Would love help to analyze OSCAR

[TheClerk]

Hi all,

I've been only using my CPAP for 7 days. Things seems to be going good; I don't have full night sleep yet but, the time I do sleep, it seems a lot less eventful than before!

I started watching some videos on how to interpret the OSCAR charts and, will continue to do so. I've purchase the package with "unlimited" follow-ups with my DME/sleep clinic and, they seem like a good place. As such, I am probably in good hands but, I'd still like to be able to understand the basics as far as my reports goes.

As such, I wanted to show you last night's report, simply to confirm 2 things. It was a rather uneventfull night (which is good!)

To put things in context:

- Went to bed a bit before midnight (I forgot to change the machine time this weekend); although in Canada, I couldn't stop watching the election coverage...
- Bathroom brake around 4:30 with, as far as I remember, good sleep until then.
- Less good sleep after that brake, as is usual since I began CPAP (although before that, I would go to the bathroom more often and wasn't getting any good sleep at all)

So, first graph is the entire night's graph. Using the P10 with the medium cushion the first 2 days didn't seem to produce much leaks but, last night, I had a more troubled sleep after my bathroom brake and, I really felt like it was difficult to have a proper "fit" of the pillow. So, my question regarding this graph is whether these kind of numbers for leaks are worrysome in the long run. I mean, expanding the flow rate at those times whith highest leaks, I see the flow line a bit crazier but, I am unsure to the effect of my actual sleep. Should I discard this as a non issue, seeing I don't recall awakening because of it and the rate is pretty low?

The second graph shows my OA. I simply wanted to confirm if this was a text book case of an event? Am I interpreting this correctly if I say that the graph would indicate I stopped breathing for about 20 seconds, which was followed by a leak spike, which would maybe indicate I opened my mouth to breathe? What you don't see is that the "inspiration time" graph also shows a spike.

Again, I'm not complaining about getting an AHI of 0.30 (when my home sleep test stated 34.2!); I just wanted to confirm I'm interpreting things correctly.

Thanks for your help.

[khauser]

You're doing great, especially for just 7 days in to it. It sounds like you are sleeping better, but not yet ideal. That's coming ... you're still getting used to living with this change.

Other's with more experience than me will chime in, but there's nothing in your graphs that cause concern. All of us have some events still. You'll see things go up and down with time. The most important metric is how you feel. The numbers are secondary to that, by far.

Keep it up!

[LSAT]

https://www.resmed.com/en-us/sleep-apne ... ve-apneas/

[TheClerk]

Thanks to both of you for your input.

As I said in my post, I wasn't doing this post to "solve" a problem; I already understood hat events will still happen and, also understood that getting anything below 5 events per hour on CPAP is technically considered a success.

My 2 questions were:

1- Do I have to worry about the leaks. khauser stated he doesn't see anything of concern in my graph so, It would imply that, the leaks are a non issue.
2- Did I "analyze" the graph showing the OA event correctly? Just want to confirm if that was a "textbook event" that, if I see that, there is no doubt about an event having taking place.

Thanks again

[deerhound]

Wish I had a leak rate like yours!

[Okie bipap]

Many people would like to have your leak rate. The events you isolated are events flagged by your machine. However, you can see where you took a deeper breath just before the event happening. This indicates you were probably awake and moved slightly in your sleep. We often have these micro awake events during the night. The machine is programmed to detect even sleep breathing. When we are awake, our breathing is normally not very even like it is when sleeping and this often causes the machine to flag events which are not true sleep apnea events. I hope I haven't confused you more with this explanation.

[Pugsy]

The one flagged zoomed in on event....I also think that the big gulp of air prior to the flagged event means you probably had an arousal of some sort from something. Probably don't remember it and that's normal as well. I would call it SWJ or sleep/wake/junk and not call it as a real asleep event.

Now this example below...note that the flow rate is always nice and smooth and no big gulps of air. These are real asleep event flags.
Sometimes the changes are very subtle but in the case with the one you zoomed on...fairly big obvious gulp of air. We don't breathe like that when we are asleep.



Your leaks are a total non issue unless they are waking you up. The machine can actually compensate fairly well for leaks up to around 35 L/min. ResMed calls large leak territory at 24 L/min but that's an ultra conservative number and the machine doesn't start having real issues with recording or responding until leaks exceed 35 L/min or so and for a prolonged period of time. Short big leaks..not a big deal unless they wake you up anyway. I might see 30 L/min leak for 5 minutes...mask movement or whatever. I sleep through it and I shrug my shoulders and move on.

Now any leak that disturbs sleep no matter how big or little does need to be worked on but from the stand point of the fact it is disturbing our sleep and anything that disturbs our sleep is unwanted.

How old are you? Male or female? Do you normally have to pee frequently during the day? I am wondering why the pee break...Now maybe there is some other reason.....but I do wonder why.

Overall...very boring report which is extremely good.

[TheClerk]

The one flagged zoomed in on event....I also think that the big gulp of air prior to the flagged event means you probably had an arousal of some sort from something. Probably don't remember it and that's normal as well. I would call it SWJ or sleep/wake/junk and not call it as a real asleep event.

Now this example below...note that the flow rate is always nice and smooth and no big gulps of air. These are real asleep event flags.
Sometimes the changes are very subtle but in the case with the one you zoomed on...fairly big obvious gulp of air. We don't breathe like that when we are asleep.

Gotcha! Thanks.

Your leaks are a total non issue unless they are waking you up. The machine can actually compensate fairly well for leaks up to around 35 L/min. ResMed calls large leak territory at 24 L/min but that's an ultra conservative number and the machine doesn't start having real issues with recording or responding until leaks exceed 35 L/min or so and for a prolonged period of time. Short big leaks..not a big deal unless they wake you up anyway. I might see 30 L/min leak for 5 minutes...mask movement or whatever. I sleep through it and I shrug my shoulders and move on.

Now any leak that disturbs sleep no matter how big or little does need to be worked on but from the stand point of the fact it is disturbing our sleep and anything that disturbs our sleep is unwanted.

Thanks for the information; I'm really grateful.

How old are you? Male or female? Do you normally have to pee frequently during the day? I am wondering why the pee break...Now maybe there is some other reason.....but I do wonder why.

Overall...very boring report which is extremely good.

I'm a 47 years old male with excess weight. I do pee frequently during the day. No known health issues on that front though. As for the night's pee break; I can't say for sure if I wake up because I need to pee but, if I wake up and I need to pee, I am too self conscious of that fact to be able to get back to sleep, even if I could "hold it in", I'll just worry I'll have an "accident" If Iwake up only once per night for the rest of my life, I will consider myself lucky compared to before...

Thanks again everyone.

[Pugsy]

Some people just pee often. It might be that is what you do. It might also be that years of apnea events sort of caused the brain to get into the habit of when you wake up you figure "I am awake, I might as well go pee".
Now that said...nocturia is a common side effect of sleep apnea. So pre cpap...there might have been some pee breaks related to sleep apnea nocturia. When sleep apnea is the only cause for nocturia....once we get effective therapy we lose the nocturia from at least the sleep apnea but it obviously won't help if the nocturia is from something else or just habit. Per your report you OSA therapy is now well managed and the pee break shouldn't be related to sleep apnea.
Is it related to something else or just habit...don't know but it creates a problem because it disturbs your sleep and you have trouble going back to sleep which of course we don't want.

Now you are new to cpap therapy and some sleep issues do seem to come with the fact that everything is new and sometimes with time you won't be in a situation where you have trouble getting back to sleep.

At some point since you also report frequent urination during the day....do have a chat with your doctor about it and have the old prostate checked out. You aren't of the age where BPH is common but it wouldn't be impossible....so do talk to your doctor about it at some point in the future.

I think you are doing very well for being so new to therapy. Much farther along than I was at your stage.
It will get better and easier with time as well.

It is very possible that as your brain adjusts and you learn to sleep more soundly that your overall sleep quality will improve and the one remaining pee break might also disappear. It might just do that if you sleep more soundly.

[TheClerk]

Thanks Pugsy,

Yeah, I'm considering myself lucky to have adapted this rapidly and, crossing my fingers that it will hold.

Yesterday, I tried the Eson 2 for the second time. I tried it 2 days ago but, switched back to the P10 during the night as I had trouble managing leaks. Last night, I kept the Eson 2 the entire time. I woke up at around 4:30 (which was about 7 hours after going to bed), went to the bathroom and adjusted the mask as there was a leak and, I was able to get back to sleep more easily than usual.

Looking at OSCAR, the leaks were really higher than with the P10. Not sure what the best number to use is but, the 95% number is 14.40.The machine flagged a bit more events with 1 RERA and a couple Open airway. (AHI of 0.73 so, I'm not worrying at all) I am not posting my report for now as I will try to control the leaks before I do. Upon waking up, I was feeling fine but, 2 hours in, I am yawning a lot so, I guess the leaks had an impact on my sleep and the last 2 hours after my pee break did not help.

Anyway, trial and error and 1 day at a time.

Last question: does changing the type of mask in the resmed change anything in the treatment? I forgot to change pillow to nasal since I was using the Eson 2. Is it only for report purposes?


Thanks again.

[Pugsy]

95% numbers (either leak or pressure) don't really mean all that much. The actual definition is AT OR BELOW for 95% of the night.
It is NOT an overall average or anything like that.

Not changing the mask type from pillows to nasal doesn't really affect therapy or function. Not a big deal.
Might maybe affect the leak result ever so slightly but not a big deal.
I once tried a full face mask for a week after always using nasal pillows. About 5 days in I realized I hadn't changed the mask type so I made the change. Absolutely nothing changed significantly. I saw a very minor 1 or 2 L/min difference in leak numbers which could very well have been nothing more than normal variance from night to night anyway.

Use the mask that you feel lets you sleep the best and feel the best during the day and won't worry about the numbers.
Numbers don't guarantee much except a nice math score. How you sleep and feel is the most important thing. Without that...nothing else matters.

[TheClerk]

Thanks again Pugsy,

I am using the 30 days windows to test mask. My DME/clinic seems to really encourage that and they have loaners so, I'll try the Eson 2 for a few nights more, switch back to the P10 a bit and, probably ask to try a 3rd. one, either another nasal one or, even a full face, just in case I start to switch on my back more. Even though I noticed that, since I'm on CPAP I seem to move a lot less and stay on my side most of the time, I still awoke a couple of times when my torso switched almost fully on my back and my jaw opened and I started leaking and snoring.

Before I would toss and turn a lot more, even to the point I was doing 270 degrees turn, to the dismay of my girlfriend who never quite understood why my brain would choose to take the longer 270 degrees path, to achieve a 90 degrees turn!!!

So, I'll see how things develop but, at the very least, it's positive on my girlfriend's mental health so, happy wife is happy life!

[TheClerk]

Gosh! It would be so cool if last night was a preview of things to come!!!

Saturday night was "so-so"; I had a good first part of the night but, as usual, the part after the usual waking up was less than perfect. Result: I woke up with a headache and had to take a nap midday.

This is why the following report for Sunday night starts at 13:00. the night itself only shows 2 events but, I'm pretty sure they are false positive, as I remember being awake around that time, waiting for the 6:30 alarm to come. I might have dozed off a bit but, nothing serious.

As usual, the second part of the night was not as good as the first but, better than most nights prior.

I don't feel quite as refreched as I would like but, with the unrefreshing night before, I was happy to see that, this morning, I left the bed with no hesitation, no body aches, no grumpiness and, with enough willpower to do a few simple morning exercices

It also reaffirmed my appreciation of the P10 mask... The last few days, I tried the Eson 2 and, although I like the fact that when I breathe in that type of mask, I "fell" the air around my nose, the leaks that I can feel as I turn on my side. and the fact I never really know if it's too tight or too loose is bugging me.

As for the P10, I sometimes feel like I can't "feel" the air going in my nose as much as I think I should. I also go back and forth between the Medium and Large. Nonetheless, with last night's report, it seems clear it's doing it's job...

I do have a question though: the only issue right now is that I'm waking up feeling a bit like I have a runny nose; I'm wondering if it's like a "rainout" and I should fiddle with the humidity? I have the heated tube and, if I remember correctly, my respiratory therapist told me to not play around with the hose temperature but, with the humidity. I just don't know if I am supposed to put it higher or lower? (I know it should probably be evident but, somehow my brain isn't cooperating...)

[Pugsy]

With the slightly runny nose are you having any sneezing, itching, congestion like symptoms?
What is your humidity setting currently?
What is your ambient bedroom temperature?
What is the hose temperature setting?
Do you know the ambient humidity in your house? If not, consider getting one of those little gadgets that tells the humidity in a room.

Humidity needs vary widely among people who use cpap. Google cpap rhinitis and start reading.

As for the advice to not change the hose air temp....stupid...unless someone knows your ambient room temp and whether or not you might be increasing the chance of condensation in the hose or mask with any changes to humidity. They probably have it set to "auto" thinking that auto works perfectly but I can tell you from personal experience it doesn't always work so perfect depending on actual ambient bedroom temps.

A common feeling with the use of any cpap mask, after a period of adjustment and use, is waking up in the middle of the night and not feeling like the machine is moving enough or even any air....we wonder if the machine is even on. It's the brain acclimating to the air pressure to the point that it thinks "things are normal" and it's okay with the new normal. I had this happen to me a lot during the first 6 months of cpap therapy when I started. It can panic some people and is a bit alarming until we realize the machine is indeed on and doing its job. What I would do is just briefly pull the mask away from my nostrils to feel the air moving against my nose.

[TheClerk]

good morning Pugsy!

No sneezing, itching or congestion like symptoms. Simply a "wet" sensation.

Humidity setting is at 4
Bedroom ambiant temperature: thermostat is set to around 72F (22 Celsius)
Hose temperature is 27 Celsius so, around 81F

Last night, the bedroom window was open, seeing we are having a hotter than usual weather for the season here in Quebec, but, we did start to use the electrical heating as the weather started to drop lately. Nonetheless, the night was a bit chilly and, the "wet" nose has been happening for some days.

I'll try to find the humidity meter that I know is uselessly lying around somewhere in the house...

As for the mask, I hear you; I know it works, as I pulled it a couple of times and I can see that plenty of air is coming out of it. Still, somehow, that little brain of mine can't seem to compute the fact that it doesn't feel the air trying to rush in when I ain't breathing in when I can clearly feel it if I simply pull the cushion back a bit. Also, I don't know if I have a deviated septum but, I have had issues for a long time with air not getting in one of my nostril as much as the other. That, coupled with the fact the feeling changes when switching position, makes me way too much self conscious about everything.

In any case, since the beginning, I removed the ramp and, changed the 6-20 settings to 7-20, both to react to what I was seeing in OSCAR and make sure I had the feeling of having enough air. Looking at OSCAR, I think I could even start at 7.5 but, I don't want to change things too fast.

Thanks.