Trying to understand oscar data and symptoms

[Sleepyroshi]

Hello, I have mild sleep apnea (says doctor) and I have been on cpap a couple years. Nothing has changed since I started really and the main issue that I have is that when I am falling asleep (not asleep) I stop breathing and panic and then gasp for air. I can literally feel myself not breathing and I like panic trying to breathe an it takes a second or two for me to be able to breathe again. It happens 20-30 times on a bad night. I almost never sleep more than 3 or 4 hours at a time once I do fall asleep.

Both sleep doctors I have been to have no idea what it is because they say everything on my sleep reports is normal and that my apneas are barely there. Clearly these events I'm having are not showing on their end. I have downloaded Oscar to try and find it on my own but am not really sure what to look for. I have been trying to figure this out for almost 2 years and still have had no luck.

I have added a few screenshots from when I tried to sleep earlier and experienced at least 10 of these "forgetting to breathe" events. I was hoping someone could maybe shed some light on anything that stands out.

I will be trying to order another sleep study and I would like to try an ASV machine however there is no way my insurance will cover it with my current AHI being so low.

Thank you for any input you can give me!

[srlevine1]

Ask your treating physician to consider if a device change to bi-pap or ASV would be appropriate to treat clear airway events.
Other forum members with greater experience with centrals and clear airway events may have additional suggestions. regarding settings and EPR.

[Jay51]

Great points by Steve.  Reducing EPR from 3 to 2 or 1 or even turning it off can reduce central apneas.  Your problem may not be related to something else though.  5 AHI is right on the border of acceptable therapy.  

You may want to lower your min pressure a little bit.  That may help you fall asleep faster.  Maybe down to 7 or 8 or something like that (so you don't feel air starved).  Don't get it too low though that you feel air starved.  

What really jumps out at me is your very long inspiration time.  I cannot tell from your charts exactly what is causing it, but it is very long (about twice as long as your exhale and over 3 seconds).  If someone can see from the chart what is causing this, please post.  

Try to relax.  It took me a very long time to get used to my machine and pressure also.  Turning down the pressure was the key that helped me adapt.  Then later when I got used to it, I could increase the pressure very slowly for better therapy.  

Your respiratory rate is a bit low also (median of 10).  Average is 12 to 20 or so and can vary.  Your machine can't help with this.

[Jay51]

Do you mind uploading a couple (maybe 3) 3 minute zooms of any times that you are asleep so that we can take a closer look at your flow rate charts?  Just click on the cursor on any 3 places where you know that you were sleeping and move the cursor until it shows 3 minutes of data.  Then upload them here and we may be able to see why your inspiration time is longer than normal (based on your median data summary).  Thanks.

[Sleepyroshi]

These are 3 screen shots of the zoomed in flow rates for about 3 mins each. These are from a couple nights ago and I believe I was fast asleep during these. I chose 3 kind of random zoomed in areas that seemed to be where a lot more apneas were going on although I'm not sure I got right on them. Let me know if I did this wrong or you need to see something else. 

Thank you

[Jay51]

      

Thank you very much for posting those 3 charts.  Normal flow should pattern should have rounded tops.  Flat, or jagged tops, etc. mean problems.  

Your1st chart has some abnormal tops (the inspiration/inhale portion of your breathing at night).  2nd chart looks ok.  3rd chart has the abnormal tops again.  

Here is a chart I got from apneaboard that shows a normal top #1 (inhale) vs. some abnormal looking tops (#'s 2-7).  There are several things that could cause abnormal tops:  snoring, upper airway resistance, etc.  

You may want to look even closer at some of the abnormal ones (say a 30 second or 1 minute zoom) of some of them and try to figure out which pattern of the 7 they look like.  

Your other numbers look ok.  Your inspiration time is much better in this chart.  Maybe the other night with the 3.2 second inspiration time median was a one off?  If so, then don't worry about it.

[Sleepyroshi]

Thank you everyone for your responses. I made some changes last night and lowered my minimum pressure to 8 and turned my EPR off. I did feel like 8 was a bit low but it's probably because I'm so used to 11. However, I did have a much better night and actually slept through the night for a change.

I've added some screenshots of last nights sleep.

Once again, any information you can give me is so greatly appreciated. I am noting everything down so that I can research further and also bring to my doctor. You all are great!

---

I also took 3 screenshots of my flow rate zoomed in. As you can see one of them is a 3minute zoom with a central event. The next one I zoomed in even more on the central. The third one I took is a zoom of a spot where I saw a big change in the reading. I'm not sure if it was something that be worth looking into. Does any of this stuff give anymore information?

Hope everyone is having a great weekend.

[Jay51]

Congratulations on coming here to apneaboard and asking questions and posting charts and taking suggestions.  I am glad turning down your min pressure has helped you sleep better.  Also turning off EPR has helped.  

Your central apneas have reduced.  They are probably treatment emergent centrals - they happen to some people early in therapy and go away in a few weeks as people get used to their therapy.  Hopefully, this is what is happening in your situation.  And since your AHI is still pretty low (less than 5), you are ok.  If your central apneas ever cause a greater than 5 AHI, it could be time to make some more changes; but it looks like you are heading in the right direction now with the changes you have made.   

Keep up the good work and update every once in awhile (or when any problems or concerns arise).

[Sleepyroshi]

I have been using the cpap for a couple of years now so it seems like a long time to still be getting them from it but I will keep an eye out on them

[Jay51]

The way the medical system/insurance works is that if your AHI is consistently under 5 even with some central apneas, they will most likely keep you at your current machine.  If you AHI ever gets over 5 with lots of central apneas, they might switch you to a different machine.