Sierra

I did a check back through my data and did not see anything like this. My respiratory rate seems to sit quite stable at 20. There may be some benefit in displaying the Flow Rate graph beside the Respiratory Rate graph and zooming in to see the detail. I am not a doctor, and am just guessing a bit. It may be an issue of shallow breathing so it has to be more frequent. Some people end up with a BiLevel machine that can assist breathing to some degree by using a large differential pressure between inhale and exhale. This is a bit different issue than general apnea. I don't see any apnea events during those periods of time.

This Daily screen is also showing similar issues of many obstructive events when the inhale pressure is maxed out at 15 cm. The good news here is that it does not seem to be creating central apnea events. They are much more difficult to deal with.

This report does however show a period of Cheyne Stokes Respiration (CSR), which is the green highlighted area. You may want to zoom in on that area to see what the Flow rate graph looks like. Notice that the Minute Ventilation is also going up and down quite a bit. Ideally the Minute Ventilation should be a fairly smooth level line indicating your breathing rate is stable. I would be worth looking at your Statistics to see how often you are having CSR. It would be also worth discussing it with your heart doctor especially if it is happening frequently.

Again, I hope that helps. Any questions just ask.

First on the Mask Pressure Plots Disabled issue, you could try going to File, Preferences, and the Waveforms tab. There is a box to check to restore the defaults. That may be worth a try. I checked my SleepyHead and all boxes on the left are checked off. The second thing you could try is upgrading to the latest version of OSCAR which is 1.2.0. Make sure you download the version that matches your 32 bit Windows operating system. The latest version is at this link. Or, you could try clicking on Help in OSCAR and see if there is a Check for Updates option which may let you download it that way. On a quick search I saw some indication that your issue may be a bug in OSCAR, and the later version may fix it.

Comments on the daily report:

• The red Pressure trace which is your inhale pressure is going up to the maximum of 15 cm and you are having a significant number of obstructive events and some hypopnea events as well. On the surface this indicates that 15 cm is not enough pressure to keep the airway open.
• However, the green Pressure trace which is your exhale pressure is being kept 3 cm lower at 12 cm of pressure. It is quite possible that when you are having those apnea events it is occurring on the exhale part of your breathing pattern.
• The reason this is happening is that your EPR (Expiratory Pressure Relief) must be set to full time and at 3 cm of pressure reduction on exhale. If the mask pressure graph was working you would see the pressure going up and down on every breath.
• You have two choices to address this. The first is to simply increase your maximum pressure which is what your doctor has recommended, and I presume done by now. The second way, and in my opinion the better way, is to turn the EPR off, or set it for ramp only.
• With the EPR off your inhale and exhale pressure will be the same, and pressure will not be dropping on each exhale. That is how my machine is set up. This effectively gives you 3 cm more pressure WITHOUT increasing the maximum pressure setting. The simple way to test this is to simply turn Pressure Relief Off on the My Options menu. That presumes you have that option. It may depend on how your machine was set up.

Those are my initial thoughts. If turning the Pressure Relief off works to reduce events, there is a more sophisticated way to disable it when you are sleeping but still have it active when you are going to sleep. Let me know if you are interested in that. Here is a Clinical Guide PDF for your machine to read if you want to understand what all the options are.

Hope that helps some. If you have questions just ask.

I would post the Daily screen only and for a start a day when AHI is higher and has a balance of OA and CA events. This is an example of what it should look like and which graphs to include. You can move the graphs up or down by left clicking on the title and dragging them up or down. Also if you click on the black triangle beside the date in the top left corner you can hide the calendar to save some space. Also under File, Preferences, Appearance, you should uncheck the box that says "Show event breakdown Pie Chart". It is redundant and takes up useful space on the left. Last if you press F10 you can hide the Navigation bar on the right to gain more screen space. I find the bar to be just in way, and not helpful.

When you have a mixture of OA and CA events it is sometimes called Complex Apnea. And, it is quite complex. Your body uses carbon dioxide in the bloodstream to regulate breathing. I'm sure I am over simplifying but when your overall blood circulation is low the regulation of breathing can be unstable. The depth of breathing can go too high, too low, too high, and so on. Between these cycles it can stop causing an central apnea event. Exactly how it happens is not fully understood, but a CPAP can also upset the carbon dioxide levels and aggravate the instability. The higher the pressure used, the worse the problem can be.

In any case post your Daily report and then I can comment better.

Good that you are on a PC. That makes it much easier for me. First the process to include a Daily Report screen shot in a post here:

1. First arrange your report somewhat similar to the layout I have posted above. You can click on the vertical titles of each graph and drag it up and down to get the best graphs showing. The ones I have showing are the most important in my opinion. It is best to maximize the size of the window you are using.
2. Simply press the F12 key, and watch the bottom right corner of the screen. It will display where the screen shot image has been saved on your hard drive. It will be something like C:Users/Your Name/Documents/OSCAR/Screenshots.
3. Use File Explorer to find this folder. You should find a file name of the screenshot you saved ending in .png.
4. With this forum open in another window, and with a new post open, then go to File Explorer and left click on this file you saved. Then drag it into the post. You should see a message that it is uploading.

That is basically it. Don't drag more than one of these images into the post, or it may get hung up in the spam filter. Just pick a good one to look at, with more events -- a night of concern.

Will answer in more detail when you post your Daily Report, but a few quick comments:

AHI is basically the CA+OA+H events added up. There are RERA events which get flagged but not included. There are very occasionally Unidentified events (green colour I think), and I am not sure they get included or not.

My view is that OA and CA events are equal in severity. No airflow goes in or out of the lungs during the event. Hypopnea events are less severe as there is partial airflow in and out.

The main issues are OA and CA events. They are equal in severity but differ greatly in cause. More pressure can keep the airway open and reduce OA events. However more pressure does not help with CA events as the airway is already open. For reasons that can be complex the body just decides not to breathe. And again for complex reasons more pressure can actually increase the frequency of CA events. That is why I would like to see your Daily reports before commenting on the value of increasing pressure. When you have both CA and OA events the pressure can be a balancing act. Not too high and not too low...

Actually when the OA event lasts for 3 minutes you really do not get any oxygen for 3 minutes. If you zoom in on a OA or even CA event by left clicking to see the detailed flow for each breath you will see that airflow goes to ZERO. That is why apnea is a problem. If you were to use an oxygen monitor you would see oxygen saturation in the blood drop significantly during an event.

I am 71 and like you I have had issues with irregular heartbeat. Mainly for blood pressure issues, but also to deal with the heartrate I take bisoprolol. Is is very similar to metoprolol but lasts longer and is more uniform in effect. I became concerned that it was causing more CA events, as it slows the heartrate. I discussed with my doctor, and although I don't think he was real convinced I got him to reduce the amount in half. I think it may have helped reduce the frequency of CA events. Something to discuss with your heart doctor.

Do you ever get areas highlighted in green on your OSCAR report. Those are indications of Cheyne–Stokes respiration. It also can be associated with an irregular heartrate. It can also generate a whole series of CA events. Something to look for on your OSCAR daily reports.

Hope that helps some for now. Post a Daily report and we can go from there.

Are you using a PC or Mac? Let me know and I will be able to help you more on how to post your OSCAR Daily Report here.

On the question as to why ResMed ignores the apnea events during high leak times, the reason I have read from ResMed is that that the leak interferes with their ability to distinguish what type of apnea event it is. They take the approach of not reporting them rather than reporting them wrong.

On the identification of events what ResMed does is speed the fan of the CPAP up and down quite rapidly to see how the pressure responds. If the airway is closed (OA - obstructive) the pressure goes up and down quite a bit in sync with the fan speed. If the airway is open (CA - clear airway or central apnea) then the pressure does not cycle up and down so much.

To zoom in on a event you just left click on the events bar near the event. Repeated clicking zooms in more and more. The other way is to use the up and down arrow keys.

Here is what a central event looks like. See the highlighted area. After 4 seconds of no flow the machine starts to cycle the fan speed. Notice the width of the mask pressure (blue) cycle.

Now here is an obstructive event. Note that the blue mask pressure cycle is much more and paints a wider blue band.

That is what you are looking for.

If you look on the left of the OSCAR Daily report screen you will see four tabs named Details (default), Events, Notes, and Bookmarks. The Events tab will identify each event during the night and how long it lasts. Higher up if you go to the Overview tab instead of the Daily one you will see a graph of the Total Time in Apnea. It is somewhat useful as it adds up the time you are in apnea rather than the number of events.

In any case if you post what type of computer you are using I should be able to explain how to post your daily report screen.

First on the high leak rate correlating with lower AHI I would suggest one possible explanation is that on ResMed machines they suppress the reporting of apnea events when the leak rate is over the redline. So you may in fact be having them while the leak rate is high, but they are not being reported. I believe you are using OSCAR. If you go into a day where you have high leak rates you can scan across and see if there are any reported events during the grayed out periods of time where the leak rate is high. I suspect you will not find any flags for events. I reviewed several days of where I had high leak rates and could not find any. Here is an example.

See the area I have zoomed in on. There is a CA event right before the high leak rate grayed out time, and two hypopnea events after, but nothing during the high leak time. This does not mean there are no events, it just means they are not being flagged. I further zoomed in on this period of time to see if I could find any events. See this further zoomed in screen shot and in particular where the green vertical cursor is located. That has all appearances of being an apnea event but was not reported.

If you go through a similar process of looking through your results during high leak times you may find something similar.

With respect to the thought that obstructive events causes mask pressure to build up and cause leaks, I have never seen that. If you look at the mask pressure trace in the screen shots I posted above there is no indication that mask pressure increases during a high leak event. Remember that your mask has a fairly large vent flow that is always venting air even when you are inhaling or exhaling or during apnea events. The fan in the machine increases and decreases in speed to maintain the mask pressure constant. There is always some fluctuation of pressure with each breath and during an apnea event this fluctuation may even decrease. There is no need for the mask to leak during an obstruction event as that is the purpose of the mask vent.

If you want to post a daily report of a typical night I could comment on the pressure issue. Ideally post one from before the pressure adjustment. Whether or not a pressure increase would be helpful depends on the types of events you are having and when during the night they occur. But if you post I would be happy to comment. When you have the screen displayed, assuming you have a PC, just press F12 and take note of where the screenshot is being saved. Then use file explorer to find the file, left click on it, and then drag it to an open post here. It will be copied into the post.

Hope that helps some,

I don't have this machine. My wife has a S9 machine and claims it causes her allergic reaction. She also claims if she washes the mask daily instead of weekly it helps. I have the A10 and have no issues with mine.

It sounds like you are doing quite well. Some comments on your settings:

• The default minimum setting on these machines is 4 cm of pressure. Many can find that too low for comfort. You may want to ask about increasing that pressure up to 6-7 cm.
• Most of your events seem to be obstructive and not too much clear airway. You may be able to get your AHI lower than 3.4 with a bit more pressure. The 90% pressure of 8.8 cm is not that high. You should ask about increasing that minimum even higher up to 9 or 10 cm. So you don't have too much pressure when going to sleep you should ask about using a ramp with a ramp start pressure somewhat lower at 6-7 cm.
• Your diagnosed AHI was fairly high at 49.7. You should get a lot of benefit from a CPAP.

It may not seem intuitive, but you could try a nasal pillow mask instead of a full face. This will force you to breathe through your nose. I take Otrivin very occasionally, but not as a matter of routine. I find breathing though my nose keeps everything clear.