YEA My First Oscar submission

[scf]

There is method to my madness. (Smiling devil face emoji).

[zonker]

There is method to my madness. (Smiling devil face emoji).

i'm keeping my eye on you....

[palerider]

a swelled head?

I'll have to open the other half of the french doors.

[scf]

[scf]

I am still learning about Oscar and truly do not understand APAP induced CA's versus SWJ versus whatever. Last night I slept very well, put the mask on and had minimal to no leaks. I slept 4 hrs, then another 3. I did have a pulse ox on my finger at the doc's request because my initial (HOME) sleep study showed a drop to 88%, but it did not bother me. Although I took it off of my index finger at some point and put it on the other side because it felt too tight on my finger. I would greatly appreciate comments on this data from the more knowledgeable of you. I have been advised to up the max pressure by some of you but I tried and even at 12 it caused major leaks and air swallowing. I have a very small face and the small F30i is still too big. I wish they made an extra small.

Screen Shot 2021-10-26 at 12.44.57 PM.jpg

[Pugsy]

Go here and learn how to zoom in on individual events.
http://freecpapadvice.com/sleepyhead-free-software
Watch all the videos with special attention to the bottom/last video.

Time for a crash course in figuring out SWJ vs real centrals.

First thing you have to figure out though is going to be real asleep flow rate from arousal/awake flow rate breathing.
Remember....we can have arousal/awake breathing and not remember it.

Then go to the events tab on the left side above AHI numbers. Click on it and you will see the 3 categories of events.
CA/Central, Obstructive, Hyponeas
Click on ClearAiray and the menu will expand to all the flagged CAs/Centrals.
Scroll down until approximately 3:27 grouping of CA.
Click one the 2nd CA flagged in that grouping at around 03:27. I can't see the exact time but it was somewhere just shy of 3:30. So click on the second flagged CA in that cluster. The graphs on the right side will automatically zoom in so that the 2nd flagged event you clicked on is sort of in the middle of the graph.
I want to be able to see not only the flagged CA but the flow rate/breathing just prior to the flags.

Get me a screen shot.
In the meantime let me show you full awake/arousal related centrals....give me a minute to find the screen shot.

[Pugsy]

Bad night in terms of insomnia monster setting up shop. Lots of false positive/SWJ centrals.

I never actually went to sleep until around 01:33. Even had a false positive hyponea (false positive flags can be any event category...not limited to centrals....Palerider had a night with a gazillion false positive OAs a while back. He knew for sure he wasn't asleep just like I knew for sure I wasn't asleep for all this mess below.

insomniacentrals.PNG

insomnianight.PNG

Real asleep breathing and real asleep flagged events.



Asleep breathing is very regular and uniform when compared to awake/arousal related breathing.
Below a couple of zoomed in examples.
Asleep breathing circled in red.

Same time frame graph but zoomed out a bit. Everything that isn't circled in red was awake/arousal related.

[palerider]

I am still learning about Oscar and truly do not understand APAP induced CA's versus SWJ versus whatever.

Well, it's very "Simple", (did you hear the sarcasm? )

'swj' or more formally called 'transition apnea' is(are?) caused because your body has different systems that control awake breathing and asleep breathing, and as you drift in and out of sleep, you'll naturally pause breathing, if that pause lasts long enough, the machine will flag an apnea, but in a sleep lab, they'd just say "oh, transition apnea" and not count it.

APAP induced CAs are more complicated, maybe. You have to understand that what makes your body want to breathe has little if anything to do with oxygen levels, and all to do with the amount of carbon dioxide in the blood, more CO2, more 'must breathe now!' urge. Too little CO2, and your sleeping self just says "meh, I'm fine, I'll get around to it later" and you don't inhale. As the CO2 builds up, the ''respiratory drive' increases and you breathe.

A CPAP with different pressures on inhale and exhale increases the amount of ventilation, ie, it's increasing your tidal volume (amount of air in each breath), and that extra ventilation blows off more CO2. if it's enough extra, then you end up below that 'need to keep breathing' level, and you just pause breathing until the CO2 builds up enough. That's why we suggest that people having lots of CAs try turning EPR down, or even off (thus reducing the extra ventilation), to see if it makes a difference.

Some people are more sensitive to that extra ventilation than others are, (around 1 in 7 people, depending on what study you look at) and thus can have cpap induced CAs.

I hope that helps.

[scf]

Wow, thank you both so much. What a tutorial! Hubby golfs tomorrow so I will sit down and assimilate all of this and learn how to zoom in, and hopefully understand it. You two are awesome. (God and goddess emojis).

[scf]

Hi, oh wise ones. I have not done my homework on CA’s yet, but I will after you took so much time to explain it.

Out of curiosity I went back and looked at all of the Oscar data that I have. As an uneducated person, I was looking at total AHI and gauging success based on that. To my total shock I have had virtually NO OA’s since I started this therapy whether the pressure was set on the original 5/20 or 7/11 or 8/12. I had one night of 0.51 at 5/11 pressures, one night of 0.13 at 8/12 (but huge leak and aerophagia) and one night of 0.26 at 7.2/11/2.

So all of the events have been these clusters of CA’s when I was not sleeping well, fiddling with the mask, had a huge leak, etc.

What say you two? Do I need to be tweaking these pressures at all?

[Pugsy]

No.....don't go worrying about tweaking the pressures.
Even if the CAs/centrals were real asleep centrals (which I doubt anyway) more or less pressure won't/can't fix them.

I suspect that the bulk of your central clusters are related to awake/arousal breathing...fiddling with the masks or leaks...and to deal with those centrals you have to fix whatever it was that caused the arousal/awake breathing.
The centrals are more likely a byproduct of simply crappy sleep.

If this is a one off night and rare happening and you know you didn't sleep well.....probably can just shrug your shoulders and move on and no need to do the extra homework unless you just want to.
BUT if you start seeing this sort of stuff happen a lot then we do have to for sure do the homework because we have to identify the problem first before we can try to fix it.

More pressure only helps with OAs and hyponeas. Won't do a thing for centrals.

Your choice if you want to devote the time and energy but if you could do the one zoomed in screen shot that I outlined above....might tell us what we are looking at and you don't have to worry about the extra homework.

[scf]

screenshot-20211027-120109.jpg

[Pugsy]

Zoomed in too close....that's about a one minute segment and need maybe a 3 to 4 minute or so segment.

Repeat again...highlight event #27 this time. Don't zoom in any closer than 3 to 4 minutes.

[scf]

Pugsy, it looks like 2 mins. is the default on this computer.

3-4 mins.png

[Pugsy]

Those all look arousal breathing to me but what I can't see is the flow rate prior to the first flag during that cluster.
Also odd.....in one screen shot #27 event is timed at 3:53 (your latest image) and the one I was first looking at the #27 was timed at 3:27......what the heck????

Repeat one more time....click on the event timed at 3:27.
I can deal with 2 minute segments for now but there is a way to alter duration (explained in the videos)

I need to see some flow rate preceding the flagged event....that's real important. It tells us if asleep or arousal breathing was going on before the first flagged event.