Newbie, concerned about CAs / CSR like patterns, could use some insight

Hello!

I am a newbie and just 34 nights in and am still getting adjusted to the mask and pressure, etc. My usage has been good, though. I recently updated my settings to turn EPR: Off Minimum pressure: 6.2cm Maximum pressure: 8.8cm. I have 2 new masks coming in today because I know my leak has been poor.

I had an at-home test that noted 13.6 AHI and only 2 central events. I don't know if the at-home device is even capable of determining the difference between OSA and CA given it was a positional chest device and a pulse oximeter.

Here's my whole account data on sleephq, but below is a bunch of screenshots from different nights. A good number of them occur in batches, particularly within the first ~90 mins of the night. Are these legit? Should I be concerned? Sleep wake junk?

Oscar doesn't show a single CSR flag in any of the 34 nights this far but I know those go under flagged

https://sleephq.com/public/teams/share_ ... dashboard

Any of these look like CSR? (or any of them in my sleephq account)? I know they are hard to read with the leak issue.

https://imgur.com/a/xG9suKq

Welcome to the forum.

None of those flagged CAs/centrals are anywhere near looking like CSR in fact they aren't even real asleep centrals. Instead they look like post arousal flagging and you probably were awake or semi awake (you may or may not remember the awakenings/arousals).
Actually with the exception of maybe one or two of the other flagged events...those look like post arousal flagging as well.

Instead your flow rate looks more like you didn't sleep soundly much of the time.

Take a look at this thread for similar question from a newbie.
viewtopic.php?f=1&t=187767&p=1451526#p1451526

Don't worry about the leak rate unless you see yourself spending much time above 24 L/min (which is Resmed's rather conservative line in the sand for large leak territory) and IMO 30 L/min is a more realistic line in the sand. Above 35 L/min is more like where the machine has trouble recording and/or responding to events.

Are you sleeping soundly or do you remember waking often?

If not SOUND asleep nothing flagged really matters except to point to poor sleep quality.

Thanks Pugsy!

Did you happen to see any actual CA / CSRs in any of my previous nights? I just took screenshots of what I thought could be them, but not very good at finding examples, obviously. Maybe I am just being paranoid/anxious about the CAs even being flagged since my sleep study said I only had 2 all night, and the idea of possible CSR.

So I do get good nights, good question. These are all the same mask, n30i

Here's an example where there was some leak but not major all night https://sleephq.com/public/ecd7472d-dcb ... 24096974e - EPR2

Last night was pretty horrendous. Lots of leaks woke me up, and my partner said they could hear extra air blowing somewhere https://sleephq.com/public/0299a134-abd ... 564d9ec1d1 - EPR Off

This was a pretty good night, https://sleephq.com/public/8063ef5d-4ab ... b4de7af3fd - EPR off

I just found it interesting that the CAs dropped a ton when I first turned EPR off, you can see it at the end of the chart.



If you know of any resources for determining a false CA flag, that would be cool. I did find this thread, which ironically you were in and mentioned by other posters

viewtopic/t184898/These-are-NOT-Clear-Airways.html

sleepydad11 wrote: ↑

Fri May 22, 2026 1:43 pm

Here's an example where there was some leak but not major all night https://sleephq.com/account/teams/vKmap ... id=YvNoaa - EPR2

Last night was pretty horrendous. Lots of leaks woke me up, and my partner said they could hear extra air blowing somewhere https://sleephq.com/account/teams/vKmap ... _id=YvNoaa - EPR Off

This was a pretty good night, https://sleephq.com/account/teams/vKmap ... _id=YvNoaa - EPR off

None of the above links work for me because it wants me to log in.....you didn't choose the "public" link.

sleepydad11 wrote: ↑

Fri May 22, 2026 1:43 pm

Did you happen to see any actual CA / CSRs in any of my previous nights?

You had a different night link? All I looked at was the link in your first post. Last night's report. I didn't know you wanted me to go back further. I just now saw I could go back to Wed night...so I went...pretty much the same as Thursday night.

At any rate even if you had every single one of those flagged centrals last night as being a real asleep central.... you didn't have enough of them to be a problem. Having an occasional real asleep central is actually normal. It's normal to have what we call sleep onset centrals. None of yours on last night's report was even a "maybe real central". For doctors to get excited about centrals you need to be seeing at least 5 per hour and mostly all night and mostly every night and they have to be real asleep centrals.
EPR can cause it but usually when we see EPR causing them you still need to be having at least 5 per hour and must definitely be asleep.
I seriously doubt that EPR was the cause of your centrals. I think that poor sleep quality and the arousals were what caused your centrals.

If you have real centrals and real CSR (not all centrals means CSR) your machine will flag them in green. Easy to spot on the reports.
See this example below from someone who had real CSR and a real significant problem with centrals.

sleepydad11 wrote: ↑

Fri May 22, 2026 11:18 am

Any of these look like CSR? (or any of them in my sleephq account)? I know they are hard to read with the leak issue.

Nope. All look like post arousal flagged events. I also took a peek at the Wed night report....nothing of great excitement there.

Pugsy wrote: ↑

Fri May 22, 2026 2:43 pm

sleepydad11 wrote: ↑

Fri May 22, 2026 1:43 pm

Here's an example where there was some leak but not major all night https://sleephq.com/account/teams/vKmap ... id=YvNoaa - EPR2

Last night was pretty horrendous. Lots of leaks woke me up, and my partner said they could hear extra air blowing somewhere https://sleephq.com/account/teams/vKmap ... _id=YvNoaa - EPR Off

This was a pretty good night, https://sleephq.com/account/teams/vKmap ... _id=YvNoaa - EPR off

None of the above links work for me because it wants me to log in.....you didn't choose the "public" link.

sleepydad11 wrote: ↑

Fri May 22, 2026 1:43 pm

Did you happen to see any actual CA / CSRs in any of my previous nights?

You had a different night link? All I looked at was the link in your first post. Last night's report. I didn't know you wanted me to go back further. I just now saw I could go back to Wed night...so I went...pretty much the same as Thursday night.

At any rate even if you had every single one of those flagged centrals last night as being a real asleep central.... you didn't have enough of them to be a problem. Having an occasional real asleep central is actually normal. It's normal to have what we call sleep onset centrals. None of yours on last night's report was even a "maybe real central". For doctors to get excited about centrals you need to be seeing at least 5 per hour and mostly all night and mostly every night and they have to be real asleep centrals.
EPR can cause it but usually when we see EPR causing them you still need to be having at least 5 per hour and must definitely be asleep.
I seriously doubt that EPR was the cause of your centrals. I think that poor sleep quality and the arousals were what caused your centrals.

If you have real centrals and real CSR (not all centrals means CSR) your machine will flag them in green. Easy to spot on the reports.
See this example below from someone who had real CSR and a real significant problem with centrals.

sleepydad11 wrote: ↑

Fri May 22, 2026 11:18 am

Any of these look like CSR? (or any of them in my sleephq account)? I know they are hard to read with the leak issue.

Nope. All look like post arousal flagged events. I also took a peek at the Wed night report....nothing of great excitement there.

Thank you so much, this definitely helps ease my worries quite a bit. For some reason clear airway flags have really been tripping me out!

Rookie move on the links, I corrected them in my original comment. Sorry about that.

Here's my full account share actually

https://sleephq.com/public/8063ef5d-4ab ... b4de7af3fd

If you're bored and want to pick another random night or two for any troublesome markers, that would be pretty helpful

It sounds though like I need to stop worrying about a low CA AHI, especially since a lot are sleep-wake junk and prioritize comfort for now.

sleepydad11 wrote: ↑

Fri May 22, 2026 3:00 pm

If you're bored and want to pick another random night or two for any troublesome markers, that would be pretty helpful

It sounds though like I need to stop worrying about a low CA AHI, especially since a lot are sleep-wake junk and prioritize comfort for now.

I don't have time right now to take a stroll through your other reports but will do that later this evening.

And yes.....you are worrying for no real reason except you are like most newbies and freak out over a few centrals especially when most of your flagged events in any category you weren't really asleep.
These machines are good but they can't tell if you were asleep, awake or halfway in between. They are fairly easily fooled.
I know that for a fact because I have played around while awake and doing various things with my breathing to see what the machine would flag. I have a good example somewhere of just that sort of experiment but I can't seem to lay my hands on it at the moment.

I did look through my photos though and while I couldn't find my experiment I did find something else that shows asleep breathing and a truck load of centrals that really look scary on the face of it...see image below
But understand I have been on cpap coming on 17 years and and I had this happen only 3 times not quite a year ago...and for some reason the machine didn't want to call it CSR (no green) and I was really surprised to see this.
I checked with a friend of mine who is/was the head of a sleep department (so very familiar with things and who is my main person to go to when I have a question about something)....and he was as befuddled as I was but we decided to just wait and see before we hit the panic button. I had nothing in my history to blame it on. So since it hasn't happened again we decided that "sometimes shit happens and we don't know why and just shrug our shoulders and move on".

What is good about this image for centrals is it is obvious this isn't sleep/wake/junk. LOL


Now I will still occasionally have a SWJ central get flagged but those are easy to spot and shrug off. In fact probably 75% of any of my flagged events are easy to spot as SWJ... I have a lot of pain issues so lots of arousals during the night and I just accept it.

sleepydad11 wrote: ↑

Fri May 22, 2026 3:00 pm

Here's my full account share actually

https://sleephq.com/public/8063ef5d-4ab ... b4de7af3fd

I actually tried the link above and it took me to May 19 tuesday.
I couldn't get this link to let me change to any other night for some reason. Might be me....I don't know as I don't really personally use SleepHQ for my own personal reports. I did last year to share my ugly night above with my friend in the sleep lab to get his opinion but otherwise I don't really use it myself.

Let me go back to your very first share where I did go back to Wed. See if I can get it to work right.

Your May 19 report...as I expected lots of arousals but minimal flagging of events...so nice low AHI.

I was able to use your first link and took a short stroll and looked around. Again nothing but post arousal flagged events especially the central flags.

I saw this on the May 18 th report (I think it was the 18 th or 17th) and it shows a good example of asleep breathing and SWJ central flag.



Looks up to around 10:54:30 (where I drew the first red line) you were sound asleep (nice normal regular boring breaths) and then the grouping of irregular breaths and then the central flag..... and then second red line is probably where you went back to sleep. Kinda hard to tell for sure but maybe falling back asleep in and out kind of thing. It's not always clear cut....but the left red line...that's an easy one.

Asleep breathing doesn't have ANY spikes or big breaths.
Awake or arousal breathing is just all over the place sometimes easy to see but sometimes not quite so easy (except to my friend who ran the sleep lab ).
I once had a central flag that I thought was "iffy" and I asked him about it and he said "post arousal" because of one tiny little blip right before the flag.