Sleep report anomalies and their causes.

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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ejbpesca
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Sleep report anomalies and their causes.

Post by ejbpesca » Mon Nov 14, 2022 12:04 pm

On occasion my daily reports from OSCAR will show graphed data that appears to be an anomaly. Last night's report shows a cluster lasting one hour of 60 obstructive apneas lasting from 10 to 37 seconds. Graphs went back to normal and waking was 1.5 hours later. The rest of the report appears to be a good night of therapy. This cluster occurred the hour before waking. I woke very groggy but was okay and alert within an hour.

Dense clusters of events appear on OSCAR and from O2 reports, showing up about once a week, that run 30 minutes to an hour durations. It seems the one last night would not be survivable, so I wonder what is going on with my gear. Could it be a long large mask leak?, but that would not have caused the O2 ring to malfunction.

My O2 sleep report from last night also shows, in the same time frame, an anomaly of dips from 97 to 80 every few seconds for an hour. Since both anomalies are occurring with two different devices at the same time, what could be going on? Can these be actual readings of my lack of breathing and desaturation of O2? The readings seem way to drastic/severe to survive.

I am guessing a possibility is that I went into movement during sleep that caused the mask to leak and the O2 ring to loose proper contact. Then somehow the mask and ring got back into operating position for the last hour and a half of the sleep session.

These event clusters will cause your AHI to be skewed. I got 13.2 last night due OAs detected each consecutive minute for an hour. Any thoughts or experience anyone can share concerning, what I think are, anomalies on sleep reports?

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lynninnj
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Re: Sleep report anomalies and their causes.

Post by lynninnj » Mon Nov 14, 2022 2:01 pm

Any chance you rolled over onto your back during that time frame and they are accurate readings?

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Re: Sleep report anomalies and their causes.

Post by robysue1 » Mon Nov 14, 2022 2:19 pm

ejbpesca wrote:
Mon Nov 14, 2022 12:04 pm
On occasion my daily reports from OSCAR will show graphed data that appears to be an anomaly. Last night's report shows a cluster lasting one hour of 60 obstructive apneas lasting from 10 to 37 seconds. Graphs went back to normal and waking was 1.5 hours later. The rest of the report appears to be a good night of therapy. This cluster occurred the hour before waking. I woke very groggy but was okay and alert within an hour.

Dense clusters of events appear on OSCAR and from O2 reports, showing up about once a week, that run 30 minutes to an hour durations. It seems the one last night would not be survivable, so I wonder what is going on with my gear. Could it be a long large mask leak?, but that would not have caused the O2 ring to malfunction.
Sure sounds like supine sleeping with your (max) pressure not being high enough to control your OSA when you're on your back. That late in the night, there also could some substantial amounts of REM while supine going on, and that could be a double whammy to the AHI.

On your diagnostic sleep test, did they say anything about whether your OSA was substantially worse on when you were on your back? And what were your minimum O2 levels on the diagnostic sleep test?

And if you had an in-lab titration study, was any of the sleep recorded as supine sleep?
My O2 sleep report from last night also shows, in the same time frame, an anomaly of dips from 97 to 80 every few seconds for an hour. Since both anomalies are occurring with two different devices at the same time, what could be going on? Can these be actual readings of my lack of breathing and desaturation of O2? The readings seem way to drastic/severe to survive.
If the two devices are reasonably well in sync, it sounds to me that your max pressure setting is not quite high enough to prevent long clusters of events when you are on your back.
These event clusters will cause your AHI to be skewed. I got 13.2 last night due OAs detected each consecutive minute for an hour. Any thoughts or experience anyone can share concerning, what I think are, anomalies on sleep reports?
I'm not so sure they're "anomalies". It sounds to me like you might just have a significant positional component to your OSA and your (max) pressure is not high enough for the machine to provide effective support for your airway when you are on your back.

Could you post one of these monster clusters along with the pressure graph and the leak graph?

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ejbpesca
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Re: Sleep report anomalies and their causes.

Post by ejbpesca » Thu Nov 17, 2022 6:08 am

On your diagnostic sleep test, did they say anything about whether your OSA was substantially worse on when you were on your back? And what were your minimum O2 levels on the diagnostic sleep test?

And if you had an in-lab titration study, was any of the sleep recorded as supine sleep?

Four sleep tests and no one said anything, but hello and goodbye. I have never had a titration study in or out of lab. Pulmonologist says zero on yearly visits, and asks one question, "Do you use CPAP at least 4 hours per day?" No sleep person has ever seen an OSCAR report nor any report on me ever in 12 years.

Yes, I roll to my back sometimes in sleep. Looking back, with Max pressure at 20 I always had <5 AHI. I'm creeping the Max up since visiting here to find a number that gives therapy but no aerophagia. With the Max lowered, I did enjoy no dry mouth. At Max 10, came return of the dry mouth but not quite as bad as Max 20.

Here is the monster cluster that seems like bad data to me, but I guess it could be survivable.
OSCAR 11 13 22.png
OSCAR 11 13 22.png (316.2 KiB) Viewed 337 times

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Re: Sleep report anomalies and their causes.

Post by LSAT » Thu Nov 17, 2022 6:32 am

Between 5 and 6:30 your machine was running at 11 pressure and you can easily see that it was not high enough. It was trying to stop some apnea events and it couldn't do it because you blocked the pressure from increasing by locking in 11 as your max pressure. Increase the max and you shouldn't have that issue.

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Re: Sleep report anomalies and their causes.

Post by Rubicon » Thu Nov 17, 2022 6:41 am

ejbpesca wrote:
Thu Nov 17, 2022 6:08 am

Here is the monster cluster that seems like bad data to me, but I guess it could be survivable.
Can you load that onto SleepHQ (such that it is) for a closer look?
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Re: Sleep report anomalies and their causes.

Post by robysue1 » Fri Nov 18, 2022 12:43 pm

ejbpesca wrote:
Thu Nov 17, 2022 6:08 am
Here is the monster cluster that seems like bad data to me, but I guess it could be survivable.

OSCAR 11 13 22.png
Can you zoom in on the period between 5:15 and 6:30---i.e. just the cluster itself?

Or, as Rubicon suggests, would you consider posting your data to SleepHQ and providing a link for this day's daily data? That way Rubicon and others can zoom in on the cluster in order to figure out just what might be going on during that cluster.

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Re: Sleep report anomalies and their causes.

Post by palerider » Fri Nov 18, 2022 6:48 pm

ejbpesca wrote:
Thu Nov 17, 2022 6:08 am
Here is the monster cluster that seems like bad data to me, but I guess it could be survivable.
If your machine hadn't been prevented from responding by having the max pressure set too low, it's unlikely that block would have happened.

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Re: Sleep report anomalies and their causes.

Post by ejbpesca » Mon Nov 21, 2022 5:09 am

[/quote]
Can you zoom in on the period between 5:15 and 6:30---i.e. just the cluster itself?

Or, as Rubicon suggests, would you consider posting your data to SleepHQ and providing a link for this day's daily data? That way Rubicon and others can zoom in on the cluster in order to figure out just what might be going on during that cluster.
[/quote]

Sleep HQ report:

https://sleephq.com/public/cfba71a9-0f5 ... 8358ceff83

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Re: Sleep report anomalies and their causes.

Post by ejbpesca » Mon Nov 21, 2022 5:18 am

The min pressure seems to be doing well. I am creeping up the max. and good a couple of good report cards last two nights. Is it common for 1 point in cmH2O to make a significant difference in AHI?

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Re: Sleep report anomalies and their causes.

Post by Rubicon » Mon Nov 21, 2022 5:34 am

Yeah probably a back roller. Probably too long and sustained to be (entirely) REM. Surrounding breaths are significantly flow-limited:

Image

Major snoring registered.

Didn't we have this same conversation a month ago?
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Re: Sleep report anomalies and their causes.

Post by Rubicon » Tue Nov 22, 2022 6:30 am

Georgie Santayana.
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Re: Sleep report anomalies and their causes.

Post by ejbpesca » Wed Nov 23, 2022 9:27 am

Rubicon wrote:
Mon Nov 21, 2022 5:34 am
Yeah probably a back roller. Probably too long and sustained to be (entirely) REM. Surrounding breaths are significantly flow-limited:

Image

Major snoring registered.

Didn't we have this same conversation a month ago?
Similar conversation was held but in different context. In this thread I am pursuing the possibility of sleep reports containing anomalies and their causes. The question is, "Is this cluster an anomaly or is it real? If anomaly, what can cause it?" From responses, I gather that it is the opinion here that a tightly packed cluster is a correct indication of apneas, not an anomaly. The cluster in question appeared so severe I was hoping it may be an anomaly, that is, a failure of the system to report properly.

Another example of a possible anomaly is coming from my O2 ring. It will show at times, in a 30 minute cluster, O2 saturations go from 97 to 75 in 20 seconds, then back to 97 in 12 seconds, repeating the oscillation about 60 times in 30 minutes. One poster here suggested that was caused by movement claiming the saturation to desaturation and back time is too close to be possible. The pulse rate on that segment of the graph also jumped up and down from 60bpm to 90bpm in a similar fashion, but not quite as dramatic. The motion graph was near empty of events for the same period of time so I have no evidence of me shaking up the oximeter in my sleep. Perhaps I rolled around putting pressure on the ring that made it fail. Maybe blood O2 can change that rapidly. Do you think it can?

That incident got me wondering if the CPAP data also can have clusters of data that are not accurate, and maybe caused by some input the software is misreading. When a number of events happen so rapidly, it does not seem physically possible to be occurring. Could it be incorrect data, or are these packed clusters of events concise data that should be taken as an alarm bell to change something, get medical help, etc.? I see these clusters intermittently on my sleep reports. I would like to dismiss them as mistakes by the machines, not rough spots on my cpap therapy, but I don't know enough to do that. I guess I need to read articles about the accuracy of sleep and oximeter reports, and opinions here are most appreciated.

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Re: Sleep report anomalies and their causes.

Post by lynninnj » Wed Nov 23, 2022 8:53 pm

ejbpesca wrote:
Wed Nov 23, 2022 9:27 am
Rubicon wrote:
Mon Nov 21, 2022 5:34 am
Yeah probably a back roller. Probably too long and sustained to be (entirely) REM. Surrounding breaths are significantly flow-limited:

Image

Major snoring registered.

Didn't we have this same conversation a month ago?
Similar conversation was held but in different context. In this thread I am pursuing the possibility of sleep reports containing anomalies and their causes. The question is, "Is this cluster an anomaly or is it real? If anomaly, what can cause it?" From responses, I gather that it is the opinion here that a tightly packed cluster is a correct indication of apneas, not an anomaly. The cluster in question appeared so severe I was hoping it may be an anomaly, that is, a failure of the system to report properly.

Another example of a possible anomaly is coming from my O2 ring. It will show at times, in a 30 minute cluster, O2 saturations go from 97 to 75 in 20 seconds, then back to 97 in 12 seconds, repeating the oscillation about 60 times in 30 minutes. One poster here suggested that was caused by movement claiming the saturation to desaturation and back time is too close to be possible. The pulse rate on that segment of the graph also jumped up and down from 60bpm to 90bpm in a similar fashion, but not quite as dramatic. The motion graph was near empty of events for the same period of time so I have no evidence of me shaking up the oximeter in my sleep. Perhaps I rolled around putting pressure on the ring that made it fail. Maybe blood O2 can change that rapidly. Do you think it can?

That incident got me wondering if the CPAP data also can have clusters of data that are not accurate, and maybe caused by some input the software is misreading. When a number of events happen so rapidly, it does not seem physically possible to be occurring. Could it be incorrect data, or are these packed clusters of events concise data that should be taken as an alarm bell to change something, get medical help, etc.? I see these clusters intermittently on my sleep reports. I would like to dismiss them as mistakes by the machines, not rough spots on my cpap therapy, but I don't know enough to do that. I guess I need to read articles about the accuracy of sleep and oximeter reports, and opinions here are most appreciated.
Have you tried holding your breath as long as you can and see how low it goes and in what time frame?

I know that isn’t scientific but it’s a start and may answer part of your question.

My other curiosity comes from the threads about diffusers and breathing in your own co2 if diffusers are blocked. Any chance that could be happening ie bed sheets blocking?

gl

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Re: Sleep report anomalies and their causes.

Post by ozij » Wed Nov 23, 2022 9:23 pm

ejbpesca wrote:
Wed Nov 23, 2022 9:27 am
Do you think it can?
I think it can
Remember:
And obstructive apnea makes you stop breathing.
Your brain jolts you awake, because your brain got information that your blood oxygen level is too low you take a deep breath, your blood oxygen returns to normal, you drop back to sleep, repeat.
We know your clusters always come with major snoring and flow limitations - all indications that your breathing is obstructed.
ejbpesca wrote:
Wed Nov 23, 2022 9:27 am
I would like to dismiss them as mistakes by the machines, not rough spots on my cpap therapy, but I don't know enough to do that.
I think that's wishful thinking.
You got the oximeter to gauge the severity of your choking clusters. You now know how severe they are.
If you're still not convinced, you may want to set up a an all night video of yourself -- or even a sound recording that will show you your snores.

Your back rolling is major problem.
It's also telling that the cluster started just when the leak got close to max - and dropped. The scenario I'm imagining is "leak leading to arousal leading to positon change leading to apnea cluster". So, another hint that you rolled onto your back.

Once you're on your back, your maximum pressure is simply not enough.

Here's what you're up against:
Severe obstructions when you're on your back - needing more maximum pressure when they start.
A minimum pressure that's too low for keeping obstructions from happening when you're on your back.
Severe aerophagia in the past due to high pressures, though that has improved recently.
Leaks that maybe disturbing your sleep making you change position [that's based only on one chart, so this could be wrong - check it on other charts]

Here's what I would do if it were me:
Try for better mask fit / hose management or whatever fixes the leaks.
Search for better means to keep me from turning onto my back
Also try raising my maximum pressure in careful increments to avoid aerophagia.

Weren't you much better off - obstruction-wise - when your minimum pressure was not lower than 9?

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