"Flatlining" with an AirSense 10 AutoSet

I get a LOT of these patterns throughout the night, but they don’t get flagged. They last from 4ish to 10ish seconds. Can anything be done? Does anything need to be done?

Oscar pic and SleepHQ account link included (you may have to choose AirSense 10 and current date in SleepHQ, I have an AirCurve 10 Vauto on that account as well). Many thanks y’all!

https://sleephq.com/public/teams/share_ ... 00b2179ed9

OAs, centrals and hyponeas MUST have a duration of 10 seconds or more to earn a flag.

So that's why you won't/don't see named flags for those "flatline" or restricted breathing when it is less than 10 seconds....9.9 seconds won't earn a flag.

Thank you Pugsy for the reply. Are there any settings changes that may help to intervene before the event? I'm reading up on this stuff, but looking to be schooled as well. My OA and CA event flags follow a similar waveform (I think). As mentioned, I get LOTS of these, but less than 10 seconds...image below is from same sleep session.

Your settings appear to be
Min EPAP 14
PS 4
Max IPAP 18
Which even though the machine is in auto adjusting mode it can't auto adjust to anything because these settings essentially create a fixed pressure mode.

I_shot_JR wrote: ↑

Sun May 25, 2025 3:11 pm

Are there any settings changes that may help to intervene before the event?

I don't know because I can't tell what might be causing them. I also don't know if they are worth going to go killing.
About half your AHI seems to be running as central apneas and more pressure or allowing the machine to go higher won't reduce the central apneas at all. It might help reduce the OAs and hyponeas. If the pressure is what is causing the centrals then going hunting/killing OAs and hyponeas might create more centrals so you might be swapping events....not a good thing obviously.

How did you come up with the 14/18 PS 4 settings? Did you have a sleep study done in a lab with tech in attendance to try to find the optimal pressure?

Did your diagnostic sleep study mention central apneas at all or a little?

Also...the centrals that I saw...you weren't asleep. Now why you weren't asleep we have no way of knowing.
A good chunk of the OAs and hyponeas also look like you weren't sound asleep....again the machine doesn't tell us why.

I hesitate to offer setting changes because I don't know what is causing what.
Too many unknowns for me to be comfortable at this time.
The centrals could be that you had them before starting cpap or you could have had them start up because you started cpap and then PS itself is also a central trigger.
Plus I don't have a complete history.

I do know that you have a lot of SWJ Sleep/Wake/Junk flagging going on which tells us your sleep quality is in the toilet but it doesn't us why it's in the toilet.

Do you take any medications of any kind? If so, what?
Do you have any other physical or mental health issues that could impact things?

I appreciate it. Sleep study titration last month was "inconclusive" so doc said 15-20 APAP. I think the settings you saw were from my AirCurve 10 Vauto (a $25 dollar craigslist find in which I replaced the blower and experimented for a couple nights). The AirCurve comes up first in SleepHQ. That is fixed now so AirSense 10 AutoSet data shows up first. This post is based data from my AirSense 10 machine and apap use, not the AirCurve, sorry for the confusion. https://sleephq.com/public/teams/share_ ... 00b2179ed9

Health info - obese, mouth breather, no meds that impact sleep (statin, gemtesa, Zepbound, meloxicam), mental health ok overall. Below is some commentary from the titration study. I agree that I must have lots of SWJ. Takes me an hour or more to get to sleep no matter how tired I am, doc offered sleeping pills but I don't want to do that.

Ahh....I understand a little more now.

Your AutoSet report from Sat the 24th is actually a decent report (at least on paper).

Those "flat lines without flagging" that you are concerned about causing arousals may or may not be the culprits here.
They could also simply be very brief pauses in breathing for some reason or other or even related to PLMS.

Your flow limitations graph is a bit active. Not horrible but it is a bit more active than normal.
Are you experiencing any nasal congestion? CPAP can't fix nasal congestion....must use some other traditional means to deal with nasal congestion if that is what you are having.

My gut tells me that you have some "bad sleep" and that bad sleep may or may not be causing the bad sleep problems.
These machines can only fix bad sleep that is from OSA. Doesn't work at all for other causes of bad sleep no matter how much we want to put all our "bad sleep" stuff into the OSA hand basket.

You've got some insomnia issues going on...both sleep onset insomnia and sleep maintenance insomnia and that's a real bitch to deal with. Killing OAs and hyponeas is a whole lot easier.

We have a forum member here that is our resident expert on insomnia because she has lived it and has a lot of patience trying to help people with insomnia.
I am going to alert her to your situation.

Your AutoSet pressure settings appear to be
Minimum 14
Maximum 15
EPR at 1

I don't like making more than change at a time unless the situation is urgent...and this 24th report isn't urgent but you might try increasing EPR to 2 and see what happens.
If you find yourself bumping that max of 15 much....probably should increase it a bit but it isn't urgent unless the machine wants to go higher and can't and lets OSA events happen because you needed more pressure and couldn't get it.

First, thank you Pugsy for the willingness to help people!

Correct on the settings and I will up the EPR to 2 and leave min/max. Good to know about PLMS and insomnia issues. Thanks for alerting the other member. I need some help that I'm not getting from the doc, BUT I am getting more "ammo" to take to my next follow-up in late June.

I've been "mask-hopping" (AirFit F20, Mirage Quattro, P&K Vitera) with full-face masks but not recording which was used on which night. AirFit is being returned, it literally rubbed skin off the bridge of my nose, Quattro doesn't seem to seal around my face shape (I'm clean shaven now btw), Vitera feels best but I get some leaks.

I think I should stick to one mask and one set of pressures and collect data for a bit while keeping the other factors in mind.

More feedback or commentary is always welcome. I attached a couple more pics of the sleep study titration session. I feel like I'm "flying blind" since the study was "inconclusive" and "optimal pressure not achieved". Thanks again Pugsy!

I_shot_JR,

I'm the "insomnia" "expert" Pugsy referred to.

I just wanted to quickly touch base since it's a gorgeous day (albeit a bit cool) here in Buffalo and I am going outside to do some badly needed yard work.

I will get back to you tonight or tomorrow after I've had a chance to go over what you've posted.

But it would also help me help you if you could answer the following questions:

1) How long does it take you to get to sleep after you go to bed on a typical night?

2) How many times would you guesstimate you wake up each night--as in you wake up enough to know that you're awake?

3) How long does it take you to get back to sleep after you wake up in the middle of the night?

4) What do you do when you're lying in bed aware of the fact that you are not sleeping?

Thank you robysue1,

I've had cruddy sleep for a long, long time. I don't drink booze (anymore, 6+ years) or use "recreational" substances (in case that info is helpful).

1) How long does it take you to get to sleep after you go to bed on a typical night?

A long time. At least an hour. I'm a teacher and work with SpEd kiddos, and even after a long day in the classroom, it takes me 60-90 mins to fall asleep.

2) How many times would you guesstimate you wake up each night--as in you wake up enough to know that you're awake?

A minimum of 4 times. Usually to shift position or adjust mask or pee.

3) How long does it take you to get back to sleep after you wake up in the middle of the night?

Probably about 10 min. Never fewer than 6 or 7 min.

4) What do you do when you're lying in bed aware of the fact that you are not sleeping?

When first going to sleep, I lay with eyes closed and listen to the fan, usually some soft ambient music playing. Now with PAP therapy I often focus on my breaths in and out. When I wake up in the middle of the night, it's the same.

Enjoy the weather and yard work today!