taking it. Damn, looking at the Watch’s “sleeping disturbances” graph it _is_ the last 4 nights… well caught. That might be the cause, somehow. I’ll see tomorrow how it goes without!

[Sleepzilla]

ResMed's AirSense CPAP/APAP machines and AirCurve BiPAP machines do not attempt to treat CA/CSA events, because they're incapable of doing so. They utilize Flow Oscillation Technology (FOT) to detect CA events expressly in order to intentionally ignore them from a therapy perspective. This is easy to verify in OSCAR when noting that these machines increase therapy pressure in response to OA events only, and do nothing in response to CA events.

Sometimes CA/CSA events emerge during OSA therapy due peripheral effects of PAP therapy, such as CO2 being flushed from the respiratory tract, and thus inhibiting the natural urge to breathe. This is typically referred to as Treatment-Emergent Central Sleep Apnea (TECSA) and often—but not always—resolves on it's own as the patient eventually adapts to OSA PAP therapy and/or the OSA PAP therapy settings are modified in some way that makes the CA events subside to a tolerable level. (The latter often also results in an increase in OA events, requiring some level of therapy experience compromise.)

For those with CSA unrelated to OSA therapy, or with persistent TECSA mixed with OSA (like me), the AirCurve ASV model Adaptive Servo-Ventilation machines are the only therapy machine capable of actively and effectively treating CA/CSA events.

Resmed's Therapy Handbook for sleep technologists and clinicians is a great and informative reference for understanding the available therapy modes and titration protocols for the available therapy machines.

[TheStamp]

Thanks to Sleepzilla for the very detailed explanation and the link to (for me anyway) wildly overkill pdf. Was still interesting to try and grasp the basics.

So, to the meat of this message: a night without Fluimucil and here’s the result https://sleephq.com/public/ff812cc4-acf ... 55bb966cb6

MyAir says 11, but when selecting in OSCAR only tonight rather than the bits of yesterday too, it’s… man I already forgot. Nine something? Anyway a drop. But obviously I’m not an expert and hopefully I can get a better opinion

[Pugsy]

Again all events but maybe one hyponea that we see flagged are post arousal flagged events.

ResMed restart of recording happens at 12 Noon. So if you are asleep or using the machine at Noon you will see those breaks or little bits of the previous day.

How was the congestion last night? The flow limitations graph is rather active and sometimes FLs seen are related to nasal congestion and not airway collapses.

[TheStamp]

I clean my nose before bed and yesterday specifically I think it was fine. But I did have a few doubts about having stopped taking Fluimucil too soon (up to 10 days, but rarely I do less than 7 so this was unusual). I remember blocking one nostril at a time, and coming out of the experiment with a feeling of “good enough”. As far as things today, I had trouble getting out of bed, but after that I seem to have more energy. Soooo… a little too soon to say with certainty, but maybe that was it?

[Pugsy]

Here's a big monkey wrench in things when trying to isolate culprits....we don't sleep the same each night even with no changes in anything so it's hard to determine if the change in anything impacted the results with any certainty. That's why we don't get all that excited with any single night's results (good or bad). We need long term consistent usage to see how things go long term.

Your flow rate pattern still looks like a lot of crappy sleep quality from something. You may or may not remember the arousals but they are there. Maybe a tiny wee bit less last night but nothing to write home about at this time. It's normal to have a handful of arousals and not a big deal unless they seem prolonged....and it's the duration that is the problem.
Sleep is really rather fragile and the least little thing can upset it and when we don't get enough of the sleep stages we normally go through and correct duration then we don't feel so great.

And another monkey wrench.....just in general getting used to the cpap machine and mask takes a bit of time for the body and brain to get used to the new normal.

[TheStamp]

Oh yeah, I’ve been trying to replicate the conditions of the previous day best I can, to get meaningful data. However. Things different this time: no auto off, no Fluimucil, and damn I’m sure I’m missing a third, likely smaller thing. Uhm. Anyway similar meals and so on is my point. Looking at the data, I focused around 6am as I _remember_ opening an eye at least twice to see if it was time to get up, but it was 6 something so I got back to sleep. And I see what you mean, there’s a little more activity before the cluster I checked out… this gives me an idea, fully acknowledging that I don’t know what I’m talking about here: I remember waking up multiple times, barely mind you, but doing so with my mouth ever so slightly open and air obviously rushing out. Is it possible, just… a guess obviously, but is it possible that I opened my mouth a little as I almost woke up, and that’s the CA? Just a weird air pathway? And then I got to sleep super quickly?

Ah! The third thing! I recently bought a thermometer with a CO2 sensor and started to optimize the otherwise rather bad air in the room. So likely I’m getting less CO2 too. BUT that’s a few days before the increase, so I don’t know what to think.


Anyway I understand that 1 data point is absolutely nothing. Worth keeping an eye on for an emerging pattern, but that’s it… I’m going to replicate the experiment tonight and likely at least tomorrow too, to see if there’s a trend or just a wobble.

[Pugsy]

Is it possible, just… a guess obviously, but is it possible that I opened my mouth a little as I almost woke up, and that’s the CA? Just a weird air pathway? And then I got to sleep super quickly?

Entirely possible.


Remember this...and if you zoom in and don't see nice boring rhythmic breathing with no peaks or valleys...you aren't sound asleep.
You may or may not remember waking but we wake nonetheless.

I circled the for sure asleep breathing in red .....all that other stuff is arousal or maybe awake breathing but I didn't remember an awakening at that time.


same time frame but just zoomed out more so the flow rate is sort of more scrunched together.