Requesting an OSCAR decoding

[MmarcM]

Hello all. I have been using cpap therapy for about 4 years now. I had sleep apnea for about 20 years before I finally got on cpap therapy. My congnitive and concentration came back but I still get tired, not really sleepy, but just exhausted, like Im sleep deprived, feels like i had a beer, happens at around 2PM or sometimes it hits me at 5 or 6 PM, I have to get a minimum or 9 hours of sleep or it will hit me earlier in the day. I push thru my workouts in the evening, well most of the time, Im 56 and in pretty good shape, dont drink or smoke. My Resmed Myair always show average of 1.5 events per hour. I have my mask dialed in so not to many leaks, I average about 10l/min.

My last 2 sleep doctors say I just have "Excessive Daytime Sleepyness" and give my Modafinnel or other stumulants that amp me up but my body still feels like it wants to shut down. My current sleep specialiast thinks I went so long with sleep apnea than my brain, in so many words, got reprogrammed and doesnt know when I should be a wake or sleeping. Im supposed to go back for a night and day sleep study in September.

So my question is... about 5 months ago I woke up in the morning and my heart felt like it was beating a lot harder than usual, it happened again this morning, I woke up on my back and usually sleep on my side. Unfortunately my cpap machine wasnt recording to the SD card last night, I pulled the card out about a week ago and I guess I need to initiate the machine to record or something. Anyhow I thought I would post my OSCAR report from August 17th and see if anyone can make heads or tail of it. I so tired of being tired. Thanks for any help or suggestions.

[Pugsy]

viewtopic/t172378/StickyIf-you-want-CPA ... Gquot.html

http://www.cpaptalk.com/viewtopic/t1585 ... eview.html

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3286657/

The normal half-life of modafinil in humans is between 12 to 15 hours

[Miss Emerita]

Do put your SD card back in your machine so that if you have that some experience with your heart, you'll be able to see what was happening with your breathing around that time.

Some sleep guidelines say that it's best not to exercise too close to bedtime. Can you do your exercising in the morning?

Some people with disordered sleep see improvement after trying cognitive behavioral therapy for insomnia; more here: https://www.sleepfoundation.org/insomni ... y-insomnia I realize you aren't reporting wakefulness at night, but some way of restructuring your sleeping and waking lives might be of some benefit.

[MmarcM]

Do put your SD card back in your machine so that if you have that some experience with your heart, you'll be able to see what was happening with your breathing around that time.

Some sleep guidelines say that it's best not to exercise too close to bedtime. Can you do your exercising in the morning?

Some people with disordered sleep see improvement after trying cognitive behavioral therapy for insomnia; more here: https://www.sleepfoundation.org/insomni ... y-insomnia I realize you aren't reporting wakefulness at night, but some way of restructuring your sleeping and waking lives might be of some benefit.

Hello, I did put the SD card back in the machine. Ill try it again, I unpluged the unit and then back in after I installed the card, after the power cycle the readout said that the card was initiated. Interesting stuff with the CBT-I. I looked it over. I can fall asleep pretty quick, I wake up average twice a night. I usually excersise about 3 hours before I go to sleep

[MmarcM]

viewtopic/t172378/StickyIf-you-want-CPA ... Gquot.html

http://www.cpaptalk.com/viewtopic/t1585 ... eview.html

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3286657/

The normal half-life of modafinil in humans is between 12 to 15 hours

Thanks for the info. Im going over it now. Are Event Flags, Flow Rate, Mask Pressure, Leak Rate, and Flow Limit all that needs to show for an initial OSCAR report?
Once I blank out the calender, I still cant get all of the info on the left column (Statisics) to show up. I would have to screen shot once then scroll down to get the rest and take another screenshot, unless theres is a way to shrink it, maybe Im missing something.

The Modafinil is good stuff. Yes half life is what gets me. I tried different dosages and just cant fall asleep on any dosage. I love the feeling during the day but then pay for it when bedtime comes.

[Miss Emerita]

I would strongly suggest that you exercise at a different time of day.

In your reply to Pugsy, you said the Modafinil keeps you awake when you go to sleep. You also replied to me that you don't have a problem falling asleep. Have you stopped taking Modafinil?

Make sure you have the calendar and pie chart turned off in the left panel. If you can't fit everything into one screen shot, leave out the information at the bottom and include the information at the top. The key graphs are Events, Flow Rate, Pressure, Leaks, Flow Limitations, and Snores. You don't have to include anything else.

Have you talked with your regular doctor about feeling tired in the afternoon? He or she might have some thoughts about e.g. blood-sugar levels. Not every tiredness problem is a sleep-respiration problem.

[MmarcM]

I would strongly suggest that you exercise at a different time of day.

In your reply to Pugsy, you said the Modafinil keeps you awake when you go to sleep. You also replied to me that you don't have a problem falling asleep. Have you stopped taking Modafinil?

Make sure you have the calendar and pie chart turned off in the left panel. If you can't fit everything into one screen shot, leave out the information at the bottom and include the information at the top. The key graphs are Events, Flow Rate, Pressure, Leaks, Flow Limitations, and Snores. You don't have to include anything else.

Have you talked with your regular doctor about feeling tired in the afternoon? He or she might have some thoughts about e.g. blood-sugar levels. Not every tiredness problem is a sleep-respiration problem.

Ill have to try excersising in the morning just to at least try it.

I am currently not taking the Modafinil.

My bloodwork always comes back great. Including blood sugar levels, Thyroid, I even took the Thyroid anti body test because my Doc said the normal blood test for Thyroid can sometmes come back a false positive for no issues. I was tested for Auto Immune, also I am on testosterone therapy so my available test is good. I cant even remember what else I have been tested for but I feel like I have been through so many tests between my PCP, Sleep Docs and other docs such as a DO. This has been going on for 4 years so you can imagine I have been working closely with my doctors to get to the bottom of the issue. I always say this is my last hope, ie: this Forum, but im really hoping my OSCAR will show "something". It may be just a simple adjustment on my CPAP.

[robysue1]

MmarcM,

I'm sorry you are having so much difficulty right now.

Here is the data you posted:


Now you write:

I have my mask dialed in so not to many leaks, I average about 10l/min.

But in spite of that statement, the first thing that jumps out at me in your data are the leaks.

While you were officially in Large Leak territory only 3% of the night, you had some significant leaking going on from roughly 2:30 through 6:00 and between 7:00 and 8:30. Now if you were waking up feeling good and with enough energy to last through the day, then I'd say you could ignore the leaks because that would be evidence that they are not waking you up and disturbing your sleep.

But you're still exhausted during the daytime with a daily crash in the afternoon or evening and you say you feel "sleep deprived" during the daytime. So that begs the question: Are these middle-sized leaks causing you multiple arousals during the night that you don't necessarily remember?

So I have some questions:

1) Do you ever wake up in the night realizing there's a leak and you have to fix it before you can get back to sleep?

2) Do you have any problems with waking up to a very dry mouth or throat? Does your nose feel excessively dry when you wake up?

3) How do you fit your mask each night? Do you do it at your minimum pressure? Do you do it sitting up or lying down?

The second thing that jumps out at me in your data is the flow limitations. Now flow limitation data is particularly hard to parse. It's recorded by the machine and factored into the Resmed's Auto algorithm as a reason to increase pressure specifically because certain types of flow limitations can indicate the upper airway is unstable and prone to collapsing. And the idea is that by increasing the pressure, the flow limitations should smooth out to normal sleep breathing before the airway collapses enough to cause a hypopnea or an apnea. You can see the machine reacting to your flow limitations because most of the pressure increases are in reaction to the flow limitations instead of hypopneas and apneas.

And yet, your particular flow limitations do not improve with more pressure. And that's why "flow limitation" data is hard to parse: Not all flow limitations are caused by an unstable airway threatening to collapse. Some flow limitations are caused by things like nasal congestion, and they don't improve with more pressure. And a small number of xPAPers have airways that can start to look "unstable" (i.e. develop "flow limitations") at higher pressures and more pressure can make the situation worse, not better.

The leaks are also at their worst when your pressure is at or near your max pressure setting of 17cm. And there's some evidence, even at this scale, that you may be having a lot of micro-arousals that are not necessarily tied to sleep disordered breathing events. So I've got more questions to try to tease out what might be going on in order to make some meaningful suggestions about what to try:

1) Did you have a titration study done to determine an initial pressure setting? If so, what was your initial prescribed pressure setting?

2) You say you've dialed in the pressure settings. I assume that means you've experimented with multiple pressure ranges. What did the data look like if you ever used a maximum pressure setting that was less than your current max pressure = 17 cm? And objectively did you feel like you slept better even if the AHI numbers were slightly worse?

3) I also notice that you are still using the ramp. Are you uncomfortable trying to breathe at your min pressure = 11 cm? If so, is the problem that you feel like the machine is forcing you to inhale more air than you want to inhale? Or is it a different problem? (If so, please describe it.) If you are comfortable breathing at your minimum pressure when trying to get to sleep, I would suggest turning the ramp off, particularly if you are fitting the mask at your beginning ramp pressure of 5.2 cm

[MmarcM]

Hello Robysue1, thank you so much for helping.

Ok so there is a bit to unpack here.

But you're still exhausted during the daytime with a daily crash in the afternoon or evening and you say you feel "sleep deprived" during the daytime. So that begs the question: Are these middle-sized leaks causing you multiple arousals during the night that you don't necessarily remember?

You may be onto something here, which is why I waited a few days to respond, see later in my replys...

But in spite of that statement, the first thing that jumps out at me in your data are the leaks.

I forgot how important leaks can be,I used to have bad leaks and I thought I had them under control, even though I know I have a few during the night.. I still do wake up with leaks but just not as many as I used to, I found a mask that seemed to have less leakage.

So I have some questions:

1) Do you ever wake up in the night realizing there's a leak and you have to fix it before you can get back to sleep?

Yes this happens, its hard to say how many times per night because Im just so used to fixing it then dozing back off,but I would say 2 to 4 times a night

2) Do you have any problems with waking up to a very dry mouth or throat? Does your nose feel excessively dry when you wake up?

Yes on dry mouth,and sometimes during the night. My nose is not dry when I wake up but my nose does get stopped up often during the night. I sleep on my side to avoid my nose getting stopped up,if Im on my side, my nasal passages will open enough so I can breath through my nose most of the time. Sometimes I do find myself on my back during the night and I just thought if my nose is stopped up I would unconsiously breath through my mouth.

3) How do you fit your mask each night? Do you do it at your minimum pressure? Do you do it sitting up or lying down?

I fit the mask on my face while sitting up, breath in and out until the air starts to blow, then fit the mask, sometimes I fit the mask when Im stood up and sometimes after the back of my head lays on he pillow.

The second thing that jumps out at me in your data is the flow limitations. Now flow limitation data is particularly hard to parse. It's recorded by the machine and factored into the Resmed's Auto algorithm as a reason to increase pressure specifically because certain types of flow limitations can indicate the upper airway is unstable and prone to collapsing. And the idea is that by increasing the pressure, the flow limitations should smooth out to normal sleep breathing before the airway collapses enough to cause a hypopnea or an apnea. You can see the machine reacting to your flow limitations because most of the pressure increases are in reaction to the flow limitations instead of hypopneas and apneas.

And yet, your particular flow limitations do not improve with more pressure. And that's why "flow limitation" data is hard to parse: Not all flow limitations are caused by an unstable airway threatening to collapse. Some flow limitations are caused by things like nasal congestion, and they don't improve with more pressure. And a small number of xPAPers have airways that can start to look "unstable" (i.e. develop "flow limitations") at higher pressures and more pressure can make the situation worse, not better.

The leaks are also at their worst when your pressure is at or near your max pressure setting of 17cm. And there's some evidence, even at this scale, that you may be having a lot of micro-arousals that are not necessarily tied to sleep disordered breathing events. So I've got more questions to try to tease out what might be going on in order to make some meaningful suggestions about what to try:

1) Did you have a titration study done to determine an initial pressure setting? If so, what was your initial prescribed pressure setting?

Yes they did the titration during my sleeping at my sleep study. I attached a copy of my sleep report, looks like it was 11. If I remember correctly it was my first sleep doctor that made the adjustment to where it is now. I will say that my first sleep doctor is no longer practicing, Im not sure why, my experience with that office and staff gave me the impression that is was a very unprofessionally run office. At the time I thought it was odd that when they said they woould have a rep call me back for some cpap machine questions that I had, the representative that called me back to follow up with me only knew what she knew about the cpap machine because her husband has one, other than that she knew nothing else, really odd. My point is that when they bumped up my air flow, it could have made things worse...

P1030079.JPG (995.29 KiB) Viewed 9700 times

2) You say you've dialed in the pressure settings. I assume that means you've experimented with multiple pressure ranges. What did the data look like if you ever used a maximum pressure setting that was less than your current max pressure = 17 cm? And objectively did you feel like you slept better even if the AHI numbers were slightly worse?

I think what I meant by "dialed in", I was talking about my mask. I really dont know much about the pressures other than when my 1st sleep doc made an adjustment. When they bumped the max to 17, I dont remember seeing any improvements in my AHI numbers however that was a couple years ago.

3) I also notice that you are still using the ramp. Are you uncomfortable trying to breathe at your min pressure = 11 cm? If so, is the problem that you feel like the machine is forcing you to inhale more air than you want to inhale? Or is it a different problem? (If so, please describe it.) If you are comfortable breathing at your minimum pressure when trying to get to sleep, I would suggest turning the ramp off, particularly if you are fitting the mask at your beginning ramp pressure of 5.2 cm

Yes the reason I used the "ramp" function is that I felt like it was too much air for me to comfortably inhale. I may be able to take it off now that Im much more comfortable with cpap.


So after taking all this in, I decided to tighten up my mask straps , almost to the point where it was uncomfortable. I did this on Thursday 8/29 after I read your reply. I just wanted to see if this would make a difference in my OSCAR report, my Resmed "MyAir" charts online, and if it would help with my daytime sleepyness. What I found is that on my Resmed MyAir charts for Thursday and Friday night I had significantly lowered my leaks for both nights, also my apnea events were .5/hour which is lower than most previous days, I think since I removed my SD card the website is having trouble getting info from last night so I couldnt check for last night.

I was going to attach an OSCAR report for the Thursday 8/29 night but the last time I have anything recorded on my SDcard was from 8/17th, that is the day I first pulled out the card for an OSCAR to post on my original post here. When I installed the card again today, the readout showed "Preparing SD card". Not sure why its not recording, the card is fully inserted, the SD card lock is off.

I want to say that on Friday and Saturday I felt that I had a coulpe more hours left in the day where I wasnt as sleepy, however I could have just had one of my " felling a little bit better days". Maybe it may take more time to see if this was my problem all along. Or at least one problem, and hopefully resolved. Ill keep trying to get my SD card to record. I looked in the Resmed units menu and didnt see anything for SD card.

Again thank you Robysue1

[MmarcM]

I thought I would post an update.

The reason I couldnt pull up the OSCAR report from the night where I woke up with my heart beating hard, I forgot to "import" the file from my SD card, so now that has been addressed. Here is the report.

Screenshot (47).png (214.02 KiB) Viewed 8538 times

[MmarcM]

Here is my OSCAR report the night after I tightened up my mask, remember my myAir report came back with many less air leakages and less apneas that I have seen in a long time. The jury is still out on whether I fell any better, I want to say yes I do feel somewhat less tired during the day and evening. Maybe it will take some time?? Or maybe there is something else going on?

[robysue1]

Mmarc,

I finally got around to looking at your data in this post.

I thought I would post an update.

The reason I couldnt pull up the OSCAR report from the night where I woke up with my heart beating hard, I forgot to "import" the file from my SD card, so now that has been addressed. Here is the report.

Is this the night where you woke up with your heart beating hard? If so, do you remember which wake it happened at?

At any rate, here's what I see in this data:

1) Both wakes may very well have started out as normal post REM wakes based on the time they occur. And since hear rate goes up during REM, maybe you woke up before the REM episode was fully over.

2) The length of the first wake is problematic. Is this the one where you woke up with your heart beating hard? Or did you just get out of bed to go to the bathroom and the break was longer than expected?

3) The length of the second wake appears to be between 5 and 10 minutes. Ordinarily that's long enough to remember, but short enough to not be a huge issue in terms of sleep continuity and subjective sleep quality. Again, it's worth asking: Did you go to the bathroom while you were awake?

3) There's a lot of activity in that flow limitation graph, although most of it is pretty small in terms of the scale. Flow limitations may or may not be significant, but yours are triggering pressure increases and right around 4:00 AM, they are also correlated to a small cluster of events. (Any chance you flipped on your back around then? If not, it could be this is a REM cycle even though it would be a bit early given that you turned the machine back on around 3:00 AM)
You might want to bump up your minimum pressure a bit. That might smooth out the flow limitations and that might result in you feeling better in the daytime. Or not---it's really difficult to tell with flow limitations.

4) There are some obvious pesky-sized leaks during the first session for the night. But I don't think leaks are what woke you up. If I had to bet, I would say either the flow limitations woke you up or it was just a normal post-REM wake that happened before the REM cycle was completely over or both. Could the flow limitations by themselves cause your heart to beat hard? That's above my pay grade.

5) It looks like a larger leak may have woken you up just before 3:00. Again, it's possible that the original cause of the wake was a normal post REM wake, but the leak caught your attention and caused you to fully wake up. Overall I would not be particularly worried/upset about this wake since I don't think it means much---unless this is the wake where you woke with your heart beating hard.

[robysue1]

Here is my OSCAR report the night after I tightened up my mask, remember my myAir report came back with many less air leakages and less apneas that I have seen in a long time.

Here's the data for this night:

While these leaks superficially look worse than the leaks on the other night, they are actually quite a bit better. It's the vertical scale that is causing these leaks to look worse. Here' the whole leak graph is trapped below 12 L/min. In the previous night the leak graph's vertical axis went up to 45 L/min.

So if the tightened up mask is still comfortable, then I'd say you need to keep it about as tight as you had it on this night.

There is still more activity than a lot of folks would want to see in the flow limitation graph. And flow limitations are the cause of most of the pressure increases. But whether the increased pressure is working to reduce the amount of flow limitation is not clear at this scale. Also worth noting: Even though there is a whole lot of activity in the flow limitation graph, almost all of it is well below the 0.33 line. People with really bad flow limitation graphs see a lot of activity that is well above 0.5.

The jury is still out on whether I fell any better, I want to say yes I do feel somewhat less tired during the day and evening. Maybe it will take some time?? Or maybe there is something else going on?

Yes, it can take some time PAPing every night before you start feeling substantially better during the day time. And it's common for the improvement in reducing daytime fatigue/sleepiness can be gradual---so gradual that you may not notice much difference day-to-day, but the small differences accumulate and a few weeks after starting to sleep well with the machine, you realize that you don't poop out as early as you used to.

[MmarcM]

Is this the night where you woke up with your heart beating hard? If so, do you remember which wake it happened at?

Yes, but it wasnt during the night that I woke up with my heart beating hard, it was when I woke up in the morning and got up out of bed.

2) The length of the first wake is problematic. Is this the one where you woke up with your heart beating hard? Or did you just get out of bed to go to the bathroom and the break was longer than expected?

I cant say whether I woke up in the middle of the night to go to the bathroom but i might have gotten up to do a small chore in the middle of the night like help my mom go to the bathroom or something like that

3) The length of the second wake appears to be between 5 and 10 minutes. Ordinarily that's long enough to remember, but short enough to not be a huge issue in terms of sleep continuity and subjective sleep quality. Again, it's worth asking: Did you go to the bathroom while you were awake?

I just dont remember, but if it was for 5 to 10 minutes I may have gotten up to help my mom who is living with us right now

3) There's a lot of activity in that flow limitation graph, although most of it is pretty small in terms of the scale. Flow limitations may or may not be significant, but yours are triggering pressure increases and right around 4:00 AM, they are also correlated to a small cluster of events. (Any chance you flipped on your back around then? If not, it could be this is a REM cycle even though it would be a bit early given that you turned the machine back on around 3:00 AM)
You might want to bump up your minimum pressure a bit. That might smooth out the flow limitations and that might result in you feeling better in the daytime. Or not---it's really difficult to tell with flow limitations.

Again I just dont remember about flipping on my back because it was a while ago.

I do want to add that I am pretty sure that I adjusted my minimum pressure down a long time ago, it was because I "thought" I was not exhaling completely, would a higher minimum pressure cause me to feel like I am not exhaling my breath completely, I can bump it back up some.

[MmarcM]

So if the tightened up mask is still comfortable, then I'd say you need to keep it about as tight as you had it on this night.

I decided to switch my current full face mask that just butts up to my nose and covers my mouth, to my full face mask that actually covers my whole nose and mouth, I can actually get it tighter without feeling uncomfortable. For the last 3 nights with my "new" mask, my leaks are now under 5 l/min. This is good!

There is still more activity than a lot of folks would want to see in the flow limitation graph. And flow limitations are the cause of most of the pressure increases. But whether the increased pressure is working to reduce the amount of flow limitation is not clear at this scale. Also worth noting: Even though there is a whole lot of activity in the flow limitation graph, almost all of it is well below the 0.33 line. People with really bad flow limitation graphs see a lot of activity that is well above 0.5.

So if I decide to increase my minimum pressure, Im not sure how much and Im not sure how to do this. I looked on my Resmed's menu and couldnt find an adjustment for this. Is this something my Sleep doc will need to do?

Thank you