Oscar chart -- do I have a problem?

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
Gfox
Posts: 24
Joined: Mon Jun 27, 2022 11:51 am

Oscar chart -- do I have a problem?

Post by Gfox » Mon Jun 27, 2022 12:44 pm

Hi all--

Thanks for taking the time to look at my case. I have had sleep issues for years by now and started using CPAP as a remedy a few years ago following a sleep test telling me that I had mild sleep apnea (mostly hypopneas, AHI was about 11). The problem is that I thought I finally found a mask (nasal pillow) that works for me and keeps the leaking in check, but I still hardly ever get "good" scores (defined as <5, or and more seldom <2). I had periods (especially in the beginning when I thought the therapy was working well) when I felt I slept great and was super sharp the next day --- I don't have those anymore, sadly (hallmarks of those nights were the fully rested feeling and waking up by myself w/out alarm along with low AHI score).

Looking at my charts -- it appears I have too many CA events, which I understand could be induced by the machine or could be true Central Apneas. Should I think about pushing my doctor to investigate the CA events more? 8.45 seems way too high for a case in treatment overall.

Also, what else can one see in my charts? To me it looks like clusters of events throughout the night, but overall leak rate might be acceptable.
https://imgur.com/a/i6FtMpS

Couple of other facts about me/my case:
+ Persistent memory recall and distinct tiredness in early afternoon problems caused me to get a sleep test in the first place
+ I use mouth tape to reduce leaking (before I had a chin strap which only worked when super tight)
+ I've tried full-face masks but could not get used to them w/out leakage (currently I use the AirFit™ N30i Nasal CPAP Mask with the Air Sense 10)
+ I am overweight male (~200lbs) but I lost 40 lbs 2 years ago and things were not greatly improved either, now back to 200
+ I typically can keep the nasal mask on the whole night, but last night I took it off after the initial 6 hours (I slept another 3 hours w/out the mask)
+ I also track my sleep with a sleep tracker (Oura Ring) and the results here are mostly poor in my book --- sleep scores between 45 and 65 (very seldom over 70). Also, the REM and deep sleep are at ~30 minutes for the most part. Sometimes I get up to 1.5h REM sleep but seldom more than 40 minutes of deep sleep
+ Alongside with the CPAP treatment, I do work on general sleep hygiene elements (e.g., keep room dark, I do wear ear plugs, ad-here to wind-down times etc.) since I wonder whether CPAP helps at all / is needed and whether my sleep issues are caused by something else

Thanks for any thoughts here .... just at a wit's end on whether I actually need to improve the regular CPAP treatment and have a problem here, or whether there might be other issues going on that I have not uncovered yet (e.g., different treatment needed like bi-level CPAP etc.).

Best,
G.

_________________
MachineMask

User avatar
Pugsy
Posts: 63941
Joined: Thu May 14, 2009 9:31 am
Location: Missouri, USA

Re: Oscar chart -- do I have a problem?

Post by Pugsy » Mon Jun 27, 2022 12:58 pm

Do you wake frequently during the night? If so, any idea why?

Have you actually checked to see if those flagged CAs/centrals were real asleep centrals or if they are arousal/awake breathing false positive?
http://freecpapadvice.com/sleepyhead-free-software

Do you take any medications? If so, what?

I am sorry but I can't really comment on your report because when you cram so many graphs on one image that makes all of them so tiny I can't really see them well enough to evaluate them.

In general first of all you need to figure out if those centrals are flagged when you are for sure asleep or if they are related to awake breathing irregularities.
Sounds like your sleep quality leaves a lot to be desired and if that is the case and you aren't sleeping good it is entirely possible those CAs/centrals are a symptom of the poor sleep and not the cause of the poor sleep.
When we don't sleep so great we don't feel so great even if we didn't have OSA messing with things.

_________________
Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier
Additional Comments: Mask Bleep Eclipse https://bleepsleep.com/the-eclipse/
I may have to RISE but I refuse to SHINE.

If you want to try the Eclipse mask and want a special promo code to get a little off the price...send me a private message.

User avatar
zonker
Posts: 11011
Joined: Fri Jun 19, 2015 4:36 pm

Re: Oscar chart -- do I have a problem?

Post by zonker » Mon Jun 27, 2022 1:48 pm

welcome to the zoo, gfox!

see this link on how we'd like to see your oscar charts arranged-
viewtopic.php?f=1&t=182425&p=1390059#p1390059

also, when you get the chance, pls fill in your equipment profile. that way, your machine and mask show up in every one of your posts, as mine does below.

good luck!
people say i'm self absorbed.
but that's enough about them.
Oscar-Win
https://www.apneaboard.com/OSCAR/OSCAR-1.5.1-Win64.exe
Oscar-Mac
https://www.apneaboard.com/OSCAR/OSCAR-1.5.1.dmg

Gfox
Posts: 24
Joined: Mon Jun 27, 2022 11:51 am

Re: Oscar chart -- do I have a problem?

Post by Gfox » Mon Jun 27, 2022 1:51 pm

Thank you very much!

So, I do not wake up frequently as far as I can tell. Last night (the one I posted), I remember waking up and taking my mask off, which then clearly marks the end of the session. I remember some nights when I have to get up to urinate but seldom these days.

Good point on the resolution: Here are some zoomed-in screenshots of areas of concern. I watched the video you linked on the CAs and I am not sure whether those are just arousals or actual central apneas:
https://imgur.com/a/zDDpmZT
https://imgur.com/6RWU2m5
https://imgur.com/a/t7uKDXI

No medications other than vitamins during the day and magnesium and melatonin before bedtime. The latter I introduced fairly recently but does not appear to do much for me. Overall, I can fall asleep very quickly (within 5-10 minutes) and generally sleep through. At some point I did record myself sleeping and observed that I am quite active in terms of rolling around and changing positions. Guess this might contribute to the issue or is a function of the arousals.

Many thanks!

_________________
MachineMask

Gfox
Posts: 24
Joined: Mon Jun 27, 2022 11:51 am

Re: Oscar chart -- do I have a problem?

Post by Gfox » Mon Jun 27, 2022 1:56 pm

Another optimized view on my graph:
https://imgur.com/a/CRb9SjB

Thanks, everybody!

_________________
MachineMask

User avatar
Pugsy
Posts: 63941
Joined: Thu May 14, 2009 9:31 am
Location: Missouri, USA

Re: Oscar chart -- do I have a problem?

Post by Pugsy » Mon Jun 27, 2022 2:04 pm

Of the 3 links you posted zoomed in on...only the top link is useful.
The flow rate is what you have to zoom in on and
can't be a 20 minute segment...must be a 3 to 5 minute segment so
1...the middle and bottom links don't even contain the flow rate and the segments are too long.
So too long of a segment and you didn't even include flow rate.

But the top link image looks like arousal breathing to me. Given that leaks are also present at the same time I am betting that the leaks caused an arousal and that's why the irregular breathing happened.
Just because you don't remember an arousal/awakening doesn't mean it didn't happen.

You must be sound asleep for a central to be real. If you aren't asleep it simply doesn't count.

_________________
Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier
Additional Comments: Mask Bleep Eclipse https://bleepsleep.com/the-eclipse/
I may have to RISE but I refuse to SHINE.

If you want to try the Eclipse mask and want a special promo code to get a little off the price...send me a private message.

Gfox
Posts: 24
Joined: Mon Jun 27, 2022 11:51 am

Re: Oscar chart -- do I have a problem?

Post by Gfox » Mon Jun 27, 2022 2:31 pm

Great -- thanks! I see definitely some instances where it looked like the leaking might have something to do with the arousals/CAs but there are others where I am not sure about this.
Posted a few shorter ones per your suggestion:

https://imgur.com/a/Gm14pN1
https://imgur.com/a/1Mc4hjq
https://imgur.com/a/FkJ6npB
https://imgur.com/q7aff2Ky

If my leaks are indeed causing the issues/arousals, then one could maybe deduct: The therapy is working (and hypopneas/ apneas are averted) but leakage is causing me to wake up and is driving up the CAs --- possibly causing me to get suboptimal sleep as a secondary effect.
Are my leaks though in the normal spectrum of what one can expect, or should I aim for lower leakage overall?

thanks again, very helpful.

_________________
MachineMask

User avatar
Pugsy
Posts: 63941
Joined: Thu May 14, 2009 9:31 am
Location: Missouri, USA

Re: Oscar chart -- do I have a problem?

Post by Pugsy » Mon Jun 27, 2022 2:50 pm

Bottom link doesn't work for me.

First 2 images....looks like arousal breathing to me. You have to evaluate the flow rate (breaths) that occurred immediately (minute or so) prior to the flagged event and that's not asleep breathing to my eye at all.
Your 3rd link...zoomed in too much and it distorts the flow rate.

Here's an example of asleep breathing and arousal/awake breathing all in one image. I circled the asleep breathing in red.
Anything not in red means not asleep and that includes the flagged events being false positives.
Asleep breathing is VERY regular and rhythmic...not spotty or with big gulps of air.
Watch those videos again.

Image

and a more zoomed out version of the above segment

Image

_________________
Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier
Additional Comments: Mask Bleep Eclipse https://bleepsleep.com/the-eclipse/
I may have to RISE but I refuse to SHINE.

If you want to try the Eclipse mask and want a special promo code to get a little off the price...send me a private message.

User avatar
Miss Emerita
Posts: 3416
Joined: Sun Nov 04, 2018 8:07 pm

Re: Oscar chart -- do I have a problem?

Post by Miss Emerita » Mon Jun 27, 2022 3:24 pm

I'm seeing some possible breath-holding too. Try this: right-click on the graph label for Flow Rate, select Dotted Lines, and check Zero. In zoomed-in views, this will help to clarify when you are inhaling (above 0) and when you are exhaling (below 0) and when you are doing neither (at 0). Where you see inhalation and then some time at the zero line, you may be holding your breath, perhaps as you turn over. If it lasts 10 seconds or longer, you'll have an event tag.

It's hard to know what might be causing your arousals. Leaks are a possibility. Do you think your mouth is opening during the night? Or do you think mask leaks are more likely?
Oscar software is available at https://www.sleepfiles.com/OSCAR/