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New User - Please Help Interpret OSCAR Results
#1
New User - Please Help Interpret OSCAR Results
Hi Everyone. Sorry for the long post but I really needed to get this out. I'm a 37 male, 5'-10", 185 lbs, and have had problems with sleep for as long as I can remember. I find myself waking up several times in the middle of the night and going to use the bathroom. I never feel refreshed when I wake up. I feel sleepy. I have low energy during the day, etc. A few months ago I started being more aware of what happens when I wake. I notice that I wake up a couple hours after falling asleep gasping for air with my heart racing. I used the app Snorelab and found out I snore as well. I sleep in a separate bedroom from my wife because of my troubles with sleep so I had to find the snoring out through the app.

I started to read about sleep apnea and it sounded like what I was dealing with. I made an appt with a sleep doctor and he had me do an at-home sleep study (he said insurance typically declines in-lab studies as a step 1 these days). Unfortunately, I didn't sleep that night, or if I did it was only for an hour or two. The result was a 4.5 AHI. I knew this number wasn't accurate and my gut feeling was that if I had actually slept it would have been higher. I went back for a follow-up and he put in for an in-lab study due to inconclusive at-home study. I am still waiting to find out if my insurance will approve. If they don't, I will have to do another at-home study and hope I sleep that time. This process has taken months, as most of you probably know about, but in the meantime I still feel like crap every day. I can't get a good night's sleep no matter what I try and it's taking it's toll.

My doctor declined to prescribe a cpap until I can get a 5 or higher AHI on a sleep study, which I understand, but I wanted to see if I could try a cpap just to see if it would offer some relief. I was able to buy a refurbished machine online and have been using it the past three weeks. It took about a week and a half to get used to, and I've been using OSCAR and adjusting my pressure settings as I go and have gotten to where it is comfortable for me to use but I still need some help interpreting the results and tuning. Pressure lower than 5 makes me feel like I'm suffocating, and over 9 seems like it wakes me up from being too high. Setting 6-9 has felt pretty good so far. The problem is I still find myself waking up 2 or 3 times per night. I don't feel much improvement during the day, but I have read it can take a while to feel the difference. In addition to the cpap, I have been using ear plugs (because every tiny noise either keeps me from falling asleep or wakes me up), night guard since I grind my teeth, and mouth tape since I was opening my mouth with the night guard. Can anyone read my results and let me know what they think? Are there adjustments I should make? Do I not actually need a cpap in the first place? Is there anything y'all can suggest? The clear airway events are what concern me the most. Thank you for any and all help/insight!


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#2
RE: New User - Please Help Interpret OSCAR Results
Honestly going into a doctor going "I want a CPAP" the doctor going "you don't need a CPAP" and you going "I am going to get one anyways" sounds no different then going into a doctor and going "I want antibiotics" the doctor going "you don't need antibiotics" and you going "I am going to get one anyways".

Even if you were at 10 that night most insurances won't approve a CPAP unless you are over 15. Rather than trying to self diagnose you might want to see if there is something else causing the issues because if you are using medical treatment for one thing to cover up symptoms that could be being caused by something entirely different you might not be diagnosed properly in time, for all you know you are being woken up because in the laying position a tumor you have in your brain is pressing on the wrong areas, not large enough to be causing any major symptoms, but enough to be detectable if you are not actively trying to fix the symptoms rather than find the cause.

I am not saying that is the case, obviously, but my point is is that if the sleep doctor is going "hey your numbers are normal that is not the issue" then you might want to look for other things that might share similar symptoms rather then just trying to hide the symptoms, you are playing a dangerous game and could be totally ignoring symptoms for something far more serious if you are set in your mind that "oh it must be apnea, sure the test said it wasn't the doctor said he wouldn't give me treatment for apnea, but I am going to immediately conclude they are both wrong and I am right and that it couldn't possibly be something far more dangerous that I am ignoring by treating the symptom while ignoring the cause". I went into the doctor with suspected TB and ended up finding out that I had Thyroid cancer, so just because you may think you have x you have to remember that y,z,w,v, and q all also share similar symptoms so if you are getting told it is not x, odds are it is not x and as such you should tell your doctor you are still having the same symptoms and they can figure out what to check next if it isn't x.
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#3
RE: New User - Please Help Interpret OSCAR Results
(06-08-2022, 05:06 PM)hh9797 Wrote: Honestly going into a doctor going "I want a CPAP" the doctor going "you don't need a CPAP" and you going "I am going to get one anyways" sounds no different then going into a doctor and going "I want antibiotics" the doctor going "you don't need antibiotics" and you going "I am going to get one anyways".

Even if you were at 10 that night most insurances won't approve a CPAP unless you are over 15. Rather than trying to self diagnose you might want to see if there is something else causing the issues because if you are using medical treatment for one thing to cover up symptoms that could be being caused by something entirely different you might not be diagnosed properly in time, for all you know you are being woken up because in the laying position a tumor you have in your brain is pressing on the wrong areas, not large enough to be causing any major symptoms, but enough to be detectable if you are not actively trying to fix the symptoms rather than find the cause.

I am not saying that is the case, obviously, but my point is is that if the sleep doctor is going "hey your numbers are normal that is not the issue" then you might want to look for other things that might share similar symptoms rather then just trying to hide the symptoms, you are playing a dangerous game and could be totally ignoring symptoms for something far more serious if you are set in your mind that "oh it must be apnea, sure the test said it wasn't the doctor said he wouldn't give me treatment for apnea, but I am going to immediately conclude they are both wrong and I am right and that it couldn't possibly be something far more dangerous that I am ignoring by treating the symptom while ignoring the cause". I went into the doctor with suspected TB and ended up finding out that I had Thyroid cancer, so just because you may think you have x you have to remember that y,z,w,v, and q all also share similar symptoms so if you are getting told it is not x, odds are it is not x and as such you should tell your doctor you are still having the same symptoms and they can figure out what to check next if it isn't x.

Hey, thanks for the reply! I'm sorry about your thyroid cancer and hope it is treatable. I get what you're saying. My doctors don't seem to have any other ideas of what could be causing my sleep issues. All of my lab work is fine, and physical examinations haven't turned anything up, except for my sleep doctor noting that the back of my throat is very cramped due to large tonsils, tongue, and uvula. I'm definitely not trying to box myself in on a self-diagnosis. I'm still working through the process with my doctors and insurance, but the process is taking months. One of my doctor's recommendations on my at-home sleep study report is an auto cpap, but he wanted to wait for an in-lab or second at-home study before prescribing. I just wanted to see if I could do something to get some sleep in the interim. If a cpap is not the answer for me, I'm totally fine with that. I wanted to try it while waiting these past few weeks for insurance to dictate my next steps.

To me, it seemed like everything pointed to sleep apnea. The waking up gasping for air, waking multiple times per night, snoring, daytime sleepiness, lack of energy, and now seeing actual apneas and hypopneas in OSCAR, all led me to believe I may have some form of sleep apnea, but you're right, I'm not a doctor.
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#4
RE: New User - Please Help Interpret OSCAR Results
Tell me about it, taking months is extremely frustrating, when I went through the cancer stuff I ended up using almost all of my FMLA time just trying to find out what was wrong with me (took 7 of the 12 weeks just to figure out what was wrong, another 2 weeks waiting to do the surgery and another 2.5 weeks recovery time after the surgery before I could return to work using up 11.5 of the 12 weeks, I unfortunitly was not allowed to work during the discovery phase because that was right at the start of the pandemic where if you had anything wrong with you you were pretty much not allowed in public). That first few months back was super frustrating having to listen to the Geiger counter screaming at me from 30 feet down the hall with 2 walls between me and it (I work in a hospital and they have Geiger counters near the dock exits so that nothing radioactive accidently goes into the regular trash dumpster).

But yeah it took a long while to figure out what was going on and it was extremely annoying, but it is 100% worth figuring out the cause and treating the cause rather than just treating the symptom, you don't want to accidentally ignore something that is easy to treat if it gets caught early but hard to treat if ignored.

And yeah the cancer stuff went fine, surgery was easy, radiation was easy, the hardest part was just how long it took to get the thyroid hormones to the proper levels (took about a year before I didn't feel like I was constantly trying to function after a 48 hour work shift levels of fatigue) because while those hormones are off holy cow you feel like you could sleep 24 hours a day and still be exhausted, I have had days working 25 hours straight and then having to drive an hour home on no sleep and compared to the fatigue of the thyroid hormone stuff that was nothing in comparison. Will have been 2 years since I had my surgery at the end of this month actually and will be having my final every 6 months appointment before being able to only have to do a check up every year at the end of this month.

But yeah, while obviously treating the symptom for the short term will help you feel better and is worth doing, don't fall into the trap of treating just the symptom without finding out the cause because you don't want to accidently ignore something that should not be ignored, it really sucks how long it takes but it is worth it in the long run.
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#5
RE: New User - Please Help Interpret OSCAR Results
MileyCyrax, some of your data indicates sleep apnea.  But as has been pointed out, you sleep problems may be due to other issues. I suggest you do a search for sleep hygiene. It is import that you know that your machine and most other Phillips machines have been recalled for safety reasons. See the thread linked below for more information.

http://www.apneaboard.com/forums/Thread-...ght=recall
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.

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#6
RE: New User - Please Help Interpret OSCAR Results
(06-09-2022, 10:54 PM)Melman Wrote: MileyCyrax, some of your data indicates sleep apnea.  But as has been pointed out, you sleep problems may be due to other issues. I suggest you do a search for sleep hygiene. It is import that you know that your machine and most other Phillips machines have been recalled for safety reasons. See the thread linked below for more information.

First thing I did was remove the foam from the machine. The blower hours were only around 200 and the foam looked like it was in good shape. I've been practicing good sleep hygiene for quite a while. I used to have problems falling asleep, but after adjusting my sleep hygiene over time, I now fall asleep very quickly.
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#7
RE: New User - Please Help Interpret OSCAR Results
(06-09-2022, 10:11 PM)hh9797 Wrote: Tell me about it, taking months is extremely frustrating, when I went through the cancer stuff I ended up using almost all of my FMLA time just trying to find out what was wrong with me (took 7 of the 12 weeks just to figure out what was wrong, another 2 weeks waiting to do the surgery and another 2.5 weeks recovery time after the surgery before I could return to work using up 11.5 of the 12 weeks, I unfortunitly was not allowed to work during the discovery phase because that was right at the start of the pandemic where if you had anything wrong with you you were pretty much not allowed in public). That first few months back was super frustrating having to listen to the Geiger counter screaming at me from 30 feet down the hall with 2 walls between me and it (I work in a hospital and they have Geiger counters near the dock exits so that nothing radioactive accidently goes into the regular trash dumpster).

But yeah it took a long while to figure out what was going on and it was extremely annoying, but it is 100% worth figuring out the cause and treating the cause rather than just treating the symptom, you don't want to accidentally ignore something that is easy to treat if it gets caught early but hard to treat if ignored.

And yeah the cancer stuff went fine, surgery was easy, radiation was easy, the hardest part was just how long it took to get the thyroid hormones to the proper levels (took about a year before I didn't feel like I was constantly trying to function after a 48 hour work shift levels of fatigue) because while those hormones are off holy cow you feel like you could sleep 24 hours a day and still be exhausted, I have had days working 25 hours straight and then having to drive an hour home on no sleep and compared to the fatigue of the thyroid hormone stuff that was nothing in comparison. Will have been 2 years since I had my surgery at the end of this month actually and will be having my final every 6 months appointment before being able to only have to do a check up every year at the end of this month.

But yeah, while obviously treating the symptom for the short term will help you feel better and is worth doing, don't fall into the trap of treating just the symptom without finding out the cause because you don't want to accidently ignore something that should not be ignored, it really sucks how long it takes but it is worth it in the long run.

Wow sounds rough. I was just notified yesterday that my insurance approved the in-lab study so I just need to figure out which day to schedule it. I'm looking forward to finding out the cause, but until then I am happy to be getting some relief using this machine.

I've noticed a pattern every time I wake up. There is a steady increase in the leak rate, some events, a spike in flow rate, and then I wake up, take off the mask and go to the bathroom. I like that the large leaks and BND events can show me on the graph when I wake up to being conscious. It looks like it's the same pattern every time I wake up. Does that indicate the mask is slipping off and not providing enough pressure to prevent the events, thus waking me up? That's how I read it but I have no idea if that's right.


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#8
RE: New User - Please Help Interpret OSCAR Results
When you finally get that in-lab sleep test, talk to the doctor about using a prescription sleep aid so you can clock some actual sleep.  Be sure to stop using the machine at least two days before the test; there can be a carry-over effect.

On the subject of sleep hygiene: From your posted charts, I see one bedtime that's very different from the other two, and two sessions that are quite short.  Do you generally go to bed at the same time?  Do you generally get at least 7.5 hours of actual sleep?

A fair number of your events are central apneas: cessation of breathing for at least 10 seconds or more without obstruction.  These may reflect arousals from sleep.  See if they look something like what you see below when you zoom in on them.  You're seeing deeper inhalation and exhalation, along with irregular breathing; these indicate an arousal.  Because this washes out some CO2, your drive to breathe is briefly paused.  In itself, that's not a problem; the problem is the arousal.

And something to be aware of: a few lucky souls spend their first night on CPAP and wake up feeling like a million bucks.  For the rest of us, change comes slowly and gradually.  You're only 3 weeks in, so it's too early to try to assess what CPAP is or isn't doing for you.

Your settings seem OK.  You might try turning the ramp off, since that would eliminate one cause for pressure changes.  I'm going to guess that the main reason for the (few) pressure changes you're seeing are flow limitations.  Raising pressure isn't a terribly effective way to treat FLs, so if pressure changes might be contributing to your unrefreshing sleep, you could try setting your min = max = 7 and see how that goes.  Finally, you could try using C-flex to see whether you like it any better.

But one change at a time!  Otherwise you won't know which change is having what impact.

It's really hard to draw conclusions from your charts about whether you are likely to come in above the AHI=5 cutoff when you have your next sleep test.  One thing I do see is that you are not doing much snoring at all.  If you were a heavy snorer before, then the air-stenting provided by the machine is having at least some effect.


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#9
RE: New User - Please Help Interpret OSCAR Results
(06-10-2022, 03:28 PM)Dormeo Wrote: When you finally get that in-lab sleep test, talk to the doctor about using a prescription sleep aid so you can clock some actual sleep.  Be sure to stop using the machine at least two days before the test; there can be a carry-over effect.

On the subject of sleep hygiene: From your posted charts, I see one bedtime that's very different from the other two, and two sessions that are quite short.  Do you generally go to bed at the same time?  Do you generally get at least 7.5 hours of actual sleep?

A fair number of your events are central apneas: cessation of breathing for at least 10 seconds or more without obstruction.  These may reflect arousals from sleep.  See if they look something like what you see below when you zoom in on them.  You're seeing deeper inhalation and exhalation, along with irregular breathing; these indicate an arousal.  Because this washes out some CO2, your drive to breathe is briefly paused.  In itself, that's not a problem; the problem is the arousal.

And something to be aware of: a few lucky souls spend their first night on CPAP and wake up feeling like a million bucks.  For the rest of us, change comes slowly and gradually.  You're only 3 weeks in, so it's too early to try to assess what CPAP is or isn't doing for you.

Your settings seem OK.  You might try turning the ramp off, since that would eliminate one cause for pressure changes.  I'm going to guess that the main reason for the (few) pressure changes you're seeing are flow limitations.  Raising pressure isn't a terribly effective way to treat FLs, so if pressure changes might be contributing to your unrefreshing sleep, you could try setting your min = max = 7 and see how that goes.  Finally, you could try using C-flex to see whether you like it any better.

But one change at a time!  Otherwise you won't know which change is having what impact.

It's really hard to draw conclusions from your charts about whether you are likely to come in above the AHI=5 cutoff when you have your next sleep test.  One thing I do see is that you are not doing much snoring at all.  If you were a heavy snorer before, then the air-stenting provided by the machine is having at least some effect.

Hey Dormeo, thank you for the very detailed response. I will ask the doctor for a rx sleep aid. That is a good idea to not have the study be a waste due to not sleeping. I will also stop using my machine for a couple days before as you suggest.

I wanted to post different nights that had results more unique from one another showing a bad, worse, and okay night more or less. I thought that might make it better for analyzing, but probably not. One of those nights I turned it off every time I woke up and went to the bathroom. Another one I think I fell back asleep without the mask and woke up again and put it back on. Many of my nights are more similar to the June 7 image. I generally go to bed at the same time every night and try to get at least 8 hours of sleep, as in from the time I fall asleep to the time I wake up for the last time.

Yeah, the central apneas look like your image to me. I attached an example.

I've been reading a lot of stories people post about their experiences starting with a cpap and prepared myself for the possibility I wouldn't feel a difference for a while. Was hoping it would be a first night success story but didn't get my hopes up.

I've tried with the ramp off, but being at the starting pressure off the bat is a little overwhelming for me when I'm getting into bed. I like having the ramp on for while I get settled in bed and read before going to sleep. The ramp is finished up by the time I am ready to fall asleep. I just looked up flow limitations, and zooming in on my graph I see the flattened slopes for my inhales. One thing I notice is that when I inhale, after a certain point in each breath, it feels like the machine decided I'm done inhaling and reduces the pressure before I start to exhale. My lungs want to keep inhaling but it becomes more difficult at the end of the breath when that happens. I can try making that adjustment to the pressure, and I'll see how C-flex feels compared with A-flex. Thank you for the suggestion. I will not do both at once, as you advise.

I wouldn't say I was a heavy snorer before, but on the one night I used the snorelab app there were about 8-9 samples of snoring. The cpap has reduced that down to 0-1 times per night, so it must be doing something right in that aspect.


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#10
RE: New User - Please Help Interpret OSCAR Results
By all means keep ramp if that feels better to you. (But be aware that one of the guidelines for sleep is to use the bed only for sleep and sex. It was hard for me to stop reading in bed, but I do think it has helped me sleep better.)

Your snippet is exactly what an arousal looks like. So if that's what most of your CAs follow, then the CA problem is really an arousal problem.

I'll have my fingers crossed that you have a really reliable in-lab sleep test.
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