Anderson5420's OSCAR Data

[anderson5420]

Dave, I don't think my OSCAR screenshot shows excessively high leaks or a mask problem. Here is what Gideon had to say about the meaning of the 95% leak rate (post 10-2-20, copy and paste):

the 95% is a statistacal value that means that 5% of the recorded values exceed that value or more correctly 95% of the values are at or lower than the specific value. (sic: statistical).

My 95% leak rate was 33.6 l/min. This means only that 5% of the recorded values were more than 33.6 and 95% were less than that figure. The more telling figure seems to be "time over redline" which was 11.828%. Round that to 12%, and it means I was below the leak redline 88% of the time, which does not indicate to me that I was not getting effective therapy!

I am using an "old style" Resmed P10 nasal pillow mask, and I have a new P10 being shipped that now has adjustments that the old ones lacked. I will be having a follow-up with sleep PA within a few weeks and one of out topics will be masks. I can say I tolerate nasal pillows way better than any other style of mask though.

[anderson5420]

congrats on the new machine. I didn't re-read this thread but seem to remember you had considerable ca in the past.

your median leak rate is not bad at all but good to get your 95%tile below 24 or better. looks like most of your leaks are above 18ish cmw so if you could try reducing max pressure to see if it improves leaks without allowing a lot of ca.

based on this last chart alone, if it was me, I'd reduce max ps to 12. if it helps leaks, great. if it helps leaks but enough ua/ca crop up to affect how you feel, you can go back up 1 cmw at at time looking for the sweet spot.

we don't know if your hypopnea are obstructive or central. you can try raising min ps to 4 to see if it helps.  personally I'd also raise epap to at least 6, especially if your h turns out to be obstructive, but it probably isn't all that necessary. your max epap appears to be set at 14 but it's not going anywhere near that so you can drop it to say, 10 or just leave it.  

the main thing is to try to reduce pressure related leaks by reducing max pressure.

Thanks for the advice, and yes I had quite high CA in the past. In fact virtually all my apneas were CAs.  It took some time and a third all-night sleep study (second titration study) to get the sleep doc and PA to agree to prescribe the ASV machine. Before that they kept saying my CAs were "treatment emergent" and would just go away if I continued with the AirSense 10 Autoset. It took seven months to convince them that was not happening!

I will revisit your post, and I can certainly agree that it would be wonderful to get my 95% leak rate below the leak redline. But being below the leak redline 88% of the time is where I am, and I will probably wait for the follow-up visit with my sleep PA required after getting a different machine before I even think about tinkering with the settings.  I am not afraid to tweak settings, but it just seems too early after only two nights. I have not even run last night through OSCAR yet, I will do that this morning!

[anderson5420]

Night 2 with AirCurve 10 ASV.  95% leak rate of 31.2 inching toward goal of less than 24! Time below leak redline down to 6.556%.

[turk0ZzZz]

Night 2 with AirCurve 10 ASV.  95% leak rate of 31.2 inching toward goal of less than 24! Time below leak redline down to 6.556%.

I am not an OSCAR pro by any means.. But could you possibly have CA unchecked? As it is not showing up in your charts at all...

[SarcasticDave94]

The leak rate trace from this OSCAR shot is better than the last one due to, not specific median, 95%, or Max numbers, but that it's overall lower. Most of your leak rate on yesterday's shot was either just below 24 or above it, that's why I said leaks were an issue. I failed to describe it in this way yesterday, so that's probably why it might not have made much sense. Today's is much better as it's not close to 24 as much of the elapsed time compared to yesterday's.

[turk0ZzZz]

Re: my other post.. NVM, just read through another ASV thread and the chart looks just like yours .

[sheepless]

turk, asv doesn't identify obstructive or central apnea. all apnea are 'unclassified'. I should be able to say why but don't remember exactly; something to do with how it treats ca i think.

[anderson5420]

I am not an OSCAR pro by any means.. But could you possibly have CA unchecked? As it is not showing up in your charts at all...

No, settings are all the same on OSCAR for AirCurve 10 ASV as for AirSense 10 Autoset.  Nothing changed in the settings. With the Airsense 10 Autoset, I always had a very small OA index and all the rest was the much larger CA index and a small hypopnea indea. The only thing different is that the SD card on import now identifies itself as an AirCurve 10 ASV. I think if I were having CA events, there would be a CA index reported by OSCAR. This kind of mirrors what the sleep tech told me after the second titration study - "When I switched to ASV mode, your central apneas literally disappeared." I don't know why there is not a CA index that shows zero, except if there have never been any events in that category, it may be that it does not report anything. Gideon would need to explain that.

[Sleeprider]

Your ASV has resulted in a great improvement, however I think you may need to add to EPAP min for the hypopnea. That said, your AHI is less than 2 and your CA events and all the other bad stuff is gone. I hope your therapy is feeling better than this image below. I hope you take the time to compare tidal volume, respiration rate and minute vent; all greatly increased with ASV.

[SarcasticDave94]

Yes I agree. EPAP Min bump up would clean up these Hypopnea. It might even show an improvement with a bump of 1 to the EPAP Min making it 6. I think if done, it'll show results overnight.