can someone read my oscar chart and tell me if it's good or bad?

[mugen4u]

yeah i hope to get at least Bipap soon. Last night i slept about 5 hours with the device (yay) but during REM sleep my central AHI went way up to 12 and then went down to 5, only for it to go back up to 12.

overall AHI was 6, of which 5.8 central.

when i look at my breathing patern i can clearly see that it is messed up, it's like my brain forgets that it needs to breathe out.
breathing in goes fine, but after that my brain gets confused lol

[Expat31]

You are focusing on the right area. In REM sleep, things can go a bit wild with respiration increasing.

A further point on central events less than 10secs. I believe they can create "micro arousals" disturbing sleep, especially if in a repetitive cycle. It becomes a cumulative effect. Perhaps some people have a tolerence of these types micro events. 

Most likely depending on each persons individual sensitivity.

Just a opinion, based on personal experience. It is worth what it is worth...

[mugen4u]

last night i slept about 8 hours with the device, and excluding the falling asleep part i did about... 7 hours with the device? this is a new record :-D 
however the results don't make me happy and i don't know where to begin.

First of all: AHI of 8 for the entire night is ok, but where the heck did all those OSA events come from suddenly? i almost never had any of them since i used the device, not even after changing pressure. i don't recall eating something that could increase this, i also didnt have a stuffed nose and used the nasal strips as well.

Also, highest AHI was 20 but i can't tell if it's because of OSA or because of CSA.

If i did not have any OSA events then my CSA AHI would be around 3.5, so the OSA messed up my numbers big time :/ 

total OSA events: 29 events
total CSA events: 30 events

if i only had the 30 CSA events for a total of 7 hours sleep, won't these numbers be reasonably fine?

[Expat31]

As previously discussed, we can't do much about central apneas, as most likely the job of some kind of bi-pap, which your doctor seems to acknowledge, but needs some 4 hour daily compliance history first, I suppose to be able to justify the higher cost machine.

Concerning the obstructives, normally these are dealt with by increasing the minimum pressure, and having a maximum pressure as a safety barrier to catch any other obstructive event.

I don't understand the statement  "Also, highest AHI was 20". Your AHI for the night was just 8.2 ?

I find the big handicap in analysing your graphs is you being on a fixed pressure. Normally movements in pressure can tell us a lot. For example, in APAP mode, we would see the machine reacting to the occurance of hypopneas and obstructives. We could then titrate your machine so as to be able the control these.

You have only one fixed pressure, and it is most likely inadequate. But we are blind, we just don't know your actual pressure requirements. I think it would be also useful information for your doctor.

In this situation, we cannot give any explanation of the sudden variances in obstructives without this essential basic information. I think it would be useful information for your doctor.

I would like to revisited APAP, and set minimum pressure to 10, maximum to say 12, and let the machine do the work to see where it goes.

Of course hopefully you get a bi-pap to resolve everything.

As a note which I forgot to mention previously, sleep aids and pain killers can encourage the development of central apneas.








Concerning the big chan

[mugen4u]

happy new year everyone! and thanks for all your help so far :-) this is the year i will have my sleep apnea under control and finally feel beter after dragging this along for about 8 years now

[Expat31]

Happy new year to you.

I am sur 2015 will work out fine. I think you have all the compelling arguements now for your doctor to take notice. You have just to make sure you have the required compliance hours of at least 4 hours.

I think in most of France it is 4 hours also, but in my department 31, it is only 3 hours (for the social security to pay)! Why it is an exception, I have no idea, never found an explanation.

[mugen4u]

Thanks. my doctor called me and said she had enough data for now because i managed to use the device over 4 hours several nights in a row. 

however she decided not to start Bipap yet because the AHI and CSA is so much lower than before we started treatment, something about my body has to get used to CPAP and that breathing out is still causing problems. she was hoping that if my body get's used to the device that my body will adapt and that the AHI will stay below 5 which is 'normal'. 

but on my first PSG sleep study about 1.5 years ago my AHI was 8.2 of which 7.2 Central and i felt almost the same as i do now, well not as tired as i do now but still felt like sh*t. 
So her telling me that if my AHI is below 5 then that would be a great start gave me doubts. 

However if i don't feel any better in a month even tho the AHI is and remains below 5 she thinks i still have to many micro arousels caused by the low AHI and that she wants to give me some kind of medication that helps me breathe and controls my breathing or something? this medicine is only used for very complex central sleep apnea and thus, for my case. 

i am glad that my overall AHI is below 5 for now and i do need to see where things go and if i feel better soon. 

she said that almost everyone has some central apnea events in their sleep, but in my case it is messing up my oxygen or something so she still wants to keep things going with CPAP and eventually if needed the medication. 

she has over 30 years of experience when it comes to sleep apnea so i do kinda trust her with all of this, however i still have doubts. What if my AHI remains far below 5 but i still feel like sh*t? does that mean that my symptoms are not caused by sleep apnea in the first place? 

i highly doubt a sedentary lifestyle for 10+ years causes these symptoms, but i am not a expert.

Ps, i added last nights result. for some weird reason my OSA went up a bit but CSA still below AHI 5

[Expat31]

Hi,

It sounds like she is using the usual excuse of many doctors, that at 5 AHI or less, everything is normal.

You are right to have doubts, and  "she was 'hoping' that if my body get's used to the device that my body will adapt and that the AHI will stay below 5 which is 'normal'. Not very assuring.

To explain the changes in AHI, you had a clustering of central events around 23.10h, and also between 23.30h and 23.45h.  

You can see the clusters clearly in the flow rate graph.

These clusters look very like like positional apnea and make up the majority of your total time in apnea of 7:02 minutes. This could be a significant reason for poor sleep quality.

SarcasticDave made the point of clusters back in his post of 26th of December. It would be helpful to read through the link positional apnea. It provides a detailed explanation.

Briefly, this can be caused by supine sleeping where the head falls on the chest, distorting the trachea, and consequently air flow. A thick pillow can also have the same effect.

A self explanatory video of supine positional apnea makes the point clearly. It can in certain circumstances be relevent for lateral sleeping also.

If this is true, it would explain a lot.

Note -changing pressure will do nothing to resolve positional apnea, only a physical change will help.

[mugen4u]

i do sleep on a relatively firm pillow but it is designed for sleeping on the back and side.
I do however have another pillow of cotton where my head isn't bend in any way, but that wont solve central sleep apnea but only OSA and my OSA count is very low.

[Expat31]

I had positional apnea, and produced both obstructive and centrals. Often these centrals are "false positives.

Resmed machines can find it sometimes difficult to determine centrals, unlike with all the sensors of a full lab test.

You can try to examine each individual event in the events tab marked central. Not always easy to tell. 

But roughly, if you see the breathing pattern before the event, and after the event, and the previous pattern continues as before, without a recovery "bump", and  there is also no corresponding "bump" in pressure, due to the machine not detecting any obstruction, then it is a central apnea, or clear airways event.

But it's up to you want you want to consider.