[CPAP] Trying to understand this breathing pattern

[Palathius]

I am new to Sleep Apnea, CPAP, and Treatment.  I have been under treatment now for about 7 weeks.  My results have been very mixed. One day my AHI will be 4.x the next 15+, the following between 6 and 10, and everything in between with no change in treatment.  Then my provider will make changes to my machine and we start over with again very mixed results.

Up until the 11th of November, I was relying on the F&P website for data analysis and my provider's guidance. They kept saying things needed tweaking without really explaining what they saw or what they were tweaking besides the pressure. After the 11th my CPAP stopped downloading to my iPhone and uploading to the F&P website I started looking for an alternative so I could see the data, that is when I found OSCAR.

I downloaded my data and I can see mixed settings and very inconsistent results. It looks to me like the provider is mostly guessing what to do, I could be wrong as I am not used to reading this type of data and so I am new to understanding the results.

I've attached a few screenshots of the OSCAR results from the details, overview, and statistics views I need help interpreting the results so I can advocate for positive changes in my treatment regimen.  Right now due to my lack of understanding I am not sure how to figure out what is going on or what to change.  I also don't have tremendous confidence I am able to effectively communicate with the provider and I am concerned because of my lack of knowledge I might advocate for a change that won't affect my treatment positively. For example, I am thinking my CPAP machine is malfunctioning or just isn't right for my therapy, or the provider is not knowledgeable enough to treat me correctly. Neither of these might be correct.

I've read the OSCAR guide and besides the changes to my CPAP settings and not understanding if any specific changes are helping I also have a question about the APNEA event the reporter keeps flagging, I cannot find any references to understanding what is happening during the event. If my reading is correct then I am watching a very slow inhale breath that is extremely shallow in nature, before I suddenly inhale successfully and exhale normally.  Then repeat a few breathing cycles later. Is this correct?


   
   
   

[Gideon]

Apnea is simply an 80-100% restriction in breathing for 10+ seconds

The section you zoomed in on I can't determine a cause for. You do have 2 clusters of obstructive events later which usually indicate a form of positional apnea usually caused by chin tucking.

Tell us about the pillows you use and read about the soft cervical collar in my signature.

[Geer1]

Do all of the apnea look like that? Post up a few more examples and some examples of the hypopnea would be good too.

This looks like central apnea but would like to see more examples to confirm.

[quiescence at last]

i am also looking at the data, and it is pretty hard to see much correlation between AHI and pressure band, partly because the changes were only for a day or 2.

based on the overview your settings for Nov 8 thru 16 gave you the best so far. Looks like min 10 max 12 and EPR of 1. I think I would widen that to min 10 max 13 and EPR of 1, then give us some plots to show how that goes. each night is different, so you'll probably want to give us charts from three representative nights.

From your close up shot, I believe you have awake breathing all the way up to 43:46, when your breathing transitions to a normal sleep breathing pattern. The machine counts those events, but they are not really 'sleep' apneas.

QAL

[Palathius]

Hi Gideon,

I've used 3 different pillows at this point. I am predominately a left side sleeper. I am deaf in my right ear and so if I do shift I tend to wake because I hear something.  Occasionally I wake up on my back, but it is pretty rare.  So my pillows are all designed for side sleepers.

Pillow 1. a very soft foam-based pillow, is about 4 months old and is somewhat impacted now. (the only pillow for the past 7 weeks)
Pillow 2. a memory foam based pillow with contours for the shoulder, neck and head.  
Pillow 3. a medium weight foam-based pillow, that I tend to use only when I am sick with a head cold, to raise my head a bit to allow for easier breathes while congested.

I'll look at the cervical collar you have in your signature.

All my apneas now look pretty similar to the ones I posted.  I'll post more tomorrow for you all to review.  

The pressure analysis is along the same lines I was thinking, though at one point very early on my RTT had the APAP on and set the min to 10 and the max to 15, this appeared to not be working.  The charts, which I will post either later tonight or tomorrow show the Flow Rate maxing out still.

David

[Geer1]

Your pressures will max out because this machine appears to only flag apnea and not differentiate if it is central or obstructive and therefore must be programmed to increase pressure regardless of type of apnea.

As QAL mentioned it looks like you may have been awake to the left of apneas and that is one of the reasons I think these are central and what would be called sleep transition central apnea.

The other reason I think they are central is because of how they start and end. You have a smaller amplitude breath before each apnea and then a long slow exhalation period during which apnea occurs because your body isn't actively attempting to breath until all of a sudden breathing kicks back in and when it does it just picks up on a normal rhythm again.

If this was positional as Gideon was thinking I would expect to see some large amplitude recovery breaths after each apnea rather than just a continuation of regular breathing.

As mentioned seeing some more examples would help confirm these are centrals. If these are centrals then your one comment "For example, I am thinking my CPAP machine ... just isn't right for my therapy" is correct and it explains why nothing you have tried has helped thus far.

[Sleeprider]

The pattern is consistent with chin-tucking, aka positional apnea, and while the posted example does not show recovery breathing, we should look at more examples before concluding whether apnea is potentially central or not. The lack of a trend for AHI vs pressure or EPR both point to positional obstructive apnea. Higher flow limit is consistently associated with lower pressure and EPR. I'm pretty sure we are looking at obstructive sleep apnea, and that it is positional in nature. http://www.apneaboard.com/wiki/index.php...onal_Apnea

[Palathius]

Thanks, everyone for the feedback.  I'm posting some more examples showing the same patterns from my last 3 nights.  I'm looking at some leaks at some event times on 2 of the 3 nights, but none on 1.  It looks like I am either shifting or waking and getting the result that reports out as an apnea. I'm wondering if another machine would flag a clear airway/central where the F&P is only capable of flagging the apnea...  

           

[SarcasticDave94]

If it is Positional Apnea, the brand of the machine doesn't much matter. Pressure can't remedy it. Either a flatter pillow in moderate cases and a soft cervical collar for more severe.

[Geer1]

I am sticking with central apnea for multiple reasons.

First example shows a potential arousal due to flow limitations followed by 3 transition apnea, hypopnea and minor periodic breathing while breathing stabilizes.
Second example shows another potential arousal followed by a group of apnea that are not poster child central apnea but closer to central than obstructive in looks, also some more periodic nature noted.
Third example shows some similar stuff again so all are showing a somewhat central nature.

You almost never have a complete cessation of flow rate, the apnea almost always occur on a long slow exhale in which air continues to flow out.

Cardiogenic oscillations appear to be present in a number of these apnea which is only possible in central apnea.

Looking back at your overview data your results are wildly inconsistent and do not change significantly based on the different settings tried, central apnea is notorious for being inconsistent.