Interpreting OSCAR Data

This is my first post. I am learning how to interpret all the great data that OSCAR provides and am asking for a little help with that. Thanks!

I zoomed in on 3 events that took place around 6:20am this morning 2 CAs and 1 OA.
My first observation is that the pressure didn't change for either of the CA's, but went up for the OA. This seems consistent with other events I have looked at.
The mask pressure also went up right away for the OA, but dropped for the CA's.

1. My conclusion from these 3 data points is that my Resmed Airsense10 Autoset (clinical Mode Setting = Autoset) is responding to OSA events but not CSA events. Is this correct?
2. What is the correct interpretation for the flow rate around these events?

As soon as I receive a proper data cable I'm going to also upload my Wellue O2 data into OSCAR and see how the low O2 levels (90 to 95 for about an hour a night and 87 - 89 for about a minute or two) correlate with my events.

What else do I need to be looking for or research?
I need to get my sleep doc to do something as my peripherial neuropathy is getting unbearable and I am hammered with it nearly every morning I wake up with it lasting most of the day.

To my eye it doesn't look like you were asleep when those items were flagged.
The breaths are too irregular to be asleep breathing.

Interesting observation...it is possible that I was awake. I get up 3 to 5 times per night.
Is there a recommended behavioral protocol when getting up so as to not muddy the data?
- As soon as I am conscious that I'm awake I take off my mask and turn off the CPAP.
- When I get back into bed I put the mask on last and breath through my mouth until I'm settled on my side with pillows all around me and then start breathing through my nose (which autostarts the Resmed).
Is there anything else I can do to get more accurate data?
I think I read somewhere on this site that a Resmed may confuse being awake with a CA. Is this true?

All these machines can measure is air flow or breathing. They cannot measure sleep status.
Our awake breathing is much more irregular than asleep breathing and these machines see this irregular breathing and think that it is some sort of apnea event if it lasts long enough and meets certain criteria.

If we aren't asleep then those irregular breaths that got flagged don't really mean much except if we see a lot of it we know that our sleep wasn't so sound.

Hold your breath for 10 seconds....that's essentially what happens with a 10 second central apnea in that the airway is open but no air is moving.

While it is common to see flagged CAs/centrals where it's obvious we weren't asleep....it's not limited to centrals...we can have OAs and hyponeas flagged when awake.

Here is an example that shows both asleep breathing and awake breathing. I circled the asleep breathing in red.


Here's the same time frame except I have zoomed out a bit more so you can see more breaths. Again I circled the asleep breathing in red.


We don't take big gulps of air when we are asleep.
Here are some examples that show the big gulp (circled in red) which then is followed by a pause in breathing and then some sort of apnea flag.

LogCastle wrote: ↑

Sun Jan 19, 2025 5:59 pm

1. My conclusion from these 3 data points is that my Resmed Airsense10 Autoset (clinical Mode Setting = Autoset) is responding to OSA events but not CSA events. Is this correct?

This is correct and it's because of the way the machine is programmed to react.

Obstructive apneas are assumed to be caused by a collapsed air way, and that means you need more pressure to help keep the airway open. So after the apnea is over, the machine increases the pressure. Note: The machine does NOT increase the pressure in an effort to "blow open the airway"---it's not capable of producing that much pressure. The idea is that your body will arouse itself enough to tell the muscles around the upper airway to tighten up, and that will naturally open the airway. The increased pressure then makes it more difficult for the airway to collapse again.

Central apneas are assumed to be caused by a CO2 blood concentration problem. In other words, the breathing has stopped, but there's no effort to breath and the airway remains open. When this occurs during actual sleep, the problem is usually caused by the brain not responding to an increased CO2 blood concentration in the expected manner. (The trigger for "inhale now" is the CO2 blood concentration, not the O2 concentration.) Additional pressure does not prevent central apneas, and, in fact, can contribute to triggering a whole cluster of them: The additional pressure can cause some people to hyperventilate a bit and thus breathe off too much CO2, which leads to another central apnea when the brain doesn't send an "inhale now" signal to the lungs and diaphragm because the CO2 concentration is too low to trigger the "inhale now" response.

2. What is the correct interpretation for the flow rate around these events?

Like Pugsy, I'm inclined to write this cluster off as "sleep-wake-junk" breathing, but it would be useful to see a bit more of the breathing pattern just before 6:21:40. There is a big inhalation that looks like a possible arousal there, but it's hard to say for sure without seeing a bit more of the breathing before this cluster of events.

I need to get my sleep doc to do something as my peripherial neuropathy is getting unbearable and I am hammered with it nearly every morning I wake up with it lasting most of the day.

Serious question: Why do you think the sleep doc is the one to talk to about your peripherial neuropathy? One of the more common causes of peripherial neuropathy is diabetes. Have you been tested for diabetes?

LogCastle wrote: ↑

Sun Jan 19, 2025 7:26 pm

Interesting observation...it is possible that I was awake. I get up 3 to 5 times per night.
Is there a recommended behavioral protocol when getting up so as to not muddy the data?

There's not a specific recommended behavorial protocol when getting up in the middle of the night. Most people turn the machine off if they are going to get out of bed to go to the bathroom.

For a short wake when you just turn over in bed to get more comfortable? Waking up enough to turn the machine off and then back on may or may not be useful. What I mean by that: For some people, the process of waking up enough to turn the machine off and back on is a recipe for prolonging the wake and making it more difficult to fall back asleep. For other people? It's not a problem. So what to do when you wake up in the middle of the night and you don't intend to get out of bed is really a personal choice. Either way, the data is going to be somewhat ratty, but in the long run, the bits of ratty data are not as important as we sometimes think they are.

- As soon as I am conscious that I'm awake I take off my mask and turn off the CPAP.
- When I get back into bed I put the mask on last and breath through my mouth until I'm settled on my side with pillows all around me and then start breathing through my nose (which autostarts the Resmed).

Sounds like you have a method that works for you. So don't try to fix what ain't broke.

In time you should be able to look at your Oscar data and rather accurately say, "This is when I fell (back) asleep because this is when normal sleep breathing starts."

Is there anything else I can do to get more accurate data?

Except for not lying in bed for excessively long periods of time while consciously not sleeping, there's not much you can do to get "more accurate data". The basic idea is that if you are asleep most of the time you are using the machine, then the data is accurate enough for determining if your PAP therapy is "working" in the sense of preventing most of your obstructive apneas and hypopneas from occurring. That's why most sleep docs are content to look at the overall AHI measured for a period of several weeks or several months rather than the nightly AHIs, particularly for patients that are not experiencing any kind of problems using the PAP machine.

It's also important to keep this in mind: The average person with totally normal sleep has some spontaneous arousals and a few very short wakes each night that they do not remember when they wake up in the morning. It's typical to arouse when you turn over in bed. It's typical to have a very brief wake after the end of a REM cycle. For a person with normal sleep these things don't interfere with waking up in the morning feeling well rested and refreshed in part because they are so short. Problems with sleep quality can occur when a person starts obsessing over every time they find themselves awake in the middle of the night simply because that often triggers remaining awake long enough to remember the wakes the next morning: Multiple long wakes during the night (i.e. sleep maintenance insomina) is a real problem for a lot of people (both those with sleep apnea and those without)

I think I read somewhere on this site that a Resmed may confuse being awake with a CA. Is this true?

Yep. Pugsy explained this.

I will add this: In my own data, the machine seems to score my intentional (wake) holding of breath as OAs rather than CAs. I think the reason is that I may close my epiglottis while holding my breath. And when you do that, the FOT algorithm used by the Resmed machines detects air is not getting all the way down the windpipe (because of the closed epiglottis) and hence the machine interprets the FOT algorithm's result as data for scoring an OA.

Serious question: Why do you think the sleep doc is the one to talk to about your peripherial neuropathy? One of the more common causes of peripherial neuropathy is diabetes. Have you been tested for diabetes?

I had an A1C about a month ago and it was 5.6 (historically it has been about 5.1). My doc didn't seem concerned about diabetes with this number.

I'm seeing a neurologist for a bulging disc at L5 that causes tingling and numbness in my feet and one bout of sciatica so far. But every few years I seem to go through a period of peripherial neuropathy that makes my feet worse, but also affects my arms, hands, face, eyes, tongue and even my mid section (along with brainfog, head aches, dizzy and disoriented, being tired nearly all the time, and if it gets really bad my balance and coordination are affected). So I'm trying to get back in to see my Nero for these other symptoms.

I have been diagnosed with Hashimoto's, but my Thyroid panel numbers over the last few years have been in the "normal ranges". I take a small dose of NP Throid every morning. All my other bloodwork is in normal ranges.

I have hypertension and am on a med for that and borderline high cholesterol and am trialing a med for that the next 3 months.

I take Dupixent for Nasal polyups and asthma and both of those are finally under control.

Using a CPAP is pretty new for me (about 9 months so far) but my previous mask of 6 months didn't feel like I was getting enough cool fresh air. My current mask is much better. I have also been using a Wellue O2 ring because it is often giving me readings in the low 90s and upper 80s while I sleep. I was hoping to correlate my O2 data with my CPAP data in Oscar to see if anything interesting showed up. My odd set of symptoms are much worse in the morning upon waking up and last into the afternoon or evening. This is the main reason I am thinking that whatever is going on is mostly happening while I sleep. If Oscar yields anything interesting I want to give it to my sleep doc.

After writing all this it may seem like I'm a health wreck, but in spite of all this I do a bit of hiking (420 miles last year with 70k ft. elevation gain) to stay is reasonable shape (though I'm about 25 lbs over my optimal weight).