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[CPAP] OSCAR confusing me with leaks/apneas
#51
RE: OSCAR confusing me with leaks/apneas
Here's what I've got for an analysis. This is way above my paygrade what I've seemingly uncovered about my data.

Events Happening Without Being Flagged


I decided to see mess with the user flags to flag the respiratory events that are waking me but not being flagged by the Respironics Machine. 
So, set the flag to 30% and 5 seconds, and sure enough there are a fair bit of these events happening. Some completely under my nose as they are extremely subtle.

If I factored these flags into the AHI, my AHI is still at or above 5 AHI. Some nights I'm at 10 AHI with the flags.

I'm unsure as to what these are, positionals or something that indicates inadequate pressure?
[Image: 152c9fe7101818ef70d93d97eb27df10.png] [Image: 225b34bc3eb4698b5e9ac2e2b1a2b242.png]

Even with this UF, some events still are not flagged...?
[Image: 56b55f21eb1450c1c9afcbb80b1eb229.png]

I understand in some instances the user flags can be seen as excessive, but they seem to point out some serious problems here. As they align with the Fitbit's sleep stage tracker.
[Image: 7baf545bad69c0c49890fcf0b0e6766b.png]


Flow Chart Confusion


Looking into the deeper parts of the flow rates, referencing this
[Image: Flowlimitations_Classes.png]

In the beginning of the night, most if not all flow shapes look like Class 1, with some deviations into the 2 or 6 range.
[Image: b2ee3ce7414fb2bb0ed447f49dbc9ad9.png]


However, looking at shapes that occur with these user flags they seem to evolve? as the night continues.
Initially... they took on a Class 6 Shape, a inhale that is stopped by a plateau and then continued.
[Image: 405253f86d7b7a83f858140585987e73.png]
[Image: 680732b4caa77a481663276866456394.png]
However, after the recovery from these initial flow limitations/respiratory events as seen in the user flags.

The architecture of the inspiratory shapes changes completely, almost every. single. flow-wave. afterwards is either a CLASS 2, or CLASS 6.
I assume as the chart says, this indicates a serious flow limitation.

I will show these charts, as you can see there were no significant flow spikes or even flags of any kind in this part of the flow chart.
[Image: 8479fab59f033b7801c0b9ed575830cc.png]
But, zooming in reveals... this entire section looks like this. Completely different.
[Image: 23c60dc6372b880bca9135eeb152f3c2.png]

This occurs throughout the night
[Image: 193fee3a92be6bbd1dd25fb7f8063438.png]
[Image: 67b595123bf1770c485bc38fccf71122.png]

And at the later ends of the night, they turn into almost exclusively Class 2's.
[Image: 2faf3696634bd71e3a30efc5bb1f189e.png]

And this continues until I wake up, at around 1:00.
[Image: f7a2634b691acca8b705cf80caab092c.png]

To my knowledge there is such thing as a cardiogenic oscillations as the Wiki points out, but I would figure you'd have those the entire night rather than in onset? Nor are there any CA's flagged from what I can tell.
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#52
RE: OSCAR confusing me with leaks/apneas
maybe I'm not reading your chart right or I'm otherwise missing something but I don't see any events at 10 or 12 in post #47.

scroll through that messy flow rate between 2:30 & 3:30 at a 10 minute view scale. post a pic if you see anything resembling my screenshots in posts #40 & 41. or of anything that might shed light on the cause of those spiky peaks and troughs. also, do you think you were asleep or awake during that period?
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#53
RE: OSCAR confusing me with leaks/apneas
(05-05-2021, 06:34 PM)sheepless Wrote: maybe I'm not reading your chart right or I'm otherwise missing something but I don't see any events at 10 or 12 in post #47.

scroll through that messy flow rate between 2:30 & 3:30 at a 10 minute view scale. post a pic if you see anything resembling my screenshots in posts #40 & 41. or of anything that might shed light on the cause of those spiky peaks and troughs. also, do you think you were asleep or awake during that period?

Apologies, I should probably be more specific. I meant 10 as in 10:00 - 11:00, and 12 as in 12:00 - 1:00
Lot of clusters here.
[Image: 167ac2fa22ebf9571496154914cf2db0.png]

The time period between 2:30 and 3:30 were times when I was awake, just wake/sleep/junk. My sleep start time was 3:30

I don't see a screenshot in #40, and #41 is referencing these clusters as similarly seen above. I assume you are referring to the PLM flows? I looked at the ones you've posted as well as the ones posted on the Wiki. 

Whilst there are deviating peaks, they are not as consistent as yours and they do not consistently go back and forth from 20 to 80 as yours do, there is no significant arousal period during this time as you've mentioned. All significant peaks seem to be from recovering from a respiratory obstruction or event.

Any thoughts on the flow rates and unflagged events? I am curious as to whether I will need to adjust my machine for EPAP or just get a BiLevel to resolve these issues.
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#54
RE: OSCAR confusing me with leaks/apneas
sorry, got sloppy trying to cut corners. I meant my screenshot in post #36. even if you were awake, rls might show up. IF it's present, it could explain a lot. continuing to try to pin down whether sbd/apnea events occur before movement or vice versa using video and oscar would be informative.

I don't have much of anything to tell you about unflagged events. we all have them and intuitively I wouldn't think they'd cause significant desats although it makes sense to me that cumulatively they'd wear us down. I'd think you'd treat them same as other obstructive issues, which, with your machine means raising pressure, particularly epap. I've no experience with PR machines but try flex if you haven't. otherwise, you may in fact fare better with a bilevel.
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#55
RE: OSCAR confusing me with leaks/apneas
(05-05-2021, 07:30 PM)sheepless Wrote: sorry, got sloppy trying to cut corners. I meant my screenshot in post #36. even if you were awake, rls might show up. IF it's present, it could explain a lot. continuing to try to pin down whether sbd/apnea events occur before movement or vice versa using video and oscar would be informative.

I don't have much of anything to tell you about unflagged events. we all have them and intuitively I wouldn't think they'd cause significant desats although it makes sense to me that cumulatively they'd wear us down. I'd think you'd treat them same as other obstructive issues, which, with your machine means raising pressure, particularly epap. I've no experience with PR machines but try flex if you haven't. otherwise, you may in fact fare better with a bilevel.

I have it set to C-Flex One, I'll see if I can tweak it around. I'm aware that the Wiki says that C-Flex is nothing like ResMed's EPR, but I guess it would be better than nothing. The Sats aren't really a concern for me, its rather the unflagged events being responsible for disturbing my sleep.

Comparing the unflagged events, they appear to be unflagged hypopnea's rather than flow limitations and PR seemingly flags hypopnea's at random, but the flow limitation flags are appearing in areas with those Class 2 and 6 Flow shapes as I mentioned above.
[Image: dc8a96eb4e0687d6d885f2a6d53e7ec2.png]

Seems to me that the culprit is just unflagged events and flow limitations that PR isn't paying attention to?
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#56
RE: OSCAR confusing me with leaks/apneas
godletmesleep your message means so much. In over 30 years of my cpap experience the sleep docs and techs never clued in that we must have sleep quality too. We need to find ways to prevent disturbances in our sleep.
DaveL
Compliant for over 30 years


I'm just a cpap user like you. I don't give medical advice. I hope to learn everyone, and that's why I share here. 
Seek the advice of a physician before seeking treatment for medical conditions including sleep apnea. Sleep-well

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#57
RE: OSCAR confusing me with leaks/apneas
(05-05-2021, 08:40 PM)DaveL Wrote: godletmesleep your message means so much.  In over 30 years of my cpap experience the sleep docs and techs never clued in that we must have sleep quality too.  We need to find ways to prevent disturbances in our sleep.

Yeah.

Too bad we can't get any of the other flow rate-oriented people on the forum to respond...

Tried C-Flex to see if it would help with flow-limitation curves, it arguably just made it even worse. I don't know what to do.
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#58
RE: OSCAR confusing me with leaks/apneas
Today is just full of misery, I feel like garbage.
If anyone wants to look at the flow charts, the whole theory and concerns are in #51 and some additional comments in #55.

Going to try taking the flow chart issue & user flags cropping up to other forums to see if I can get some more input on it.
Maybe I should just make a new thread here? Evidently this one has outlived its usefulness Sad
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#59
RE: OSCAR confusing me with leaks/apneas
(05-06-2021, 12:27 PM)godletmesleep Wrote: Today is just full of misery, I feel like garbage.
If anyone wants to look at the flow charts, the whole theory and concerns are in #51 and some additional comments in #55.

Going to try taking the flow chart issue & user flags cropping up to other forums to see if I can get some more input on it.
Maybe I should just make a new thread here? Evidently this one has outlived its usefulness Sad

Sorry I'm not much help -- I've only dealt with flow limits in the ResMed universe.

I've been at this 7 years now, and I still can't figure out what my flow limits mean... *sigh*
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#60
RE: OSCAR confusing me with leaks/apneas
guessing about the apparent random fl flag in #55, 6 of 8 breaths preceding the flag show signs of being flow limited. in my unsystematic observations (with resmed machines), flags often appear after a brief lag; i.e., after the fact. it might make sense insofar as (I assume) the algorithm must take a moment to assess the condition and signal the flag. just a thought.

I don't mean to be flip but a) I'll say again that it would be useful to figure out what role movement is playing; and b) if you're worried about flow limitations and raising epap and trying flex hasn't helped to your satisfaction, trying a resmed vauto might be your best next move (but if something other than a vanilla floppy palate type reason is causing your flow limitations, changing to a bilevel may not help, although you'll learn something either way).
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