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Are my apnea events being accurately recorded?
#1
Are my apnea events being accurately recorded?
I have been struggling with sleep problems for over a decade. I sleep a minimum of 12 hours a night, often 16 or more hours, and I am constantly extraordinarily tired all day to the point that I am completely unable to work and am essentially disabled. It didn't occur to me that I could have sleep apnea until someone who has been diagnosed with sleep apnea witnessed me sleeping and told me that I sound just like him while I'm sleeping (someone has recorded him sleeping before so he knows how he sounds) and he said he is as confident as can be that I have sleep apnea. I also got a pulse oximeter and have been measuring my oxygen saturation as soon as I wake up, and it is often low. I have an appointment with a sleep specialist, but I have to wait a long time before my appointment, and if using a cpap can make me feel functional then I can't wait that long, so I went ahead and bought one online. From reading on this site, it sounds like maybe it was illegal that I bought it without having a prescription, but I'm confused because the website I bought it from is well known and reputable and not at all somewhere that I would think would sell something illegally, but I digress...

I have been using the cpap for about a week now, starting at a low pressure and working my way up to about 11. The software that came with the cpap has registered that I have had between 0 and 4 apnea events per night, however from looking at the graph I can clearly see countless times where it goes flat. I am confused. Is the 0-4 number correct, meaning I actually don't have significant sleep apnea, or is the way the graph looks to me accurate and I do in fact have significant sleep apnea? Can anyone please help me interpret the graphs and tell me if it looks like I truly am ceasing to breathe numerous times when I sleep?

The screenshots I am attaching show am example of where it flagged OSA, one single time when it flagged CSA, and an example of when the graph went flat as though I wasn't breathing but when it didn't flag an apnea event.

It also shows that my mask has extremely high leakage (almost always 50+). I don't know why it has such high leakage, because I feel like the mask is airtight, but perhaps the mask isn't the right size. (It is a full face mask if that makes any difference) I am wondering if perhaps the high leakage is somehow causing it to not properly flag apnea events.

Can someone please tell me if they think I am truly having more apnea events than the software is flagging? I would do nearly anything to actually have enough energy to function and not need so much sleep. My sleep issues are completely destroying my life.

OSA detected:
   

CSA detected (this is the only time it has flagged for CSA, the other times have all been OSA):
   

Example of when it looks like apnea events, but wasn't flagged:
   

Thank you so much to anyone who can help!
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#2
RE: Are my apnea events being accurately recorded?
Have you tried to use OSCAR (program linked to up above)?

I am not familiar with your machine and it doesn't appear to be compatible with OSCAR, it it was it would be much easier for us to help interpret. This program seems to give some similar data but has some oddities I don't know how to interpret and am not sure if that is because of the machine/data or your breathing.

This is one reason we recommend Resmed Autoset machines because they have good functionality and data capability that makes them easy to interpret.
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#3
RE: Are my apnea events being accurately recorded?
I have tried to use oscar, but it wouldn't work. My cpap is not compatible with Oscar.  The software I used is the one that came on the SD card that came with my machine.  I spent over $800 on it, so I'm not exactly going to go out and buy another expensive machine when I just got this one, and assuming I do have sleep apnea, I assume I will be getting a CPAP paid for by my insurance after I am officially diagnosed, so if I have a choice of which machine to get at that point, I will look into getting the one you mentioned.

I can't imagine there could be THAT much difference in how different programs chart the data from a cpap though, is there? Airflow in L/min is airflow in L/min, no? And leakage in L/min is leakage in L/min, right? Is there any reason it would be showing the line on the airflow graph going flat so much like that unless I wasn't breathing?

What specifically are the oddities? I have noticed that when I wear the mask while I am awake and am looking at the live graphing, the airflow graph goes sideways momentarily about 1/3 or 1/2 of the way through my inhalations. So if that is part of what you are referring to, then I'm pretty sure that is because of the machine, and not because of my breathing. However, this pattern does not ALWAYS occur on the graphing from during my sleep. My hunch is that if I inhale faster/harder, then the momentary sideways movement is absent. In order for this to be the cause of the larger sideways spots in the graph, however, I would have to be inhaling for 10+ seconds, which seems improbable.
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#4
RE: Are my apnea events being accurately recorded?
Here are two more screenshots, one showing ten minutes of time instead of two minutes, and one showing 60 seconds, in case that is more helpful.

10 minutes of time:
   

This shows 60 seconds, and might especially be helpful because it shows that it is interpreting the flat part of the graph as a bunch of little inhalations and exhalations. The places where it did flag apnea events, it did NOT interpret it like this, but interpreted it as one single inhalation/exhalation cycle. To my eyes, the events where it flagged it, and the events where it did not flag it, look basically indistinguishable in nature.
   
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#5
RE: Are my apnea events being accurately recorded?
Your program shows airflow, OSCAR shows what it calls flow rate. I would assume they are the same but the main difference is that OSCAR flow rate is both positive (during inhalation) and negative (during exhalation). I think the difference is that your data shows machine flow rate and doesn't subtract vent or leak rates to try and calculate flow rate in/out of your lungs whereas these other machines do those extra calculations. This would explain why it is never negative and I assume changes in vent or leak affect your flow rate chart more than what we normally see.

My gut interpretation of the data posted is that the examples you are posting are central apnea. The periods you posted that show almost flat flow rate usually show little humps up and down which are probably cardiogenic oscillations (small flow in/out of lungs caused by your heart beat sending pulses of blood through the vessels in your lungs expanding them with each heart beat), these are only visible in central apnea because if there is obstruction in the upper airway you obviously can't see the effects of heart beat on lung volume at the machine.

If this is central apnea the question becomes whether your central apnea is idiopathic and existed prior to using this CPAP machine or if these are treatment emergent central apnea. Either way this machine is not capable of treating central apnea. If they are treatment emergent then they may go away over time.

I don't get why you should have to wait so long to see a doctor for this, also waiting months to see a doctor without first having a sleep study done is a waste of time. You should get your primary care doctor to send you to a clinic that can do a home sleep study which would be capable of diagnosing both obstructive and central apnea. I would imagine you could get that done in a week or two and then would just have to wait a while for the results to be reviewed and then maybe you would see a doctor at that time (here in Canada the clinic that does the test gets a doctor to review study results and you usually don't even see a sleep doctor, just start CPAP if that is what the reviewing doctor prescribes).
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#6
RE: Are my apnea events being accurately recorded?
(03-19-2022, 06:04 PM)Geer1 Wrote: Your program shows airflow, OSCAR shows what it calls flow rate. I would assume they are the same but the main difference is that OSCAR flow rate is both positive (during inhalation) and negative (during exhalation). I think the difference is that your data shows machine flow rate and doesn't subtract vent or leak rates to try and calculate flow rate in/out of your lungs whereas these other machines do those extra calculations. This would explain why it is never negative and I assume changes in vent or leak affect your flow rate chart more than what we normally see.

Geer1 is probably correct. F&P's Sleepstyle machine has the same behavior, and OSCAR has to work hard to try to compensate for it (as OSCAR expects the flow to be positive and negative around zero).

Your leak rate is also probably the sum of intentional leak + unintentional leak. Unintentional leak is the value of most interest as it is usually the only one you can do anything about.

The leak graph in the first two hours of the D18032022 graph probably is showing no leaks and a constant pressure as the graph has a flat top for those hours. The spikier part of the graph for the remaining hours, with constant pressure, probably does reflect mask leaks.,
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#7
RE: Are my apnea events being accurately recorded?
Thanks, both of you. You say my machine is not capable of treating central sleep apnea, so what is capable of treating it? Would treatment emergent CSA begin on the very first night of using a CPAP? My charts look similar for every night I have used it; there doesn't seem to be any increase in the apparent apnea events. Also, is it very likely I could have CSA? I understand it is usually caused by a stroke or similar event, is that right? I am 29 and have never had any sort of stroke or seizure or anything like that. I do have very high blood pressure that takes four different medications to control, and which was diagnosed when I was 19 but I'm pretty sure I had it since I was at least 15 because I had doctors often tell me it was high when I was that young. I don't know why I would have high blood pressure so young, especially as I am not obese and don't have horrible eating habits. I am finally trying to take care of my health and have some tests scheduled to try to get to the bottom of it, but I'm wondering if the high blood pressure could be caused either in full or at least partly by sleep apnea.

I do have extremely large tonsils. So I have wondered if they could be causing obstructive sleep apnea.

I would love it if my primary care doctor would prescribe a sleep study, but she said "I don't know what kind of sleep study to prescribe so I am referring you to a sleep specialist." I'm pretty sure that was just a way to get business for her colleague. I have to wait to see the sleep specialist and then wait who knows how long to get a sleep study and then to get it interpreted by the doctor. I also have a psychiatrist and I asked her about prescribing a  sleep study, but she just said "I don't know much about sleep studies."

That makes sense about intentional and unintentional leak.  What is a typical intentional leak amount?  The graph certainly looks much "cleaner" and more "rational" when the leak rate is steady instead of spiking up and down. Compare:
   
   

So, I guess my biggest question right now, is could treatment emergent sleep apnea begin on the very first night of using a cpap? Or would it take more time? Because my chart from the very first night definitely showed what appear to be flat areas. And if it is central sleep apnea, and this machine won't treat it, then what would treat it?  And if it is treatment emergent, then does that mean I didn't actually have sleep apnea to begin with, and I'm just making things worse by using the cpap?
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#8
RE: Are my apnea events being accurately recorded?
Also, perhaps this is noteworthy:  This is an image from the second night I used the cpap, and is also when I had it set to the lowest pressure I have ever used, which was in apap mode with the pressure ranging from 5.9 to 7.4, and p90 being 6.3 and p95 being6.4 .  There are significantly more apparent apnea events than later nights when I used a higher pressure.  If it is treatment emergent CSA, then shouldn't the apparent apnea events increase with increased pressure and increase the longer I have been using the machine? Does the fact that the apparent events decreased when I used a higher pressure setting indicate that it is helping? I'm so confused now as to whether or not I should keep using the machine or not...

   

Thank you so much to both of you for taking time out of your day to answer my questions. I really appreciate it.
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#9
RE: Are my apnea events being accurately recorded?
The Breas software doesn't look to be compatible with your machine.
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#10
RE: Are my apnea events being accurately recorded?
What is Breas software?  I am using the software that came with the cpap.
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