OSCAR RESULTS AND INTERESTING APNEA

[erolalper]

Hello, I request serious help from the experts I use Resmed S9 Elite CPAP device. I have been using Resmed P10 nasal pillow mask for 10 days. I'm currently using it with a constant pressure of 9 (my doctor said 8 ) and the EPR is set to 3.

As can be seen from the link above, my apneas usually start 5 minutes after I go to bed, and most of my apneas usually occur within the first 10-20 minutes. I'm really curious about the reason for this. Other points I am curious about are: I was using a Philips Dreamwear nasal mask with a tube at the top until 10 days ago. It got a little old and I switched to Resmed P10 with nasal tube and nasal pillow, hoping to get better results. After this transition, I noticed that my AHI and leakage values increased slightly. I think I wore the mask properly, but maybe I should use a different size device. (I'm currently wearing size M) I'm trying it out but I haven't decided yet. Is S or M better for me?

What can you tell me if you interpret my graphs?

Thanks.

https://imgur.com/a/NOcS145

[Pugsy]

How long does it take you to go to sleep?

[erolalper]

Well, I'm not sure, but it doesn't take too long.

[erolalper]

So it's very interesting. I look at the duration of apneas one by one. The number of apneas that started 5 minutes after I went to bed is 7 apneas. And it corresponds to a total period of 5 minutes. I went out of one apnea and went into another apnea 5-10 seconds later.

[Pugsy]

We can't see up close what is happening with those events. So that means we are just guessing.

How about using SleepHQ so we can zoom in on the flow rate and see if you were awake when those events got flagged.
There's a free version to it and if you post a link to the daily report we can actually zoom in on the flow rate and check for evidence of asleep breathing vs awake/arousal breathing. If you weren't asleep when those events got flagged it means nothing other than you weren't asleep.

[erolalper]

Thank you for your valuable help. You can find the Sleep HQ link below. When I check the flow rate, I think I am not breathing when those events are marked. The interesting part is why does apnea intensify when I first lie down? Other days are also the same.

https://sleephq.com/public/0e300753-f7b ... 6638ff87f0

[Pugsy]

No, you aren't breathing when those flagged events show up but you weren't sleeping either.
None of those flagged events occurred when you were asleep. All are awake/arousal related. I scrolled through all the flow rate.
You are pausing your breathing (hold your breath for 10 seconds or more)....that's what you are seeing. Voluntary pauses in breathing.
They aren't real asleep apneas and for them to matter you have to be asleep.

Remember the machine only measures air flow and that includes awake/arousal air flow (breathing).

So lots of arousal/awake breathing. Not unusual at all when someone is having trouble either going to sleep or staying asleep for any number of reasons and being brand new to cpap is a very valid reason.

Give yourself some time and experience and things should settle down a bit.

Asleep breathing is circled in red below. All the irregular breathing and flagged events .....I wasn't asleep so it doesn't count for anything other than to point to some crappy sleep quality from some unknown reason that isn't/wasn't related to the airway.



Same time segment but just zoomed out a little more so you can see the bigger picture.

[erolalper]

So can I ask something? How did you know I wasn't asleep? I am sending an expanded version of my flow chart in the link below. I stopped breathing before the apneas, but how can we understand that this is happening when I am not asleep? Because before all my apneas (this is probably the case for everyone), a nearly straight line forms on the flow chart. What was the difference between this and that that made you feel like I wasn't asleep? Thanks.

https://imgur.com/vdfSWJz

[Pugsy]

The irregular breathing pattern is a dead give away for not being sound asleep.

Asleep breathing is VERY regular and rhythmic and doesn't have big gulps of air showing up. We don't take big gulps of air when asleep.

Look at the individual breaths and look for a pattern....smooth and rhythmic means asleep...choppy and irregular means not asleep.

Here's a couple of real asleep OA events of mine. Note the very smoothness and consistent same pattern of the breaths.



See the gulp of air I circled here below....that's telling me that I took a big gulp of air and then paused my breathing for a short time.
That makes the flagged event a NOT asleep flagged event and it doesn't count. I don't know what happened here but maybe I was just turning over in bed. Took a breath, turned over and went back to sleep.

[erolalper]

Thanks Pugsy, I got it now. So now comes the crucial question. Why am I experiencing these events while trying to fall asleep? Why would a person hold his breath for 15-20 seconds while trying to sleep? These are the durations of the apneas we mentioned that I experience while not sleeping.

[Pugsy]

Your machine is just calling them like it sees them. Remember ....it has zero idea as to whether or not you are asleep or not.

They ARE NOT real apnea events....they are just normal irregularities in our breathing that we do all the time and never notice.

Quit calling them apneas...they aren't apneas in the sense that it matters.

IF YOU AREN'T ASLEEP.....THEY DON'T COUNT FOR ANYTHING EXCEPT POINT TO POOR SLEEP QUALITY.

Fix the sleep problem first....those "events" will reduce. Nothing else you can do at this point...

Oh. yeah....quit worrying so much about stuff you don't need to worry about. It won't help the sleep quality at all.

[erolalper]

Ok, thank you. I will try this.

[erolalper]

No, you aren't breathing when those flagged events show up but you weren't sleeping either.
None of those flagged events occurred when you were asleep. All are awake/arousal related. I scrolled through all the flow rate.
You are pausing your breathing (hold your breath for 10 seconds or more)....that's what you are seeing. Voluntary pauses in breathing.
They aren't real asleep apneas and for them to matter you have to be asleep.

Remember the machine only measures air flow and that includes awake/arousal air flow (breathing).

So lots of arousal/awake breathing. Not unusual at all when someone is having trouble either going to sleep or staying asleep for any number of reasons and being brand new to cpap is a very valid reason.

Give yourself some time and experience and things should settle down a bit.

Asleep breathing is circled in red below. All the irregular breathing and flagged events .....I wasn't asleep so it doesn't count for anything other than to point to some crappy sleep quality from some unknown reason that isn't/wasn't related to the airway.



Same time segment but just zoomed out a little more so you can see the bigger picture.

Hi Pugsy, I would like to remind you that I opened this issue because I had consecutive central apneas within 10 minutes of going to bed, and when you examined it, you said that I had not slept yet due to the marked apneas. This incident has stopped happening at all some nights, but it still happens from time to time. I am attaching two night photo relatively new . And I doubted whether the image where I marked was periodic breathing. I'm curious about your comment. Thank you.

https://imgur.com/a/kMZ3q0q

https://imgur.com/a/pkDjEE1

[Pugsy]

This is Cheyne Stokes Respiration periodic breathing.



Not all Periodic Breathing qualifies for the CSR label.

You don't have periodic breathing much less CSR.

Your machine didn't even flag it as any sort of periodic breathing or it would have been in green.

Why are you so fixated on stuff that is flagged or shown while you are awake?
It's called sleep apnea for a reason.....not awake apnea.

[erolalper]

I think I'm overly sensitive about these issues.
Even though I have been using Cpap regularly for 3 months, I am trying to solve my ongoing foggy head problem.
Videotaping myself while sleeping at night, sleeping with a tennis ball on my back, tracking spo2 with a smart watch, using a nose strip.
I haven't been able to solve the heaviness problem in my head yet, so I guess I started blaming everything.
Thanks for your answer.