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Woofer777 - OSCAR Analysis
#1
Woofer777 - OSCAR Analysis
This my first post ever to a public forum.  I have read through various posts on this site which have been very helpful.

I have been using a ResMed AirSense 11 for 2 months, based on a home sleep study report (attached). My sleep has improved some with treatment and I feel more rested during the day.  However, I am getting high centrals, which were not present on the sleep study.  I am also experiencing high pressures which are uncomfortable.   

I would appreciate a review of my Oscar results to help determine what is going on. I have attached a few screenshots from one night that are typical of recent results. 

Other Information:
I have turned the Ramp off and have tried EPR at 0, 1, 2, and 3. I did not notice a significant change in numbers or how I slept from the various EPR settings.  
I have changed pillows and added a chin strap, both which helped results from where I first started.  
My sleep positions vary during each night from back, side, and stomach.
I have an in-line oxygen machine attached with a setting of 2.   I’ve checked my oxygen readings with a ring monitor and levels stay sufficient with the machine attached.

I look forward to someone reviewing my results and offering suggestions to assist!


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#2
RE: First Post, requesting Oscar review assistance
Welcome to the forum. Could you please zoom into a segment that is only 3 minutes long, so we can see the actual respiratory flow pattern? You seem to have a periodic pattern to your respiratory flow with relatively low flow with a pattern of large spikes. The period from 03:32 to 03:35 is a good example. Zooming in will let us see if the pattern is obstructive flow limitation or central or perhaps a periodic leg or body movement. Also scan your report for any mention of periodic leg movement. Also the period from 06:20 to 07:30 shows no events but steadily declining flow. An image somewhere in that section may be helpful as well.
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#3
RE: First Post, requesting Oscar review assistance
No change with EPR brings the central apnea authenticity into question. The view Sleeprider requested will help determine if there appears to be an obstructive aspect.

There definitely seems to be some obstruction present early in the night with reduced flows and high flow limitation and also later in the night with what appears to be some textbook positional apnea.

My first thought is to try a soft cervical collar to see if it helps with a positional aspect. You already commented about pillows and chin strap so I assume you have read a bit about this.
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#4
RE: First Post, requesting Oscar review assistance
Thank you both for the replies.  I have attached screenshots as requested, plus one other time period as well.

I did not see any mention of periodic leg movement in the home report.  In the past there have been many times that I "toss and turn" during the night, and it does feel in those times that I can't get comfortable, most notably in the leg area.  I was advised by the doctors office that they would want to go straight to an overnight study, and not spend time changing or reviewing data.  Unfortunately, I would not be able to complete an overnight study until July when my insurance coverage would cover most of the costs.  With the oxygen and sleep machine treatment in the last 2 months I do not notice nearly as much restlessness.  I do wake up during the night still and change sleep positions, possibly 6 or so times. 

From reading on this site, I did in fact purchase a soft cervical collar.  I wore the collar for a couple weeks and it did reduce hypopneas even more so than the chin strap.  However, it did not seem to reduce the centrals much at all.  I was able to tolerate the collar fine, it just felt better without and I went back to the chin strap to help eliminate the chin drop.  

If it will help this review process, I am willing to start from the beginning again, and wear the collar, and try different EPR settings, if we need to get a new baseline.  I will admit with all the various combinations I have tried I did not document things very well.

1. It may require more screenshots from prior days, but are many of the events "not real" ?
2. Again last night the pressures increased up to 18, causing the mask to loose contact, loud noise, etc...  It woke me up and I was lying there several minutes breathing normal, yet the machine did not return back to lower levels.  I ended up turning it off and back on so that I could go back to sleep.

Look forward to next steps.  Thanks.


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#5
RE: First Post, requesting Oscar review assistance
Your central examples show all sorts of odd breathing and it is hard to know what is going on. They do not have a typical CO2 driven central look to them which may support this being an obstruction problem.

The other breathing shows flow limited breaths which again supports obstructive/restrictive issue.

I would go back to using the cervical collar for a bit. I would also try increasing min pressure to 10 cm.
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#6
RE: First Post, requesting Oscar review assistance
Woofer777 - What medications are you taking?
Crimson Nape
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#7
RE: First Post, requesting Oscar review assistance
I see a lot of irregular "awake" breathing near your centrals, and many of them may be simply holding your breath. There is one group of breaths at 05:07:45 that looks like CO2 induced breathing but most of it is irregular but deeper breaths that I assume are awake. Your third example shows your normal sleep breathing.
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#8
RE: First Post, requesting Oscar review assistance
I appreciate the feedback.  I went back to the collar last night (results attached) which appears did not change much if anything.  I am aware during the night of waking up often and changing sleep positions, which I assume is reflected in the "odd irregular breathing" .    

My daily medications have remained unchanged during last year:   Prevacid, Crestor 20mg , and Gabapentin (300 mg x2 )

I will try changing minimum pressure to 10 tonight.  My recent EPR settings have remained at 2.

Is the "awake" breathing causing centrals that are artificial?  I'm not understanding the reference to CO2 induced breathing.

Is there more information I can provide to narrow down root causes ( and possible solutions)?


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#9
RE: First Post, requesting Oscar review assistance
CO2 provides our main drive to breathe, not oxygen which will cause you to breathe faster but not initiate a breath. CPAPs of any flavor tends to improve your breathing which often increases the flushing of CO2 from your system and in some susceptible individuals to below the apneic threshold and a central apnea occurs because your body sees no need to remove any more CO2 from your system. With your breathing stopped your CO2 builds and as it gradually builds you start to breathe gradually increasing your breath size and often overshooting the mark as you enter a feedback loop of too much CO2 to not enough CO2 which frequently shows in the flow rate curve as a recurring pattern of waxing and waning flow rate often with a central apnea at the nadir or low flow point. This is what I call CO2 induced breathing. The cause is different but it looks like classic CSR breathing.
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#10
RE: First Post, requesting Oscar review assistance
The main issue we can try to treat is the obvious obstruction problem. Your periods of flow limitation run rampant at times and you have numerous reras, hypopneas and obstructive apnea. Your central apnea all look odd and I think that is because there is an obstructive aspect as well. There are only 2 ways to try and treat obstructive apnea, increase pressure or treat positional apnea issues. Increasing pressure is often uncomfortable as you have already noted. Positional treatments include using a cervical collar, using a single pillow and laying in a position that keeps your airway straight and open. You noted no difference with collar which is a bit surprising and it makes me wonder if the collar doesn't fit well enough to hold your airway and chin in position.

The one other thing that could be a potential issue is that some people struggle with full face masks because they are less effective (pressure supplied in oral cavity counter acts some of the pressure applied to airway. Have you tried a nasal mask?
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