CPAP Therapy Analysis Report

Patient: Bryan Wagman | Date: December 31, 2025 - January 1, 2026 | Report Generated: January 1, 2026

Overview

This report analyzes one night of CPAP therapy using granular data exported from a ResMed AirSense 10 AutoSet machine. The patient is in early-stage CPAP acclimation following a diagnosis of mild obstructive sleep apnea, with a history of difficulty tolerating therapy.

What makes this analysis different: Standard CPAP reports show daily averages. This system analyzes 250,000+ individual data points at 25 samples per second, allowing us to see exactly what happens breath-by-breath during problem moments.

Data Captured

The following data was extracted from the CPAP machine's SD card and processed for analysis:

Data Type	Resolution	Metrics Captured
High-Resolution Waveforms (BRP)	25 Hz (every 0.04 seconds)	Breath flow rate (L/s), Delivered pressure (cmH2O)
Therapy Metrics (PLD)	0.5 Hz (every 2 seconds)	Leak rate, Respiratory rate, Tidal volume, Minute ventilation, Flow limitation, Snore index
Event Annotations (EVE)	Timestamped events	Central apneas, Obstructive apneas, Hypopneas
Daily Summary (OSCAR PDF)	Daily aggregate	AHI, usage time, pressure statistics, leak summary

Session Timeline

The night consisted of desk acclimation (wearing the mask while awake) followed by actual sleep attempts:

Time	Duration	Activity	Pressure Setting
3:36 PM - ~12:00 AM	~8 hours	Desk acclimation (awake, wearing mask for compliance)	5-15 cmH2O
12:07 AM - 1:04 AM	57 minutes	Sleep Attempt #1 - Woke with air hunger, panic	5-15 cmH2O
2:35 AM - 2:56 AM	21 minutes	Sleep Attempt #2a - Couldn't get comfortable	5-15 cmH2O
2:58 AM - 3:25 AM	27 minutes	Sleep Attempt #2b - After pressure adjustment	8-15 cmH2O

Important Context: The overall AHI of 5.15 reported by OSCAR is averaged across 4+ hours including desk acclimation time. The actual event density during sleep attempts was higher.

Events Recorded

The machine scored 20 respiratory events during the night:

Event Type	Count	When They Occurred
Central Apneas	18	Clustered during sleep attempts (12:31 AM and 2:37-2:55 AM)
Hypopneas	1	12:35 AM
Obstructive Apneas	0	None - airway obstruction fully controlled

Key Finding: Central Sleep Apnea Pattern

The patient experienced treatment-emergent central sleep apnea (TECSA) — a condition where the brain temporarily stops sending the signal to breathe. This is different from obstructive apnea (where the airway collapses) and is a known phenomenon during early CPAP adaptation.

What the Waveform Data Shows

Examining the first central apnea event at 12:31 AM (24 minutes into Sleep Attempt #1):

Time	Flow Rate	Pressure	What's Happening
12:30:58 AM	±0.02 L/s	4 cmH2O	Almost no breathing - flat line for several seconds
12:31:01 AM	+2.46 L/s	7 cmH2O	Recovery gasp - large compensatory inhale
12:31:03 AM	±0.05 L/s	4 cmH2O	Returns to minimal breathing effort

Respiratory Metrics During Events

The 2-second resolution data reveals how severely breathing was impacted:

Metric	During Apnea	Normal Range	Recovery Phase
Respiratory Rate	3-4 breaths/min	12-20 breaths/min	10-14 breaths/min
Tidal Volume (breath size)	0.08-0.28 L	0.4-0.8 L	1.7-3.5 L
Minute Ventilation (total air/min)	1-3 L/min	5-8 L/min	20-30 L/min
Leak Rate	0 L/s	<0.4 L/s	0 L/s

Interpretation: At 3 breaths per minute with only 0.08 L per breath, the patient was moving approximately 0.24 L of air per minute — severely inadequate. This causes CO2 to build up, eventually triggering the brain to "gasp" for air, which is experienced as panic or air hunger.

Pressure Setting Comparison

The patient changed the minimum pressure from 5 to 8 cmH2O at approximately 2:55 AM. Comparing the data before and after:

Metric	At 5 cmH2O Minimum (Sleep Attempts #1 and #2a)	At 8 cmH2O Minimum (Sleep Attempt #2b)
Starting Pressure	~5 cmH2O	8 cmH2O
Respiratory Rate	Dropped to 3-4 bpm during events	Stable at 22-24 bpm initially
Tidal Volume	Collapsed to 0.08-0.28 L	Maintained 0.6-2.5 L
Minute Ventilation	Dropped to 1-5 L/min	Stable at 13-24 L/min
Patient Experience	"Air hungry," "panic," "had to consciously breathe"	Session was short (patient exhausted)

Preliminary Conclusion: Higher minimum pressure (8 cmH2O) appears to provide better baseline ventilation support, potentially reducing the brain's tendency to "pause" respiratory drive. However, the 8 cmH2O session was brief and the patient was already fatigued, so this finding needs confirmation over additional nights.

What This Analysis Can and Cannot Tell Us

What We Can Determine:

Event timing: Central apneas cluster specifically during sleep transition attempts, not during awake acclimation
Obstruction status: Airway obstruction is fully controlled (zero obstructive events)
Mask seal: Excellent throughout - leak is not a contributing factor
Event mechanics: Waveforms confirm true central pattern (open airway, absent respiratory effort)
Pressure response: Higher minimum pressure shows improved early-session respiratory metrics

Limitations:

Single night of data - Patterns may not be representative
TECSA often resolves - 75-80% of cases improve within 2-4 weeks of consistent use
Confounding factors - Patient was traveling, using unfamiliar equipment, already sleep-deprived
Limited sleep time - Only ~105 minutes of actual sleep attempts captured
No sleep staging - Without EEG, we cannot confirm sleep vs. wake during events

Recommendations

Setting	Tonight's Value	Rationale
Minimum Pressure	7 cmH2O	Compromise between clinician's 5-15 recommendation and observed benefit at 8
Maximum Pressure	15 cmH2O	Unchanged - adequate for obstruction control
EPR (Exhale Relief)	3 (Full Time)	Maintain comfort during exhale

Next Steps

Continue therapy with 7-15 cmH2O setting for 3-5 nights
Export and analyze data daily to track central apnea trend
If centrals persist after 2-4 weeks, discuss BiPAP or ASV options with sleep specialist
Future enhancement: Integrate Apple Watch data (heart rate, SpO2) for correlation analysis