Weird Looking OSCAR FLow Rate

[cpapnewbie18]

Hi, 

I was diagnosed with mild sleep apnea a few months ago (around 8 hypopneas per hour). While the diagnosis was mild, the symptoms are fairly moderate (sleepiness, headaches, memory issues, etc.). 

I've been using a Resmed Airsense 10 to little success. I've recently started monitoring my data on OSCAR, and I've noticed a super weird flow rate chart pattern. While my machine is saying I have few awakenings, my flow rate chart seems to say otherwise. 

My breathing pattern is super abnormal looking, with two peaks instead of a single smooth peak. Plus, this odd pattern seems to constantly precede awakenings. I've attached a screenshot of the flow rate pattern I see continuously througout the night. This pattern persists despite my having tried many different pressures (4, 8, 9, 10, 11, 12, 14). 

I'm wondering the following. First, is this pattern as concerning as it seems to me? Second, could it be caused by too much/too little pressure? 

Any help you can offer would be super appreciated. Thanks!

[Dormeo]

The dented tops indicate flow limitations. On the right of this snippet there's what appears to be a wake-up. The little oscillations around the zero line are what's called a cardioballistic artifact. It just means the beating of your heart is telegraphed to your airway; nothing to worry about.

It'd be very helpful to see your whole daily chart, including the left panel. Include all and only these graphs:

Events
Flow rate
Pressure
Leaks
Snores
Flow limitations.

[cpapnewbie18]

I've attached the extra screenshots below. Thanks for the help!

[Dormeo]

Thanks. No need to redo this chart, but next time try closing the calendar (click on the triangle to the left of today's date) and squeeze the essential graphs into one screen shot. (You can grab the horizontal gray lines that separate the graphs and push them up a bit.)

You have fairly heavy flow limitations off and on throughout the night. The FLs may or may not be affecting the quality of your sleep. Also, if they originate in your nose, your machine can't do much about them, though you'd want to see an ENT to diagnose and fix your nasal issues. But if the FLs originate in your pharynx, EPR can help.

Try introducing EPR at a level of 1 or 2 and see how it goes. If this seems comfortable, then you can try 3.

At what pressure were you most comfortable at night? If your AHI was about the same at all the different pressures you've tried, pick the one that felt the best.

[cpapnewbie18]

That makes sense. I suspect the FLs might be originating from my nose (My nose is generally semi congested and one nostril is always fairly blocked). I'll give EPR a shot and see what happens. I think I was most comfortable at pressures around 10-12 but I don't fnd 14 to be particularly difficult to tolerate. Thanks again!

[cpapnewbie18]

One more quick question: 

I've been reviewing my data going back a couple months, and it seems that there is much more stability (better looking curves) at lower pressure levels (8/9). Is it possible high pressures are causing these hypopnea events?

[Dormeo]

At higher pressures, central events can be more prevalent. These are events that don’t involve obstruction. Hypopneas can be central in nature, though from CPAP data there’s no way to know whether any given H is obstructive or central.

But are you referring to hypopneas or to flow-limited breaths?

[cpapnewbie18]

I'm basically just refering to the graph from my initial post (flow limited breathing leading to arousal). It seems those are less prevalent at lower pressures.

[Gideon]

Those flow limits are obstructive and are treated with a difference between inhale and exhale pressure.

Try EPR=3, Fulltime.