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1st post here. I'm having a very rough night. I was startled awake right at the moment of nodding off...twice!
I have been on APAP for about two weeks. Everything was pretty decent until tonight. Only issues have been some 'open airway' events. I'm not sure if they're true central apneas or just me being restless. Otherwise I've had no issues with APAP until tonight.
I use a ResMed 11, Pressure 4-14, P10 nasal pillows, EPR level 3 full time, ramp 5 mins, climate and tube temp automatic.
One two different occasions tonight I was startled awake feeling dizzy. I checked my SPO2 and it was 85 once at about 3:00am and 81 at 4:26 am. I've included a screenshot of my OSCAR data. Both events felt as if I was right on the edge of falling asleep, then I felt very 'air hungry'. I immediately checked my O2 sats and got the results above.
If I'm reading the report correctly I stopped breathing for a total of 29 seconds within the last 60 seconds of the data.
Needless to say I'm not going to be sleeping until I can figure this out. Any advice would be greatly appreciated.
Sorry you are having difficulties.
But first things first, we need to see the following graphs in this order, so we can get a complete picture, a full night, no zooming at this stage:
1.Events
2.Flow rate
3.Pressure
4.Leak rate
5.Flow limitations
(Note.Please exclude calendars so that all settings are visible)
There''s not much data for tonight. I started off trying the V-Com as recommended by others. I felt like I couldn't exhale properly. Settings at that time were:
CPAP, Pressure 10, EPR off. Then I tried it with the EPR on level 3 (the second data set).
I then went back to the standard settings as prescribed: APAP 4-14, auto climate and auto temp, ramp 5 minutes. Thanks for the help.
I sleep weird hours due to my job. There are 2 sleep sessions here.
From 2:30 pm to 7:45 pm my settings were: APAP 6.6-14, auto climate and auto temp, ramp off. I had a ton of large leaks as you can see.
The trouble started at about 2:00 am. I started off trying the V-Com as recommended by others. I felt like I couldn't exhale properly. Settings at that time were: CPAP, Pressure 10, EPR off. Then I tried it with the EPR on level 3 (the next set from 2:45 am to 3:10 am. I startled awake at 2:48 am and my O2 was 85.
I then went back to the standard settings as prescribed: APAP 4-14, auto climate and auto temp, ramp 5 minutes. I startled awake at 4:25 am and my O2 was 81. Haven't been able to sleep since.
You really are at the very early stages (around 2 weeks) of your use of CPAP, so it is difficult to draw any clear conclusions. You did state that previously all was running well. Also this is just one night only.
I can only comment at this stage in general terms rather than specific.
In these early days the body is having to acclimatise to being “attached” to a foreign body pumping air into you. It can react in strange ways until finally setting down. Also for the user having to get used to a mask strapped to the face isn't easy.
This is all in addition to a sleep debt that has probably built up over a period of months, or for many people, years.
There is one item that you brought up, that being central apneas. In these early days, these apneas can be machine induced. Usually these early central apnea events disappear.
It only becomes something to watch if continuing on a long term basis. Central apneas can come and go for no apparent reason. Sometimes they can be “false alerts”. The 29 second central you were alluding to just before waking up can be classified as Sleep Awake Junk. This is nothing to worry about. Just about everyone experiences these from time to time and frequent when just dozing.
Regarding the 29 seconds, this seems shocking, but again, this is not unusual. For real centrals, this occurs often in the phase of sleep when the body is semi paralysed, muscles shut down, and little oxygen is really needed. The body will react pretty fast and awaken you pronto if a problem !
During my sleep study (severe sleep apnea) , the longest apnea was 104 secs, average was 32 secs. And I ain't joking! So don't give it a thought.
Regarding the sensation of feeling “air hungry”, and difficulty to exhale, for the former we would need to have your Sp02 graph imported into Oscar, so as to link to apnea events, pressure, flow limitations and leaks. At the moment you have included mask pressure, instead of leaks.
Concerning difficulty to inhale this was most likely due to switching of EPR. Keep it on 3 at the moment.
One last comment on your graph presentation, we can't see all you settings, best to resize for any future posts.
Thank you for taking the time to reply. I have attached another OSCAR report of the eight hour 12 minute session of sleep after my rough night.
I feel better knowing there may be little to worry about with the CA's. My in-home sleep study revealed 53.3 AHI with only 1 central apnea detected in a 9.5 hour session.
I'm going to purchase a pulse oximeter that can be downloaded to my PC.
I wish there were an affordable device that I could download directly to OSCAR. There doesn't seem to be any real dependable and affordable options yet. At least not in the USA anyways.
Did I get the zoom out and order correct this time?
Thanks, your graph presentation is just about perfect.
A minor note, would be a bit better to reduce the y-axis scaling of your flow limitations to 0.25, instead of 1.0. This will give us better visibility. This is because the ideal maximum for flow limitations is 0.1, not 1.0. This is done by right clicking on the mouse whilst hovering over the scale column or there about.
Your graphs now are easy to read. I would like to make some very early observations thanks to this.
You have a number of large mask leaks grouped together, these can cause arousals, sleep discomfort, and falsify readings. In my experience sometimes indicating false centrals. Please read through this very informative with the mask primer HERE.
You have just provided new information concerning central apneas. What type of sleep study did you have, home or polysomnography? Did the doctor flag these, and any particular comments or recommendations? What was the breakdown of types of events making up your total AHI?
It is right to keep a keen watch on this area, now you have the facility to do so with OSCAR. It will be possible now to know in the coming weeks or so if your current centrals are actually machine induced or not. One important point, certain medicines can induce centrals, especially pain killers and some sleep aids.
But again, very early days on this. Your machine is generally working well. I think I would just increase the minimum pressure a little to reduce the hypopneas, say up to 8. If the centrals become very persistent you may have to check back with your doctor.
In general, a "simple" CPAP cannot treat central apneas. What may be needed perhaps is one of the Aircurve models. (I think there are 4 or 5 different types,) As you seem to have currently a lowish AHI, it may be difficult to justify. You may have to find some compelling arguments on this. It is something I am not familiar with.
There are some excellent posts on the forum of members who have transition successfully to a higher level machine. What can be done now however is to perhaps reduce any centrals that may be caused by “C02 washout" by reducing or eliminating EPR. This phenomenon can be the result of the of gradient between inspiration and expiration pressure, flushing out too much C02, so the brain thinks it's not necessary to breathe. (I think the brain. needs a certain remaining level of C02 to prompt breathing). The downside to this could be a little more difficult to exhale. It all depends on the person.
If you feel you may have any further information in your sleep study that may be important, please let us have details. You may want to lolk at the link at the foot of this page giving certain insights of the importance of sleep studies, and AHI make up.
Sorry, a long post again, and hopefully not too much information overload, but important to give you as possible in these early stages.
02-06-2024, 05:31 AM (This post was last modified: 02-06-2024, 05:41 AM by Soundman73.)
RE: Having a very rough night
I will definitely take a look at those links you posted.
One thing you didn't address is the low O2 saturation that I measured after awakening. These centrals may be because of my machine settings or perhaps they're real central apneas. One thing for sure is that my O2 SATs were dangerously low twice last night. I can 100% confirm that.
My O2 was79% at one time during the study
My sleep study was in home. My AHI was 53.1 with 1 central sleep apnea. Diagnosis was several OSA. I'll look at the report and see if there were any other notes made.
Sorry, I realised just after my post that you only had 1 central, I did not read it properly. Last few days have be coughing a lot at night, so was not concentrating properly, and did not pay attention to the saturation issue.
Fine now though.
Thanks for the reports. You are quite right, oxygen saturation needs to be addressed. Again, it will be interesting if the doctor flagged this. However it seems to be quite clear that your CPAP is doing a good job with the other events.
With a pulse oxymeter, data can be imported, a graph produced with Spo2 and pulse rate, and both be synchronised exactly with the other reports.
You will be able to quite easily see the relationship with centrals, obstructives of whatever may catch your eye.
As always, it data that counts, and if you do need an oxygen concentrator, you will be able to present a compelling argument with data support.
I use a Pulox, which is not very seamless to incorporate into Oscar. Too many steps. Lots of helpful information from forum members on what to buy.
Hope you can get one soon, and it willbe interesting to see what it reveals.
