how to have CA added to OSCARS "Events Flag" Graph

[Wm kintz]

I just got OSCAR 1.5.3+master-7267dafa installed and (am using ResMed AirCurve 10 ST) was able to download the data from the little data card.  I did this because my Sleep Dr, on my last visit, said: "You know, the report (the durable medical equipment) folks sent over doesn't distinguish Obstructive from Central on the Apnea/Hypoxia report. I need that information. Please ask them to do that next time." (He has more faith in their capabilities than I have found yet) Well, looking at the OSCAR documentation, I can see that there is OA in the events flags graph (for Obstructive Apneas I think), and lot's of folks who have posted their screen shots on Apnea Board have a "CA" event, that apparently is an apnea with a clear airway (~ CSA?) So I went rummaging around and found under preferences>events>a check  box for a flag for CA so I checked it. At the bottom of the list, I clicked: "OK" assuming that that would tell the program I wanted CA added to the Events Graph pinned to the top of the graph "Event Flags".  Didn't happen.  

So, since checking the box and saying OK didn't produce a line labeled CA, intrepidly, I told Oscar to go ahead and Rebuild the CPAP Data, thinking I could download the data from the card in the BiPap if OSCAR hadn't made a backup.  OSCAR did make a backup and it proceeded to rebuild the CPAP Data as asked.  But I still don't have a line in the "events graph" for "CA".  So, that is what didn't work.  How do I get a line in the Event Flags Graph that is labeled CA? I figured that rebuilding from the backup would put the CA line in.  Would re-downloading the data from the card in the BiPap work?  Anyway, what I hope to do is bring my Sleep Dr. a printout that shows central apneas and obstructive apneas as well as, apparently, unclassified apneas.  (Hopefully with the possibility of putting some of the unclassified apenas into central, that will help clear some of those out.)
Thank you, wkintz

[WisNaeMe]

A couple of things -
Did you close and reopen OSCAR after you checked the CA flag in Events>Preferences? - think this needs to be done to refresh it. Go back in to see if the tick is still there.
Does CA show up as a coloured bar in the Details Panel (i.e the leftmost data panel in the Daily Screen)?
I think it will only show once you have had a CA, so maybe you've not had any so far.

[Wm kintz]

I did close and open Oscar again, both before when I had OSCAR rebuild the CPAP data, and after seeing your suggestion, just did it to be sure.  I did open preferences > Events, checked  and the tick mark is still there.  I went to the Details panel on the daily screen and CA does NOT "show up as a colored bar in the Details Panel (i.e the leftmost data panel in the Daily Screen)?" It may  "only show once you have had a CA, so maybe you've not had any so far."  Well, my original Sleep Study in a sleep lab showed OSA with AHI of 44/hr, (no central).  I started on a BiPap machine but my Sleep Dr, who used to run the Sleep Lab in town, looked at the report he got and decided I needed an ST machine because he was sure I had Central as well as obstructive.  I've been on that ResMed ST for about 5 months now.  The Oscar Report shows that I don't have basically ANY OA now (pressures bipap 14/18) I'll attach a copy on one representative night.  I have lots of "unclassified apnea" and lots of hypopneas.  

Before I went to my sleep study I made printouts of my Garmin PulseOx's and respiratory rate graphs with the notation that I had a big Pulseox drop coincident with a BIG respiratory rate drop.  I wrote that I thought that probably meant I had at least some component of central but the technician said they didn't look at Garmin data and wouldn't even forward it on to the physician who telemed read it.  Because I knew they would ask me about snoring I downloaded a iphone app that recorded the decibel level and the snoring as audio as well as a visual representation of the time spent snoring.  I had some pretty impressive snoring and they got that at the sleep lab as well.  Oscar has deemed me snore free (0) now.  Seriously, on the 'Snore graph" there isn't any.

Based on the snoring as well as the sleep lab report I'm pretty sure I had obstructive.  The pressures seemed to have fixed that.  I still wear my Garmin watch over night and some nights I'm good (I had an SpO2 of 97 % average the other night, with a low of 89%.  Another night, same week, Average SpO2 91% overnight AVERAGE and LOW SpO2 of 78%.)  I know the Sleep Dr cares a lot about AHI, and that is clearly better, it was 44, now it's almost always below 10 and this am it was 2.6.  I will take the PulseOx readings in to my next visit to try to have my MD address these.  I have made huge strides with my sleep.  If I don't have any OA and I have AHI's above 5 all too often, then some of the unclassified apnea, I think, are very likely central.  Garmin is pretty reliable as to PulseOx's.  I compared it to a fingertip NONIN pulseox and they tracked within 1 percentage point over as long as I could bother to compare them.  I recently got a Nonin 7500 to be able to track Garmin's numbers but have every reason the think that Garmin's accurate since the Nonin 7500 and the finger tip nonin tracked as well. Two things equal to each other... and all that geometry stuff.

I really appreciate your suggestions.  I might well not have restarted OSCAR and the check mark might not have been there (It wasn't once, which is how I found the "OK" button). And I went into the detail I did to say that I'm pretty sure that I have Central since according to Oscar, my machine has fixed the OSA and the hypopneas are too persistent in the flow rate graphs.  My next appt is less than 2 weeks away but if I could get the CA to show up on the Event Graph, that would be nice.  "Unclassified" is not very helpful, but I think the flow rate graphs suggest they are central, which if Oscar is right and I'm not having OSA now with the pressure stenting, then having the hypopneas with the low pulseox's would make sense I think.

Thanks again,
Wm Kintz

[WisNaeMe]

I'm not best placed to advise on diagnosis - others will likely be along who can help interpret your data in more detail. But it might be worth starting a therapy thread on the Main Forum, it will get more eyeballs there. This being the Software thread it tends to deal more with issues such as the one you first reported on configuring OSCAR.

If you set up a Therapy Thread, make sure you post a full-screen snapshot of your OSCAR data, and then possibly a zoomed in screenshot of maybe your UA or H clusters. At the top of Apnea Board Forum there is some guidance on how to set up OSCAR for posting screenshots. If you follow that guidance closely, it helps others give better feedback on your charts.

Given the chart you posted, others are likely to say that there is a positional element to your UA's and H's, so you might benefit from a lower pillow or soft cervical collar. The UA cluster also looks like it has some periodicity to it, but you would need a zoomed view to confirm. Again, others might be able to interpret what is going on there. At times the machine struggles to categorise some events, so I wouldn't get too alarmed at UA flags just yet, hopefully a zoom in view might clarify what's going on.

Periodic breathing however, isn't always true Cheyne Stokes Respiration (CSR) or Central Apnea though. Strictly speaking CA in OSCAR refers to Clear Airway, rather than central apnea and again CA's can be as simple as breath holding, farting, changing body position or TECSAs (treatment emergent central sleep apnea).

As regards having no OA's, these are probably the more easily treated events and by almost any machine - given the right pressures. So you just might have been lucky there and might even be able to shift the H's with a bit more pressure adjustments.

The H's and UA's might require you to zoom in and look more closely at the flow chart to determine what they are or what's going on. But you will need to compare them with the other charts, such as Tidal Volume, Resp Rate, Leak Rate, Flow Limitations, etc.

It might be worth carefully looking at the Flow Limitation Chart (if you have one) to see if FL's are affecting your breathing. Some machines in certain modes (e.g. AirCurve Vauto in S mode) don't display FL's, so your ST might be one the those not collecting this data. However, you will be able to spot them in the Flow Chart (zoomed in). They usually show up as a flattened or misshapen tops of breaths.

I don't think Garmin PulseOx data can be imported into OSCAR, but you could manually/visually compare your desat event-times to see if they correlate with OSCAR flags or graphs - a bit tedious though! If you search the forum, you might find some information on whether Garmin or NONIN data is supported.

The medical profession tend to be quite dismissive of wearable tech (and OSCAR for that matter) and tend to stick to what they know or what is clinically/FDA approved - and so tend to ignore any data you can provide!

Hope this is of help.

[Crimson Nape]

OSCAR only reports the data that is supplied to it. It would appear that your model may not be reporting this type of event. Some models do not report certain events. Since your model is for treating COPD or respiratory illnesses, I'm uncertain what events your model does report. I do know the AirCurve 10 ASV does not, because it is designed to overcome CA type of events.
- Red

[Wm kintz]

Thanks again for your response.  I DO intend to post a treatment thread but if you ask for help generally folks appreciate it if you respond and since I will be seeing my Sleep MD this coming week I thought I would wait to do that till I see what he says.  I posted on the software page because I wanted to be able to supply him with information I was not sure he would be able to get from my DME supplier. What the Central Apneas were? I intend to take OSCAR with me and he will no doubt have information there that will help him answer the question. I suspect that ResMed doesn't report that for my machine since it is supposed to address that.

As for position, I have slept on my back all my life.  When my wife decided I had sleep apnea she got some foam wedges and I have used them since for about 4 years.  Once I did some reading, I decided I wanted to learn to sleep on my side so got a low pillow designed for helping folks sleep on their sides.  I have managed to do that some, but it is still an effort and I usually sleep on my back even when I fall asleep on my side.  I'm aware of the problem of bending the neck forward but the pillow usually, because of it's design, has me more extend than flex my neck.  I have reviewed my OSCAR data and literally OSCAR thinks I have no more OA and no more SNORING.  Zero.  My AHI Events per hour last night was 2.1, my Total AI reported by ResMed ST was 0.7,  my leak was 1L/min. My PulseOx however started at 85% from the time I went to sleep and crept upward  for 74 min before I reached 90%.  I will see what my Sleep Dr. has to say and go from there.  I started at AHI of 44 / hr for my sleep study, all OA, and can't find any OA or snoring since getting this machine.  That is clearly an improvement.  I had some low  SpO2's before and they remain to be addressed.  My brain has made peace with the pressure, so much, I sometimes crack the mask away from my face to see that the machine is on by hearing the air escape. 

I haven't figured out how to "zoom in" yet.  I'm sure it is in the documentation somewhere. Just haven't found out how to do that.  I'm pretty sure being able to do that will make more sense of the UA's.  I checked the flow limitation flag in OSCAR but haven't seen it show up, may well be that the ResMed ST doesn't collect that data, and "zooming in will be helpful there.  You said, "Hope this is of help."  Yes, it was/is and I suspect the ST doesn't collect "flow limitation" or "CA's".  

Once again, I appreciate your comments and recommendations.
Wm

[Wm kintz]

Crimson Nape,
I suspect your analysis is exactly the problem, that that info is not reported, so cannot be displayed.  The Sleep Dr. changed from an auto adjust BiPap to the ST because he thought that would address the Central Apnea's he thought were the issue.  Since that machine is supposed to address the CA's, maybe that is why they don't report them. though the circular nature of the issue seems to be apparent.  If you don't report them, then how do you know you have fixed them.  "I know, we will call them unclassified."  My MD asked me to ask the DME Supplier to get him that information.  I'll discuss that with them and see what they have to say about the ResMed report, if it has a way to break them out or not...

Anyway, I suspect you are right about why they are not showing up in the report.

Thanks for suggesting that. 
Wm Kintz

[Crimson Nape]

If you are experiencing CAs, then the ASV model would be more appropriate. Of course, that is if you do not have left ventricular ejection fraction (LVEF) below 45%.
- Red

[Wm kintz]

Figured out how to Zoom in and Zoom out.
just so you don't have to explain how to use a mouse ...
Wm Kintz

[WisNaeMe]

Yeh, OSCAR takes a lot of getting used to - both the volume of data and just navigating round it! Once you've mastered the zooming in and out (and panning about!), you get a better grasp of how your breathing went during the night and it helps you visualise it better. It also helps you spot the events that the machine failed to flag - their not infallible, so worth checking the flow chart regularly to spot the missed events; those that fall just shy of the 'official' event thresholds ...or even the simply mis-reported.

When you see your doctor, you also might find yourself having to reiterate what Red said about OSCAR. That it only presents the data recorded by the machine (i.e. it doesn't do interpretation or analysis!). OSCAR is a bit of a conundrum for doctors - should they trust this third-party reporting...? They tend to revert to only using 'authorised' resources, where the data provided unfortunately seems to be fairly basic and poorly presented. For some reason they rarely seem to look at the graphs - where the real action is...! and become more fixated on indices such as AHI. But hopefully your doctor is more open to making use of whatever information is available about your health and values a patient who is more involved and engaged in their therapy and treatment.

I keep copy of ResScan (Resmed's 'DME approved' clinical app) on my laptop and load SD Card data into it semi-regularly, just in case my doctor got dismissive of OSCAR. Fortunately never needed to use it - ResScan can be download here on Apnea Board (see links at top of page). But it will give you some clues as to how ResMed present the data and what your DME should have access to.

I think like everyone here, we are just trying to smooth our path towards the quick and successful management of our sleep apnea. Unfortunately it seems to require that bit more effort of our part to achieve that and hardly ideal in our sleep addled states - Hopefully your appointment will go well.

Good Luck with it!