Oscar chart

[jumblegirl]

Yes I just looked up what it stood for - but I still don't think it would be able to catch central apnea would it? There was only a small sensor on the sternum nothing else. The other issue was that the finger clamp was so tight that my finger went numb half way through the night and i had to switch to another finger (which you aren't supposed to do) but when I told them about it they didn't seem to care and still used the data. Also you can order the Watchpat yourself for $189 from Lofta and then throw it away after. There's a fancier version called Watchpat 300 that you don't throw away and you have to return, that one might be better.

If i look at my Oscar data the central apneas do have a flat line with normal breathing before so they do seem like they are real.

[Pugsy]

If i look at my data the central apneas do have a flat line with normal breathing before so they do seem like they are real.

Can you zoom in on one of the centrals that you think are real and post the screen shot?
Let's make sure what you are thinking you are seeing are indeed real asleep centrals.
It's really important to evaluate the flow rate for 2 or 3 minutes PRIOR to the flagged central to make sure the person was asleep.

The thingy on the chest with the WatchPat...that's to measure effort to breathe or chest movement kind of thing.
If no effort to breathe is made and there is evidence through the other data it collects that an apnea event has occurred then the no effort at the same time means a central apnea occurred.

With a central apnea there is no effort to even try to breathe. Hold your breath for 15 seconds...just don't breathe...that's essentially a 15 second central apnea. No air is moving but it's because you didn't even try to move the air. Your chest won't move....nothing will move really.

It's normal to have a few central apneas here and there and it is to be expected. Like it is normal to have what is called a sleep onset central apnea. It can happen when we transition from awake to asleep. No big deal to have that happen say after a REM sleep cycle has ended (it's normal to wake up after the end of a REM cycle) and then we go back to sleep so another sleep onset central can happen. These centrals are not usually a problem unless they either keep bouncing a person out of sleep so they have trouble getting back to sleep or if there are so many of them that desats occur.

We don't really have enough nights with your data where you can say you slept solidly for sure and we see more centrals than we would like to see ....to warrant urgent concern. You are too new to therapy and all that.
You need to sit back and take some chill pills and concentrate mainly on just getting used to all this new stuff...and on the back burner keep one eye on the data. It took me a full 3 months for my body and brain to get happy with my new way of sleeping. My brain was frequently waking me up to say "hey dude...do you know there is an alien on your face blowing air up your nose"....
back then machines didn't flag centrals but I have no doubt that if they could have flagged centrals I would have seen a lot of them because of the wake ups.

Anytime someone who is brand new to cpap therapy seems to have centrals flagged when we wouldn't expect them we always have to keep in mind the chance of a false positive flagging. Back to those sleep onset centrals even...just from a minor arousal that we may not remember.

Even if every single one of your flagged centrals were indeed real asleep centrals you aren't having enough of them to trigger serious alarm bells. Your doctor will want to adopt a wait and see approach. Even if they are the real deal about the only thing you can do to maybe help reduce the number are the steps I outlined above.
Reducing and/or eliminating EPR....or changing to fixed pressures are the only real tweaks you can do and there's no guarantee that they will work.

You can compare you ring thingy if you want but you have to accept the fact that the ring measures what it measures and makes guesses based on what it says it measures....and the cpap machine measures what it measures and they don't measure the same thing so you can't really compare the results.
Mostly the ring is going to maybe use oxygen levels, pulse and motion sensors to help it decide what's going on. The FitBit does something similar.
The cpap machine measures air flow...it doesn't measure pulse, oxygen or how many times you might toss and turn during the night.
You really can't compare the two.

[jumblegirl]

Thanks Pugsy that all makes sense. I will get the screenshot on Imgur and post but the centrals definitely had flat lines right before. But, last night I only had 6 centrals & 3 OAs and 1 unclassified after I reduced EPR to 1 and changed to Airfit F20 full face mask and AHI 1.25 although I was awake on and off after 3 am but I am pretty happy with this result! You are right I just need to wait and see. I definitely need to take a chill pill but it is so hard when you feel like you are brain dead from not sleeping right and maybe it won't go away. I feel much better this morning. Thanks again for all your advice and insight I really appreciate it!

[jumblegirl]

Here are some closer up Central Apneas from 2 nights ago (I can also zoom more on one specific one)

https://imgur.com/fmq4brp


and my much better chart from last night

https://imgur.com/YOCynx8

[Pugsy]

the centrals definitely had flat lines right before

It's not so much the flat line before the actual flag that you have to look at but instead you look at the breaths before the line goes flat.

Does sound like you did better last night and with the reduction in centrals happening along with the reduction in EPR then that does sound like maybe EPR is triggering the centrals. That's a very real possibility.
I have a friend who gets about 15 centrals per hour with what would be equal to EPR of 4 (if it could do it) and with what would be EPR of 3 she gets less than one per hour average.

Need more nights to see if a trend is forming.

[Pugsy]

on the zoomed in section....some of the centrals look like arousals...like the very first one flagged on the left but some of the others look like maybe sleep onset centrals. So probably a mixture of real vs arousal.

[jumblegirl]

Thanks. - another question, so I now have 4 masks I don' t like and won't use - will they take them back? all bought online. one nasal pillow, 2 nasal and one full face. The Airfit F20 is so far superior to the other. 3 I got from cpap.com where I got the machine and the other from directmedicalonline I think.

[jumblegirl]

what does a sleep onset central apnea vs arousal mean? would a real one happen during actual sleep only?

[Pugsy]

3 I got from cpap.com where I got the machine and the other from directmedicalonline I think.

It all depends on when they were shipped from cpap.com. There is a 30 day free return policy at cpap.com.
You need to read up on the policy but if you get the mask back to them within 30 days of when they shipped to you then you can get a refund.

Directmedical may have something similar...I don't know what they do or don't do. Look on their website for return policy..if any.

what does a sleep onset central apnea vs arousal mean? would a real one happen during actual sleep only?

A sleep onset arousal is normal and to be expected and is the read deal.

Arousal centrals are just awake breathing irregularities getting flagged by mistake.

Essentially yes...for a central apnea to be the real deal you need to be asleep or at least transitioning to sleep in the case of sleep onset centrals.

Awake flagged anything doesn't amount to much except when we see a lot of it that means not sleeping so great and we wonder why a person isn't sleeping so great.

Last year about this time I think it was....I woke up to an AHI of 9.4....whoa...that's bad even for me so I did take the time to zoom in on the flagged events. I had a nice normal mix of Centrals, OAs and hyponeas.
95% of the flagged events were arousal/awake flagged events. Not even iffy.
Now the rest of the story was that night was a bad night in terms of back/pelvic pain. So I remembered tossing and turning a lot due to the pain. Many, many remembered arousals/awakenings for sure. I had over did things in terms of my flower gardens and I paid for it that night.

My real asleep AHI that night was less than 1.0.
So we can have false positives in any category for any reason that might cause us to have an arousal or wake up.
And don't assume that you will remember all arousals....if we aren't awake very long we simply don't form a memory of the arousal.

During an in lab sleep study awake/arousal flagged events aren't considered in the overall statistics for diagnostic AHI.
You have to be asleep for them to really matter. The tech knows if you are asleep or not.
For home studies that don't measure sleep status it does create a bit of a problem in terms of how comprehensive the data is especially if someone simply doesn't sleep well.

[jumblegirl]

So a ‘sleep onset’ central counts as a real apnea and is if concern? Dies it mean you can’t get to sleep because you wake yourself up and would/could it be a cause of insomnia?

How would you identify on flow rate a sleep onset CA vs arousal or actually sleeping. I guess I’m not sure what arousal means because I thought the so was cause arousal or can it be the other way round?

[Pugsy]

So a ‘sleep onset’ central counts as a real apnea and is if concern? Dies it mean you can’t get to sleep because you wake yourself up and would/could it be a cause of insomnia?

How would you identify on flow rate a sleep onset CA vs arousal or actually sleeping. I guess I’m not sure what arousal means because I thought the so was cause arousal or can it be the other way round?

Sleep onset centrals are normal and really no big deal unless someone has a truckload of them and we never progresses to actual first stage of sleep or if so numerous and so prolonged that they caused desats.

Arousal....awakening from sleep for some reason or other.

How do we tell the difference??? LOTS and LOTS of experience looking at this stuff and even then it isn't always easy.

Here's an example of when I had a truckload of Centrals....I was awake for sure. Big time battle with the old insomnia monster. There is zero asleep breathing during any of these centrals. I didn't go to sleep until probably 01:30.



Here's another example I like to use....I circled the asleep breathing/flow rate in red. The rest of it and including the flagged events are awake/arousal related.

[jumblegirl]

So what I meant to write but was autocorrected was that I thought the *apneas* cause arousal - or do the arousals sometimes cause apnea ?

So: Awake CA is no problem and sleep onset CA is no problem only the ones while sleeping that cause arousal (do they always cause arousal?) are ones to be concerned about?

Sorry so many questions.

In other news cpap.com has awesome customer service and refunded for the masks and told me to discard them because of Covid. Of course I did spend a lot with them to but the machine!

In the other hand lofta only offers store credit and you have to pay to ship back….

And the direct medical place has not answered me yet!

[ChicagoGranny]

I thought the *apneas* cause arousal

Yes, apneas cause arousals.

or do the arousals sometimes cause apnea ?

No, arousals do not cause apneas. You can't have a "sleep apnea" when you are awake. An arousal may cause you to have irregular breathing while you are awake. This irregular breathing could be flagged by the machine as an apnea. (In a sleep lab, you are connected to an EEG. The EEG tells whether you are awake or asleep. Breathing irregularities while awake are not scored as Events.)

[zonker]

Sorry so many questions.

never apologize for asking questions here. you are doing good in that you are staying within this thread where the experienced folk can see what all is happening.

none of us were born knowing everything about cpap.(or anything else for that matter.) you aren't bothering us with questions. you need to know what's going on and this is the place to get your answers.

continued good luck!

[jumblegirl]

here is last nights chart

https://imgur.com/s9JEUra

mask was bothering me over the bridge of my nose (tight) so I probably messed with it more
it seems like every mask I use - great at first then after one night I hate it !
reduced min pressure to 4 for ramp because air just seemed to be blasting when I first put the mask on

graphs look ok there are some flow limitations I'm not sure what those mean

There is a 43 sec OA that's the worst one.

what is the y axis of the flow rate ? why is it not 0-100