Why does OSCAR/AirSense 11 APAP flag central sleep apnea when I'm wide awake?

[DevinJones]

Last night, my AirSense 11 AutoSet APAP was set according to the physician's orders (flow rate of 4 to 16) except that the ramping was turned off.

As I expected, it was difficult and took a lot of effort to breathe in and out at the beginning of the night when I was wide awake and the flow rate was at around 4.

OSCAR flagged many clear-airway events during this same period when I was awake (see attached screenshots for some examples).

Why did OSCAR flag clear-airway (central sleep apnea) events when I was awake?

Are these clear-airway events false?


Are these clear-airway events associated with my struggling to breathe while I was awake?

Thanks!

[Dog Slobber]

OSCAR, didn't flag them, your device did. OSCAR reports what your devices flags.
The device doesn't make a distinction (and doesn't know)  between awake and asleep breathing.

If reports events based on air flow and duration.

[DevinJones]

Okay, thanks a lot for the clarification.

So it shows that my breathing stopped at times up to 25 seconds. I remember difficult breathing at that time but not prolonged breathing pauses.

What is the correct term used to identify these breathing pauses that the APAP device flagged when I was awake?

[Gideon]

We call them SWJ. Sleep Wake Junk.

At this point our CPAP cannot distinguish between sleep and wake,. It is common for us to hold our breaths, no obstruction, when we toss and turn and these breath holds are usually classified as "Clear Airway" which we interpret, clear airway events, as Central Apnea. In the future in sure AI will be involved as well as sensors that monitor our brain activity to determine if we are asleep.

[DevinJones]

We call them SWJ. Sleep Wake Junk.

At this point our CPAP cannot distinguish between sleep and wake,. It is common for us to hold our breaths, no obstruction, when we toss and turn and these breath holds are usually classified as "Clear Airway" which we interpret, clear airway events, as Central Apnea. In the future in sure AI will be involved as well as sensors that monitor our brain activity to determine if we are asleep.

Thanks for your response.

I was definitely wide awake during the flagged events and not tossing and turning. I remember that I was consciously breathing but with effort.

If the events you already looked at are sleep-wake junk, then what are the flagged events (see new attachments) from the previous night when I was actually asleep? Are these actual central sleep apnea events?

[pholynyk]

What the others have said about sleep-wake junk is true...

However, the real problem is that the doctor who prescribed settings of 4 to 16 is not famimialr with CPAP treatment (to put it politely). A pressure of 4 cm H2O gives insufficient flow, and you feel air starved or sucking air. Most adults need a minimum pressure of 6 or 7 cm H2O to feel comfortable. You can change your settings yourself by going into the Clinicians menu. There are instructions on how to do that in the 'CPAP Setup Manuals' menu item in the black bar at the top of the page here.

[Mugsy]

This! Up your lower number til it feels comfortable to breathe naturally. For me, it started to feel noticeably better around 6 and 7 was g2g. Starving for breathe is not much fun while trying to fall asleep.

My results with Resmed 11 / Oscar normally show multiple events in the first 10 minutes of use each night logged while wide awake. Then maybe 2-5 events the remainder of the night. Definitely skews the overall results but my AHI is now low enough I no longer worry about the SWJ effect.

[DevinJones]

Yes, I know that a setting of 4 was too low for me. That's why I set the lowest setting at 8 a few nights to test out.

But at that time, my AirSense 11 was flagging a series of many central apnea events, and I didn't know how to manage the treatment. (See my most recent attachments above for some examples of those central apnea events when the lowest setting was at 8.)

I knew I had to get help with my APAP settings from the ordering pulmonologist, so I set my AirSense 11 back to the prescribed settings (4 to 16 BUT WITHOUT the ramping) for one night of data to be shared with the DME and pulmonologist on the following day.

As I'm a new APAP user at the beginning of the compliance period, I didn't want the DME or pulmonologist to be able to say that my APAP difficulties were a result of my changing the prescribed settings. I was also hoping that turning off the ramping would alleviate or prevent the problem with insufficient airflow.

When I saw the OSCAR data the following day and had had difficulty breathing with the prescribed settings and ramping turned off, I called the DME and the pulmonologist and told them about my treatment challenges and the need to adjust the flow settings or make some other treatment changes.

I'm suspending treatment until I get new orders on Monday. I don't know if APAP setting changes will resolve the problems or if I need BiPAP or ASV. I'm new to all this. Thanks!

[DevinJones]

This! Up your lower number til it feels comfortable to breathe naturally. For me, it started to feel noticeably better around 6 and 7 was g2g. Starving for breathe is not much fun while trying to fall asleep.

My results with Resmed 11 / Oscar normally show multiple events in the first 10 minutes of use each night logged while wide awake. Then maybe 2-5 events the remainder of the night. Definitely skews the overall results but my AHI is now low enough I no longer worry about the SWJ effect.

Yes, that suffocating feeling when the flow rate is too low is pretty scary.

Although, my AirSense 11 flagged clear-airway events while I was wide awake, it also flagged many more of those events when I was sound asleep.

Yesterday, the DME looked at the data and said that I'd been having excessive clear-airway events and needed changes to my treatment.