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I am going for a Sleep Study, not my first, next week. This morning I had a call from a technician or technologist, not sure of the title, to discuss the testing. He told me I had a high rate of OSA though according to Oscar I have a high rate of CSAs that are marked as CSRs and the nights I don't have CSRs I have minimal OSAs. He explained that they were not really CSRs but could be caused by unstable breathing. This does seem quite likely. He told me that they were hampered by Resmed"s refusal to release Airflow readings and that prevented them from delving deeper into what is happening. Oscar provides us with an Flow Rate but I assume he was referring to some other reading. Does anyone know what he is prevented from accessing? He is going to do the sleep over with a Bi-Pap instead of my CPAP. Thanks to your site and a lot of research I was able to stand my ground and not let him ignore my input me as they did the last time, and as I persisted he listened more carefully and we had a good conversation.
12-04-2023, 05:37 PM (This post was last modified: 12-04-2023, 05:38 PM by BoxcarPete.)
RE: Air Flow
Glad you are working to stand your ground on this one, BiPAP may or may not be a good solution for you. If your OAs are well controlled, getting the feedback loops marked as CSRs may be as simple as adjusting how much air you re-breathe. I read a meta-analysis of treatment emergent CSA this morning since I am experiencing the same thing to a small degree. It briefly referenced a study where they were able to make it go away in-lab by adding a small amount of supplemental CO2 to the patient's airstream.
The cool thing is, you don't need to have a source of supplemental CO2 because it's the primary waste product of your respiratory system. Everyone's needs are a little different, but medical types tend to be risk-averse so the amount of venting your mask provides you may be clearing too much CO2 because they are more worried about a patient re-breathing too much CO2 and the issues arising from that.
There is some information on this site about extending your re-breathed air volume here:
I would at least bring it up before going in for more testing and new machinery. I plan to fiddle around with something like this if fixing my leak problems doesn't prove to be enough.
I believe he is saying that CSR and CSA are best diagnosed in a sleep lab study with the appropriate equipment. CPAP machines approximate what is a CSR and CSA. Periodic breathing would be a better name for them in most cases, but the decision was made by manufacturers to use different terms. Typically CSR-CSA is a by-product of heart failure patients, so it can be a bit concerning when you see them pop-up on OSCAR charts.
Bravo for standing your ground! If you want someone here to review your new report, please redact the personal info and post it.
Staying with the air flow question and your saying:
Quote: He told me that they were hampered by Resmed"s refusal to release Airflow readings and that prevented them from delving deeper into what is happening. Oscar provides us with an Flow Rate but I assume he was referring to some other reading.
My suspicion is that he only has access to flow data that is much poorer (in terms of granularity) than what you are able to see via OSCAR.
If he is looking at detailed data from Resmed by using either ResScan or AirView, the flow rate versus time plot that we see in Oscar includes much finer detail than he can "see".
The reporting rate for ResScan is 1 reading every 500 milliseconds
The reporting rate for OSCAR is 1 reading every 40 milliseconds.
That is very interesting. I would be a bit nervous about making such a device but I can maybe enlist my son to help. I thought there must be something extra that the technician was referring to as I cannot imagine why he wouldn't have the information that I can read on Oscar. It further cements my belief that Resmed will do whatever it takes to make sure as many people as possible can test positive for Apnea and actively discourage their vendors from diverting from the written script. That was certainly my experience when I started nd within 2 weeks had my first CSR experience.
Quote: I cannot imagine why he wouldn't have the information that I can read on Oscar.
Unless he reads directly from your SD card, he can not see the same information that you have available on OSCAR (OSCAR does read directly from the SD card).
Thanks for the very interesting info. None of my masks have been ideal plus I have PLMD so there is a lot of movement when I sleep. I was wondering how I could record my nights sleep and match it to what it shows on Oscar and I remembered that I have a GoPro type device which I have never used so may set it up and see just what I get up to during the night. I have never believed that I have the real CSR and know that the limitations of the CPAP may cause it to name the closest thing to its description. I have a strong, healthy heart so no concerns about the heart aspect.
If they decide it is a result of my night time gyrations I am not sure what the solution would be. Except for one that I read about in a research article I came across in the NIH site. It told of a man with an exceptionally high PVC (heart arrythmia) burden, 40%, who presented at an Emergency Dept . The man was also using a CPAP which showed a high percentage of CSR, 21 percent and an AHI of 4.7(averages). After the successful ablation they found that the periodic breathing went from 21.5% to 6.1%. In addition his AHI reduced from 4.7 to 2.2. A year later his AHI had dropped to 1.55%.
It so happens that I have PVCs with a high burden of 39%. I am having my first consultation with an Electrophysiologist in January and hope to have an Ablation before the end of 2024. It may be a longshot but if all else fails it might be my last shot at obtaining restorative sleep.
Please post your OSCAR Daily charts, and post a zoomed view, 3-minutes of problem areas to include what preceded it.
And any sleep test data, the charts and tables in addition to the narrative.
Other than needing (by Medicare rule) a qualifying diagnostic sleep test is not needed. Though it is useful to prove efficacy.
I guarantee you that a PROPERLY set up BiLevel will never provide worse treatment than a CPAP or APAP. Most likely it will provide better more comfortable treatment. Except for special circumstances don't accept an ST, a very old school wave pattern with very sudden, Square Wave, changes in pressure. What it sound like if the target is a VAuto, there are other settings, such as Trigger, which we often suggest for CA events, especially those that appear in periodic breathing ResMed calls ALL periodic breathing CSR.)
Post charts, they will be very helpful in guiding our suggestions
Gideon - Project Manager Emeritus for OSCAR - Open Source CPAP Analysis Reporter
I am trying to send you an attachment but am having no success. It looks so straight forward-send a file and press add attachment but it does not do what it promises. It suddenly worked once but did not linger long enough for me to hit send. I am going to send it now in the hope that it will miraculously appear.
Your Oscar snapshot did indeed appear, however I’d suggest that you select the details tab instead of the events tab, that will provide more measurement data.
The overall problem you are experiencing seems to be periodic breathing, that is reported as “CSR”.
Note that almost all of your AHI events occur during these periods of periodic breathing. Whether those are true or real Cheyne-Stokes or not is something that requires a closer look by your healthcare team including your cardiologist.
It is my personal opinion that CSR or periodic breathing tends to confuse the machines event detection algorithms resulting in many event being scored during the wax/wane periods. A zoomed view (over 10 minute segment) would be helpful for you to see this.
