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[CPAP] Waxing and waning respiration / OSCAR charts library?
#1
Waxing and waning respiration / OSCAR charts library?
Hello everybody,

I noticed that there is often a waning / waxing pattern with my respiration at night.

Is this something I should worry about?

Also, is there a kind of « Library / book » of OSCAR charts where one could find all the data / most common questions / problems that were shared to this day with the explanation of what it means? 

I ask this because I was able to find a lot of information (Wiki, individual threads, etc.) about the notorious PAP events, like CSR, central apneas etc, but not much about other events.

I could be wrong, but it seems that people often have similar questions about their PAP therapy, and I believe it could also possibly help the admins since they often have to answer recurring questions.

Thank you again, you guys rock!


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#2
RE: Waxing and waning respiration / OSCAR charts library?
We often see this kind of oscillation in the respiratory rate of CPAP users, and it tends to be more common when central apnea events are prevalent in the results. This oscillation is actually a feedback loop alternating between hyperventilation and hypoventilation in response to increases and decreases in CO2 levels in the bloodstream. As CO2 rises, the drive to breathe becomes greater and can move towards hyperventilation, which reduces CO2. Individuals with this pattern seem to have a lag-time that is longer than "normal" individuals

You can consider reducing minimum CPAP pressure from 9.0 and/or reducing EPR from 1 to 0. Either of these changes will reduce the ventilation per breath (tidal volume) that tends to lead to this kind of variable breathing. My suggestion would be to lower minimum pressure to 7.0 and leave EPR at 1 for no, and observe the results. You don't have any apparent obstructive issues at 9.0, and it could be that your pressure needs are simply lower. The CPAP will increase pressure if it detects flow limitation leading to obstruction or hypopnea, so this is a safe approach to better titrate your needs. No need for now to make any other changes.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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#3
RE: Waxing and waning respiration / OSCAR charts library?
That's excellent, thank you very much for sharing your expertise with me.

Regards
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#4
RE: Waxing and waning respiration / OSCAR charts library?
Hi did you ever resolve this?

During a certain sleep stage - I believe REM - this is happening to me despite 0 AHI, but there are clusters of events lasting up to 5 seconds of 20% and 50% reduced inspiratory flow during this hypoventilation/waning cycle.

I think it's why my treatment hasn't been optimal since I started in 2021 and why my libido has gone to sh*t along with my blood pressure rising and absolutely atrocious memory and cognitive function.

And let's not forget my stupid red cheeks that appeared months in to CPAP and have gotten worse by the year.

Now I have seen this with someone else and Sleeprider has mentioned what it is - constantly fluctuating co2 and hypoventilation, it makes me wonder if I am damaging myself more than the sleep apnea ever did.

Yes I'm awake now but my health isn't great and my cognitive function is borderline dementia-like.

I would be very interested to know if the tips provided worked for you, or if something else did.

Best regards, 
Pete
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#5
RE: Waxing and waning respiration / OSCAR charts library?
Hi Pete,
 
Thank you for you comment.
 
I was never able to resolve this kind of breathing. FYI, I would say that these oscillations represent probably around 20% of my nights.
 
After trying a lot of things (different settings and masks, sleep therapy, pillows and a cervical collar) and while this is not perfect, I was finally able to reach decents AHI numbers (usually at 2, or less) and I feel lucky since I sleep well most of the time and my energy level is good during the day.
 
One thing that helped me is that I got a Wellue ring to check my O2 levels and hear rate during while I sleep. Since both seem to be fine, I assumed that it is safe to stop worrying about the efficiency of my APAP therapy.
 
I also have the red cheeks problem, but I had this way before I started to use the APAP. My blood pressure seems to be fine in general.
 
I hope I could help better, but I wish you good luck.
 
Regards,
 
Frank
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#6
RE: Waxing and waning respiration / OSCAR charts library?
Hi Frank,

Thank you for your reply.

You mention this occurs 20% of your night - same with me, and it occurs in approximately 3 cycles which are longer each time.

This is why I believe it is occurring during REM sleep.

I also have tried almost everything and I'm starting to believe it's a form of REM related central apnea.

I wish I knew more, as fragmented REM can seriously mess us up.

It's interesting you have red cheeks - is it due to this waxing and waning of co2 during our sleep, despite having our AHIs controlled for apnes/hypopneas etc.

Are we suffering another concurrent disorder that requires another machine to fix?

I hope Sleeprider can provide some advice. I feel like I'm getting close to the answer.

I use the Wellvue o2 monitor and see specific periods during the night of cycling up/down/up/down o2 levels normally 97% / 98% 10-20 seconds apart nonstop for some time followed by prolonged periods of completely stable o2 levels.

I'm determined to get to the bottom of this.

If you turn on your custom 1 and 2 events on Oscar entering 5 seconds what do you see, clusters of short events exclusively for these REM suspected periods of waxing and waning?

I think there's more to this story if we can get to the bottom of it.

Best regards,
Pete
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#7
RE: Waxing and waning respiration / OSCAR charts library?
If it’s happening every ~90 minutes then my understanding is that it’s generally a pattern seen during REM and is normal. That’s what I read on here and another forum in other threads. Matches up perfectly with my apple watch REM detection.
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#8
RE: Waxing and waning respiration / OSCAR charts library?
I turned EPR off completely last night and the waxing and waning was vastly improved at 6cm fixed (especially the custom event clusters during these periods) and the worse of it was limited to what I assume was the last REM cycle before waking, with my custom event flags for 20% and 50% for 5 seconds vastly reduced overall.

I think I will now nudge the pressure down slightly each night to see if over-treating is the issue remaining causing the residual waxing/waning, as my AHI is almost always 0 or under 1 at the most.

If that fails, I'll assume I am under-treated for REM stages (and more so as the next one comes around) and try smaller pressure increases instead.

Resmed APAP doesn't help during these wax and waning periods - it ignores them completely, which is why I'm fixed pressure now. The only way to experiment on these periods is to fix pressure and lower or raise manually and look in Oscar.

I definately feel more sharp today.
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#9
RE: Waxing and waning respiration / OSCAR charts library?
Apnea23, Thanks for the report, I have this problem also and think I will drop my EPR from 2 to 1 and see if I get the same positive results as you did.
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#10
RE: Waxing and waning respiration / OSCAR charts library?
So after I disabled EPR and it reduced the waxing/waning flow during REM cycles and minimised my >5 second custom events, I reduced my fixed pressure from 6cm to 5.5cm testing my hypothesis that I was being over-treated. This made the waxing/waning worse and brought it in to regular sleep also.

Despite all of that, my AHI remained zero.

I had a horrible nights sleep and brain fogged to hell and back today, with my heart rate elevated above resting for over 50% of the night. Staggering really, I'm normally 90% under my resting heart rate.

How curious it is your machine can state 0 AHI and your sleep doctor would be very happy with that, despite the fact your sleep was severely disturbed by this waxing/waning crap for a significant portion of your sleep.

My HRV measure on Fitbit was also it's lowest it has ever been.

Let this be an example of how we can have a very unhealthy night's sleep that's wrecking your mind and body - but appear on paper as though it's all bloody fantastic.

So for my next trick, now I know EPR off helps reduce the waxing/waning pattern, I shall nudge my pressure up 0.5cm each night over the next week and report back, starting with 6.5cm tonight.

I am expecting to see the waxing/waning dissapear for all sleep asides from REM, as I now suspect it was a simple matter of my REM cycles being under-treated and EPR was making it worse.

I will repeat.. Resmed APAP will happily see this waxing/waning and MANY >5 events during it clustered together and will do /nothing/ about it, essentially allowing your REM cycles (or whatever stage of sleep you're in) to be destroyed while your brain constantly has to initiate corrective o2 events and spend a significant portion of your sleep in respiratory effort.

There is no wonder in 2 years since starting CPAP therapy that my blood pressure, memory/cognitive function, hormones are all getting out of wack.

I wish I installed Oscar sooner, but because my AHI was always impeccable and I felt awake I didn't think there was any need. All the while I had entire sleep stages wrecked, with my brain putting out fires to combat the short events caused by the waxing/waning.

Anyway, I'm babbling.
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