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Periodic Breathing algorithm in OSCAR?
#1
Periodic Breathing algorithm in OSCAR?
I have an Airsense 11, and am using Oscar 1.3.1 (on Windows).  I had asked before about not seeing either periodic breathing or cheyne-stokes breathing statistics on my daily stats, and was told that if and when such breathing was measured, a field for it would appear on the Daily stats column.

Since then (months), the only thing that has appeared is Unclassified Apnea which is always 0.0.

I have had several bouts of what would have been PB on my former Dreamstation 1 on SleepyHead, and they are universally being interpreted at the still points as Clear Airway (which is fine, that would have happened on the other, too), but never as PB or C-S breathing, which is strange when looked at in detail.

What is the algorithm being used by OSCAR for PB or C-S?  Is it different than the one SleepyHead used?  I know that PB was a native stat for the Philips machine, is there any equivalent for the AirSense 11?

It's important to me, I used the PB for biofeedback to limit paroxysmal aFib, and would find it much easier to use OSCAR if I didn't have to figure it out each time on my own.

I'm including screencaps of the breathing last night as an example. The gaps between breathings (the center of which are marked Clear Airway indicating a full stop) are about 45 seconds average.


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#2
RE: Periodic Breathing algorithm in OSCAR?
OSCAR (nor Sleepyhead) doesn't flag PB or CS, it only reports what is flagged by the device.
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#3
RE: Periodic Breathing algorithm in OSCAR?
The algorithm used by OSCAR is the one that is in the Resmed firmware. OSCAR only reports what the CPAP provides.
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#4
RE: Periodic Breathing algorithm in OSCAR?
As mentioned above, Resmed doesn't flag periodic breathing as often as PR does. What you see is what you get.

What is your average AHI? Looks like you should be considering alternative treatment for the central apnea.
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#5
RE: Periodic Breathing algorithm in OSCAR?
(03-20-2022, 03:07 PM)Geer1 Wrote: As mentioned above, Resmed doesn't flag periodic breathing as often as PR does. What you see is what you get.

What is your average AHI? Looks like you should be considering alternative treatment for the central apnea.

I see. Okay, I guess I know better than to ask ResMed to do something, they apparently have gone after people for using OSCAR or at least for making videos of it.

Average AHI is 2.something.  It's usually below 2.0, but when I'm having an aFib event or if aFib starts during the night, it's 10, 12 or more, with sometimes PB (on the Philips machine) up to 15-20% (it isn't uncommon when in aFib to wake with an SpO2 in the low 90s).  I've talked to them about central apnea, they say there isn't something that can be done for this.

Thanks, Geer1 (and others)
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#6
RE: Periodic Breathing algorithm in OSCAR?
Not only can central apnea be treated, it may also be the cause of your afib rather than the other way around. The main treatment for central apnea is ASV which works similar to APAP but has backup rate to try and encourage you to breath when central apnea occurs and then it varies the pressure to regulate your breathing quickly and avoid repetitive central apnea like this which puts stress on your heart. The way central apnea like this can cause afib is because during the apnea your body relaxes slightly then during the recovery breaths it goes oh crap we need to pump oxygenated blood quickly so heart/body work hard to supply blood and then it does this each apnea over and over again until things stabilize or heart falls out of rhythm.

AHI average of 2 is good and would make it tough to convince a doctor that ASV needs to be considered. If this happens once every few weeks or something like that it may not be worth pursuing but if this is happening regularly and potentially the cause of your afib then treatment should definitely be considered. If your doctor isn't aware of ASV or doesn't realize that central apnea could be the cause of your afib then it might be worth getting a second opinion on the matter.

Jumping back to PB, you can see PB in your flow rates but one of the easiest ways to visualize it in OSCAR is to look at your tidal volume graph. You will see obvious large amplitude swings during flurries of central apnea like this, smaller amplitude swings during periodic breathing without apnea and more consistent TV when breathing is normal. With some practice you will be able to interpret it quickly with a quick glance at that chart.
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#7
RE: Periodic Breathing algorithm in OSCAR?
(03-20-2022, 06:46 PM)hkr3 Wrote: I see. Okay, I guess I know better than to ask ResMed to do something, they apparently have gone after people for using OSCAR or at least for making videos of it.

Please educate me on this!  It's nothing I have heard about.
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#8
RE: Periodic Breathing algorithm in OSCAR?
(03-20-2022, 07:19 PM)Geer1 Wrote: Not only can central apnea be treated, it may also be the cause of your afib rather than the other way around. The main treatment for central apnea is ASV which works similar to APAP but has backup rate to try and encourage you to breath when central apnea occurs and then it varies the pressure to regulate your breathing quickly and avoid repetitive central apnea like this which puts stress on your heart. The way central apnea like this can cause afib is because during the apnea your body relaxes slightly then during the recovery breaths it goes oh crap we need to pump oxygenated blood quickly so heart/body work hard to supply blood and then it does this each apnea over and over again until things stabilize or heart falls out of rhythm.

AHI average of 2 is good and would make it tough to convince a doctor that ASV needs to be considered. If this happens once every few weeks or something like that it may not be worth pursuing but if this is happening regularly and potentially the cause of your afib then treatment should definitely be considered. If your doctor isn't aware of ASV or doesn't realize that central apnea could be the cause of your afib then it might be worth getting a second opinion on the matter.  

Jumping back to PB, you can see PB in your flow rates but one of the easiest ways to visualize it in OSCAR is to look at your tidal volume graph. You will see obvious large amplitude swings during flurries of central apnea like this, smaller amplitude swings during periodic breathing without apnea and more consistent TV when breathing is normal. With some practice you will be able to interpret it quickly with a quick glance at that chart.

Okay, I will look at ASV machines, my first glance (a google search while I read your reply) showed them costing about 10x what the ResMed does. 

If I'm doing my biofeedback right it happens 1% or hopefully less than 3% of the time. 1% is usually one episode of <7hrs in a month.  My hard targets (established by cardiologist) are <10% we don't do something like an ablation, and two timing targets: at 24hrs, I need to go on blood thinners, at 48hrs it would begin remodeling.  I have several techniques I use in escalating order to get back in normal sinus.

Both the central apnea and the afib are results of a problem with my autonomic nervous system, a hard won fact given that my cardio people don't believe in that and that's pretty common for American cardiologists.  Whatever it is, its usually vagus-caused, sometimes sympathetico-vagal. It's a problem with vagal reactivity, not with vagal tone, another hard-won fact because that angle is mostly studied in large animal studies not human studies.  Almost all of what American cardiologists believe about aFib is derived from experiments that specifically screened out people without CHF (including Cor Pulmonale), and I don't have any infarcts on my heart (none detected in echo).

So I usually bring myself out of it by doing something that directly resets the vagal responses -- specifically almost the opposite of what is done during a Valsalva maneuver because I'm usually trying to get myself to breathe, not worrying about SVTs or something.  I do have the apnea while awake in these cases too, not just during sleep. It feels like my breathing got "switched to manual" and I have to take breaths and count to try to  keep my SpO2 up without hyperventilating.

If I go to bed with aFib, and the periodic breathing all stops at, say, 3:30am, then I record that I was back in sinus at 3:30am.  If I wake up and see a lot of central during the night, I prepare myself for I might have an episode. The problems with all of the above are serious because ablation is known to fail in 20% of cases, and (Univ. of York data) the 20% are precisely those who have sympathetico-vagal triggered aFib,  Since they try a second time if the ablation doesn't work, it would mean a year of my life at less than 100% while I recovered from 2 ablations, and since I know in advance it would fail, my recourse is to never get to 10%

Hope that wasn't TL;DR
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#9
RE: Periodic Breathing algorithm in OSCAR?
One of the video people who do videos about the machines on YouTube, you know those people who show you the new machine and give reviews of them (not the tall skinny pulmonary therapist, the other one) did a big review of the ResMed Airsense 11 and ResMed threatened to sue him for 1) taking the machine apart to talk about the sound damping insulation etc. and 2) telling people to download their data and use OSCAR.  I don't think he took it down and don't know whether they were being paranoid or bluffing but it happened.
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#10
RE: Periodic Breathing algorithm in OSCAR?
I use an Airsense 10 for her. I have the same problem with multiple CAs with Cheyne Stokes as you do. It started within a couple of weeks of commencing use of the  CPAP unit in Sept 2020. It has been coming and going until this month when so far I have had only 4 days without significant events. .

 If like me, your CSA/CSR experience began shortly after you began using a CPAP, then you may have Treatment Emergent Complex Apnea Syndrome. I would advise you to find a reputable sleep doctor and ask for a polysomnogram to check for this. If you do have it then the only machine that will work effectively is an ASV. Sometimes a BiPap is recommended but the research I have read is almost unanimous in stating that a Bipap will not give a good result. 
Having finally identified exactly what my problem is I am waiting to get a referral from my doctor to an independent Sleep Clinic that is focussed only on the diagnosis and treatment of sleep disorders by a group of qualified specialists with no industry connections.
Oscar shows the percentage of CSR on the first line in the Details graphic. The top Graph EVENT FLAGS shows the CSR as a green bar on the top line and the CSAs two lines below that. I saw an old post on this board regarding CAs and CSRs_- the poster was using an AIRSENSE 11. Her side bar was exactly the same as the one on the Airsense 10 with the CSR on the first line of the details list. There maybe just a glitch in the way your device was set up.
I browsed through the AIRSENSE 11 manual and it has a neat way to recognize a real CA.  You elongate the batch of CAs until the Flow Rate shows a flat line interrupted with large up and down lines which are the Apneas. If you were to draw a line from the bottom , over the top and down the other side of the Apnea it will have one or other of 2 shapes. If it is like a bell jar it is a real CA. If it is like a right angle triangle it is a OSA. Good Luck with your therapy and do consider getting an unbiased check on your condition.
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