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Apnea while sleeping on my back - OSCAR says CSR but I don't think so
#1
Apnea while sleeping on my back - OSCAR says CSR but I don't think so
I tried a test this morning to see if I could recreate what my sleep apnea would look like without my cpap machine. I set the machine to CPAP mode with 4cmH20 and took a nap while lying on my back. The pulse oximeter showed the usual sawtooth pattern I was familiar with before I used a cpap machine. The phone rang and partially woke me out of deeper sleep around 11:32AM when the sleep pattern changes. My oxygen level usually dips down into the 80s overnight, so it must look even nastier than this. OSCAR interpreted my patterns of breathing as Cheyne Stokes Respiration, but I don't that is the case, I think it's me just continuing to struggle to breath against the nasty flow limitations. What do you think? I've attached a screen cap over the duration of the nap, another showing a 2 minute period for a more detailed view, and a third attachment showing a 13 minute period as they continued to repeat. 

I will finally be getting a long awaited sleep study on June 1. It was delayed for a few months because of COVID-19. I was curious what they would see on my sleep study since I've been using the CPAP machine for a few months. I might try sleeping tonight with the machine in low level CPAP mode to see what it looks like overnight.


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#2
RE: Apnea while sleeping on my back - OSCAR says CSR but I don't think so
In the absence of other more qualified response, here is an opinion from a mere member who has seen and been brought from far more severe patterns of variable breathing. Until others chime in here with better advice a few points I suggest are here for your review.

I regret not reading your equipment listing now, so do forgive that mistake if you are doing these things.


Use a soft cervical collar. Go to next step after at least a week of no improvement.


Consider wearing a back pack, strapped as closely as you can tolerate it, to force sleeping on your sides for a week or more. Yeah, it's nigh impossible to turn over, but that has been a key to my near elimination of OSA from my 9/14/05 beginning illustrated below. That may be my most dense cluster of OSA and it was identified as CSR. That severe pattern is vs AHI of 0.2 for the past 12 months.

Consider reading or discussing with your MD the rather long and difficult research paper linked to below. I found it and am doing my best to digest its contents as I try to find ways to understand and reduce lengthy periods of short cycle variation (say 8-12 breaths) in my FR amplitude envelope (see my earlier post a few pages below about this). The recent research  raises as many questions for experts as it answers along other lines to help my understanding of loop gain's role as one of four principal contributors to OSA, some others of which are touched on.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6224344/

A figure from the paper:

   


I may be at the risk of having a "hammner" loosely in hand and, for that (lack of) reason, I may be seeing everything troubling and remotely similar as a "nail": I wondered if, say, the locations of the central peaks/highs of your FR rectangles (as short time views and good vertical scaling show) relative to length and timing of your attenuated breathing was signaling airway collapse from O2 deprivations. I'll be chasing that rabbit in looking at my own OSCAR graphs tomorrow. I would think most FL peaks would precede FR depressions, that to the contrary. But if there is any timing error in the data, maybe not so. It's far above my pay grade, but a rabbit to chase.


I've done the things I mentioned to get vastly improved sleep. However, thanks to use of an accelerometer to indicate sleep position and sudden moves,  I know what disturbances of sleep my large, sharp, and frequent unscored FR spikes show and those can be reviewed in seconds and be shown to my MD.

   

Good luck in your quest to find solutions,
2SB
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#3
RE: Apnea while sleeping on my back - OSCAR says CSR but I don't think so
Why a pressure of fixed 4?
Your EPR=3 fulltime, those two settings conflict.
And you should always include a full chart of the night for context
ResMed reports all periodic breathing as CSR. Yours, as is most, is just Periodic Breathing and is NOT CSR. Inside OSCAR we keep discussing it and we need to call it CSR just because that is what ResMed calls it.
You have fairly high flow limits. This means you need EPR to treat them, however with your Pressure set at 4 there is no room for the EPR to work.

Set your Pressures to 7.

This means your inhale pressure will be 7 and your exhale pressure will remain at 4.

With EPR in use the min setting for pressure = 4+EPR= 4+3 = 7
Gideon - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

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#4
RE: Apnea while sleeping on my back - OSCAR says CSR but I don't think so
In your previous thread you were showing results with a pulse oximeter that clearly showed a problem with apnea. I'd say with this you sufficiently proved the point, now let's let that nice new machine free. with a minimum pressure of 7.0, maximum 14.0 and EPR 3. Your conclusions that the problems arise from obstructive sleep apnea are correct. Now treat it.
Sleeprider
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