Looking for some additional input regarding Oscar data

[TehMonkeh]

Good morning,

I started using CPAP about a month ago, I don't have specifics on my sleep study / titration night reports, was just told my AHI during sleep study was 86 and my O2 dropped to like 65 during the initial sleep study. I was put on CPAP with a pressure of 18 after the titration night was done and have been having some hit or miss sleep. Some days can't get to sleep and feel like total hell the next day (I assume this is just part of the process of getting used to CPAP) and some days I feel pretty good and sleep like a rock. Last week for several days in a row I was worse off (tired) than I was before the CPAP, one day I got up at 5 for work, drove to work very tired and had to take a break and a nap at like 7:15. So I picked up an SD card and reader so I could start looking at the data in OSCAR.

So far only couple of days of detailed Oscar data right now with flow rate and everything, but im seeing what appears to be a lot of CA events. Last night for example my AHI was 9.48 (8.53 of that was CA's while .68 was OSA). Total of 63 CA events and 5 OSA, over 7h23m. I have been reading up on the board here today to try and get a better understand of the data. To me it looks like it's related to "waking up" as opposed to actual central apneas; however I am new and still trying to learn to read it so I was hoping for a second opinion before I started trying to call the dr or something. Posting a couple of screenshots below, overall for the night and a couple of events.

On the CA2 screenshot, it looks like the breathing gets out of rhythm and then the CA event, which from reading means it's possibly a false positive? Then in the Multiple CA's screenshot the breathing appears to never get into Rhythm and shows multiple CA events. I have been using the Apple Watch to track sleep, which isn't the best option from what I've read, and it does show I woke up at 3:09 and went back to sleep at 3:12, but again I don't think this is very reliable. Any insight from somebody with more experience would be greatly appreciated, and I have / can get other screenshots if it would be helpful.

Thanks in advance for any help.

[Pugsy]

Please do another screen shot but this time not zoomed in and include the stuff that is explained in this thread
viewtopic/t158560/How-to-post-images-for-review.html

While the flow rate does look like some potential for the flagged events to be false positives related to awake breathing....I am wondering if maybe the awakenings might be related to unstable breathing. Like what caused the awakening in the first place.
It wouldn't be impossible to have both...a real central apnea that causes the awakening.

Need to see the overall detailed report and all the stuff on the left side (including settings) to come up with some ideas.

Yes, there is an adjustment to having the alien on the face but before we tell you "give it time" lets see if there is anything else that might need to be done as well.

[TehMonkeh]

Please do another screen shot but this time not zoomed in and include the stuff that is explained in this thread
viewtopic/t158560/How-to-post-images-for-review.html

While the flow rate does look like some potential for the flagged events to be false positives related to awake breathing....I am wondering if maybe the awakenings might be related to unstable breathing. Like what caused the awakening in the first place.
It wouldn't be impossible to have both...a real central apnea that causes the awakening.

Need to see the overall detailed report and all the stuff on the left side (including settings) to come up with some ideas.

Yes, there is an adjustment to having the alien on the face but before we tell you "give it time" lets see if there is anything else that might need to be done as well.

I had not seen / found that thread before, sorry about that. hope this help; FYI the 3:30 or so am gap is me getting up and using the bathroom took mask off for a couple of minutes during that time.

I haven't not really "slept well" for years, some of that has obviously been cause of the OSA as it's gotten MUCH better, no more getting up 4-5 times a night just to use the bathroom etc. I usually am in bed all night but I do sleep on my stomach with my head/face on one of my arms so I do wake up and "switch sides" in the middle of the night. sometimes I remember these sometimes I don't.

ETA: uploaded wrong screenshot, some of it was cut off edited to add corrected screenshot

[Pugsy]

Oh my...fixed pressure of 18 cm..and you likely need EPR at that pressure.
How did they come up with the 18 cm.....did you have an in lab sleep study where you were actually put on a cpap machine and they played with pressures to decide which pressure worked the best for you or did they just pull 18 cm out of the blue because your OSA was so severe they assumed you needed that much pressure???

Would you be comfortable changing the pressure yourself?

Right now....lets eliminate EPR being a factor in triggering centrals....so with that high of a pressure make EPR to ramp only and not full time. You can make that change yourself. You would need to go into the clinical set up menu area and the manual below explains how to get to that setting and make the change.
So set EPR to ramp only and enable ramp and set it to maybe 30 minutes or so depending on how long you think it takes you to fall asleep. Shorter time frame if you think you fall asleep sooner.

https://www.respshop.com/manuals/ResMed ... %20her.pdf

Sometimes using EPR can cause unstable breathing which can trigger centrals...so the first thing to try to see if we can reduce centrals is the easy thing...eliminate EPR.
Since your starting pressure is so high...won't ask you to eliminate it totally because you most likely won't be able to fall asleep or exhale against that much pressure. So we compromise and limit EPR to ramp only and make use of the ramp feature.
I have some other ideas to try to optimize your therapy but they involve actual pressure changes as well as mode change but if you aren't comfortable with making those changes no sense in my advising that avenue to try.
A lot depends on how they came up with that 18 cm chosen setting.

You need to request a copy of your sleep study results...you need to know if you had centrals prior to starting cpap or not.
It's real important. If you didn't have any and now you do...then something about cpap has triggered them but if you had them prior to starting cpap then we have a different discussion.

[TehMonkeh]

I've actually had two sleep studies. the first night was a split night, and the second one was a 8hr titration on the cpap the whole time. the first night, they came in at 127 minutes and put a mask on me and played with it all night apparently ended the night putting me on bipap cause they went over 20. however, the first time they told me I HAD to sleep on my back, even thought that's not normal for me, and I think that made things worse, that's where the 86ahi and 66o2 comes from. the second night was a full 8hr on the cpap but I was able to sleep on my stomach like normal and 18 is where they got me to.

I don't have a technologic issue changing pressures, I went and changed my ramp and stuff like that, my only concern changing anything would be if insurance pitches a fit about it or something. I don't see why changing the EPR would make a difference though if im getting the prescribed 18cm.

I should note that I don't really have any issues breathing with it at 18, there's been a few times where I've run the mask fit test and just let it run and then it will stop running mask fit and stay on at the full 18 ignoring ramp all together and I fall asleep fine. the vast majority of my getting to sleep issues seem to come from one of two things; A: my anxiety/OCD worries about masks leaks and focusing on it so much I can't sleep, and B: being exhausted and not being able to get leaks to stop and then I get super pissed off and thus can't sleep lol.

not sure if this matters or not but, I started with a full face airfit f20 and even used the airtouch f20 cushion for a bit, right now im using an airfit f30i. the f20 is what I used in the titration study (second night) but I think I have some sinus issues as it seems to compress my nasal sinuses a bit restricting airflow / breathing making it difficult to breathe through my nose. also, since I lay my face on my arm when sleeping it's hard to get comfortable and not have leaks since the mask seems to get knocked a bit cockeyed.

[Pugsy]

Insurance companies don't care what the settings are or who changes them. All insurance companies care about (or even know about) is how many hours you use the machine each night. They certainly don't care about EPR use or not or what setting.

So you had an in lab titration study and they came up with 18 cm and you were on your stomach....get a copy of the reports....we still need to see if you had centrals on the first sleep study without cpap and the in lab titration study.

For now let's try eliminating EPR and see if it makes any difference in the central numbers or not.
If it doesn't then we can talk about other options and trying to figure out how many are real asleep centrals and how many are awake centrals and then maybe why the arousals that caused the awake flagged centrals.

Start with easy first...and see what happens. Might get lucky and not need to do more detective work.

[TehMonkeh]

Insurance companies don't care what the settings are or who changes them. All insurance companies care about (or even know about) is how many hours you use the machine each night. They certainly don't care about EPR use or not or what setting.

Interesting, the diagnostic center I went to, the respiratory guy I worked with for my machine and masks etc made it sound like it was a big problem if it got changed.

I went ahead and moved EPR to ramp only. Im curious though, my ramp time was set to "auto" not sure how that works exactly, it's what I been using so far. not sure if I should adjust that or not. either way im going to try the new settings starting tonight and give it a couple of days and see if anything changes. *crosses fingers*

So you had an in lab titration study and they came up with 18 cm and you were on your stomach....get a copy of the reports....we still need to see if you had centrals on the first sleep study without cpap and the in lab titration study.

I had already planned on calling them Tuesday to get a copy of those reports, just didn't seem like enough of an emergency to try and get it today / tomorrow lol

Thank you for replying and providing so much more time and insight, I saw several of the other posts I was readying you were heavily involved and quick to reply, I truly appreciate it as im sure others do to.

[Pugsy]

Interesting, the diagnostic center I went to, the respiratory guy I worked with for my machine and masks etc made it sound like it was a big problem if it got changed.

That's the first lie these people will tell cpap users because they want to scare the hell out of you so you don't go looking to change anything. They want to keep you in the dark and feed you bullshit. Power trip....makes it out like they are big and important and we are too stupid to understand all this stuff. They will lie when the truth would fit better. When they report to the insurance companies the only thing they report on is hours of use...they don't report settings or even if it is working properly or what your AHI is.
Insurance companies only care if you use the machine the minimum number of hours so they aren't wasting their money.

Auto ramp...I keep forgetting about that feature since I don't use it. How it works is the machine will suspend ramp IF it thinks you are asleep (based on your breathing rhythm) or after 30 minutes...whichever comes first it thinking you are asleep or the 30 minutes.
You can keep it on auto if you wish. Looks like you are already using it with a starting point of around 8 ish and then ramping up rather quickly. That works fine.
I don't use ramp because I don't need it because my starting minimum pressure is a lot lower than yours.

It's not an emergency to have those sleep study copies right now...and if we get lucky might not even need them but people should have their records as a matter of course anyway so they can learn stuff.

Short on time....will explain in more detail once we see what turning off EPR does or doesn't do.

[TehMonkeh]

gonna post a quick reply with some basic info info from the reports I got today, they are like 9 pages each and filled with PHI that would need to be removed / redacted before I can share it and im on my tiny MacBook Air which mamkes it more difficult, gonna edit them tomorrow at work when I have more desktop real estate.

Below is some basic info on the apnea events between the two studies just to compare basic info, not sure if this is full helpful but based on previous comments I thought his was the most pertinent data to share first. They used different formats on each report which makes it difficult to compare side by side and unless you know what some of this stuff is, it's sort of useless data so im just kind of spit balling.

split night sleep study (first one)
respiratory events summer diagnostic (the diagnostic time was 127 minutes of sleep) - Obstructive apnea = 95, mixed = 0, central = 1, Hypop AASM* = 83, Hypop CMS = 44. RDI 84.2, (can't find any listing of RERA)

titration study (second study)
respiratory analysis: 0 obstructive, 0 mixed, 5 central. 32 hypopneas, 13 met AASM, and 3 met medicare, 6 RERA, with respiratory disturbance index of 9.6,


ETA: my AHI went to 14.26 last night with 74 CA's and 7 OA's, HOWEVER I barely slept last night, I got made 2.5 -3 hours of sleep, and most of that happens after 2am (went to bed at 9pm) so im thinking it went to hell cause I was fighting to sleep and hell had so many issues with mask I ended up ripping it off and throwing it across the room for a while, looking at the info it looks like most of the CA's were related to being awake.