Resmed disagrees with Garmin

[bobdobbs]

Hello,

Been using a Resmed Airsense 11 for the past 3 months.  Finally getting pressure settings, mask, etc to good combination.  My average RDI, most nights, is around 0.8, and the flow rate curves look fairly reasonable.

(Note:  The resmed does seem to miss some events, so I set the user flag to 50% for 5 seconds.  That adds another 2-3 average events per hour.)

I also wear the latest Garmin 965 watch.

Interestingly, the Garmin watch will give me VERY low sleep scores, on most nights. (around 48-50 out of 100)  The main things seem to be:
- Long periods of low Sp02, i.e. 90% for 10 minutes
- It says my "stress" is high during sleep
- It says my deep sleep in insufficient

However, the Resmed shows long periods of good breathing patterns, very few events, etc.

Is the Resmed missing events?
is the Garmin reading my sleep wrong because I'm wearing an APAP?

I've attached a screenshot from last night.  My garmin gave me a sleep score of 48, but sleep looks OK

Any insights would be appreciated.

Thank You!

[Crimson Nape]

How would you even begin calibrating the Garmin for these parameters? Since there is no way to obtain traceability for these items, I am very skeptical of what it is reporting.

- Red

[PeaceLoveAndPizza]

Here is a YouTube review of the Garmin Forerunner 965 by The Quantified Scientist. If you have not watched this, give it a quick view. The section covering sleep starts around 16:30 into the video.

https://youtu.be/dv5l3tVYl2o?si=t3vwmrmfiR7WBKQi

[Gideon]

You were awake for about half the night. That agrees with your garmin.

Your Garmin 90% sat for 10 minutes tells me to look deeper. Does Garmin provide that data for 88%? What is the sample frequency on the Garmin O2 and can you provide a chart of the results?

[bobdobbs]

How can you tell that I was awake for 1/2 the night?  I thought the Oscar charts from last night looked pretty good.  With RDI of 0.13, and the User flag rate of 2.28, this looks like a decent night's sleep.  Clearly, I'm reading them wrong!!


Attached is the Garmin chart.  (Unfortunately, it doesn't provide more detail than this)


Garmin shows the lowest SPO2 around 4:25am, and lasting for around 10 minutes.  Looking at Oscar for that time range, my breathing looks very good, with one tiny interruption, marked by UF1 (see attached)

I've considered raising the minimum pressure.  Since the Resmed misses almost all of my "UF1" events, it may not be ramping up enough.  My UF1 is defined as 50% for 5 seconds. (This is my general complaint about Resmed.  If any event is less than 10 seconds, the machine just ignores it.  I have tons of RERA that last less than 10 seconds, so the autosense doesn't adapt for them)  


Any help would be really appreciated!!

Thank You

[Gideon]

Look at your Tidal volume. It tends to be very erratic when awake.
Note that 5 cumulative minutes at or below 88% is Medicare's threshold for qualifying for supplemental oxygen. You are at best approaching that milestone.

[bobdobbs]

Ahh, that's really interesting.

I never heard about using tidal volume as a diagnostic.  Dr. just tells me to look at RDI and maybe flow rate.  (Clearly, that's not enough)

Thank You

[bobdobbs]

Another interesting data point:

Looking through the history of my Garmin tracker, my sleep scores, in general, were better before I started using the cpap.

Average monthly range (roughly):
- Before APAP: 66-75
- With APAP:  50-60

None of my sleep was "great".  But there have been more bad days with the APAP, then without.

One thought:  Dr. prescribed Zopiclone (1/2 tablet) to help me adjust to APAP.  It does help me sleep, but I wonder if it somehow affects my breathing or tidal volume?

Thoughts?

[SarcasticDave94]

I'm wondering how many apnea and what type your sleep study report indicated. Here with the ResMed AutoSet, it reports none during therapy. It either treated the Apnea or they didn't occur in that Oscar chart. I'm leaning towards the AutoSet is treating them.

Can it be better? Sure there can be room to improve therapy.

I however think it's flawed to assume the ResMed AutoSet isn't working correctly because it failed to address user flags that are half the time of an apnea time requirement.

I'm in agreement with Gideon on the oxygen levels. It looks reasonable close to below 88 for 5 or more minutes.

[THEVGE]

I own a Garmin Forerunner 745, I love tracing data, and I have been on CPAP/BiPAP for 3 years or so. My Resmed has been useless to me for data, I have perfect scores on paper but still struggle recovering from sleep. My diagnosis was mild sleep apnea, I have self-diagnosed for UARS (not recognized in The Netherlands).

About my Garmin experiences. Please note I did not dive into how the Garmin really works, just my observations and own interpretations.
- SpO2 is very unreliable and typically underestimates actuals (compared to Wellue O2 ring, official SpO2 during sleep test and fingertip SpO2).
- Sleepscore is heavily impacted by your stress levels during sleep. So is body battery. I find this stress KPI most interesting, I believe true progress in xPAP therapy should be visible in your stress measurements and therefore sleep scores and body battery.
- Sleepscore also measures "sleep stages" but we all know this is based on an algorithm. So take it with a grain of salt. Again, I notice that if my stress levels are lower I measure more deep sleep. If I have a crappy night I typically wake up early in the middle of a dream and my Garmin shows too high REM sleep. So yes, I think the Garmin is a nice predictor, especially for trends to see if you are going the right way. But if your average stress levels are high many KPI's are impacted.

My experience is also that if you start xPAP therapy it can take long before you are able to measure improvement on your Garmin. In my case the best KPI is "stress" and as a secondary effect more "deep sleep" and healthy REM/light sleep with a good recovery of body battery. I tried many masks and some give me experienced and measured stress. I skip these masks.

So what I am saying is that with the wrong settings/mask you can induce stress, while good xPAP therapy should reduce stress. And I think the Garmin should be able to make this visible in your data. But your body needs time to get used to any setting, I have only seen improvements on longer term (not days or weeks, more like months).