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[CPAP] OSCAR confusing me with leaks/apneas
#71
RE: OSCAR confusing me with leaks/apneas
No offense but that's why so many of us like ResMed machines better. Therapy is typically much easier to dial in, the therapy feels better. Even so the Respironics has gotten you to treated levels as in under 5 AHI. To me the bookends of each session above look like you've got some SWJ AKA sleep wake junk. And no matter what setting you try, comfort is top priority. If me assuming it exists, review your settings and choose where you felt best for the therapy.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#72
RE: OSCAR confusing me with leaks/apneas
your 'trainwreck' is more than acceptable to your providers with ahi <5. of course lower is better. I do see some tendency toward clustering, the most obvious just after 2:30. you mentioned back sleeping as something to work on & that, fewer/lower pillow(s) & adjusting the cervical collar may reduce your oa.

your leaks aren't terrible but are a little high. leaks frequently disturb me & maybe you so working on that may help too.

at some point (they tell us when ahi <5 but we like to be closer to 2) we have to start looking beyond apnea & pap to identify problems & solutions. e.g., other health issues, sleep hygiene, food, drink, stress, meds, environmental disturbances like temp, humidity, noise, light, pets, etc.

you mentioned something about a full blown bilevel vs the resmed. not sure what you mean by that. it's probably a longshot but you might be able to trade in your pr for the resmed apap with epr that might make you feel better about your flow limitations which from what I've seen aren't that bad. if you're able to get a resmed vauto, that would be the better (bilevel) solution to oa, obstructive h & flow limitations.
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#73
RE: OSCAR confusing me with leaks/apneas
godletmesleep, before cpap how did you sleep? Your back? side? stomach?

How long have you had your mask? Have you bought it before? What do you like about it? What don't you like about it?
DaveL
Compliant for over 30 years


I'm just a cpap user like you. I don't give medical advice. I hope to learn everyone, and that's why I share here. 
Seek the advice of a physician before seeking treatment for medical conditions including sleep apnea. Sleep-well

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#74
RE: OSCAR confusing me with leaks/apneas
(05-07-2021, 10:14 AM)godletmesleep Wrote: The 6 Flows do not look like class 1's from what I can see, not to mention the machine started flagging those types of clusters. The Wiki provides some examples of class 1s and there is no plateau beforehand on such flows. Nor does that explain why they look different from prior breathes taken in the same night that are easily distinguished as class one.

I am starting at the zero line when evaluating those flows, not necessarily the the middle of the exhale. Doesn't seem to make much sense for someone to inhale slightly, exhale slowly, and then make a larger inhale? Or exhale and withhold their breath for a few moments before starting to inhale. That's what those 2's are appearing to be.

Then again, maybe I'm wrong, I'm just going off what literature I could find (which isn't much) Sad

I think it's quite common to have an idle period between exhale and inhale as you will find if you look at a broad range of zoomed flow graphs - that's not really "holding your breath", which would be a pause between inhale and exhale, more just relaxing between breaths.

Small ripples in the flow can be cardiogenic artifacts (i.e. a reflection of heart beating and/or blood flow in to your lungs and blood vessels near airways).

Looking at this example of yours:
[Image: 67b595123bf1770c485bc38fccf71122.png]
These all look like fairly well rounded breaths, and the machine is not flagging anything in this area so I'm perplexed as to your concern. I would argue that the inhale starts at the green cursor line (as an example).

I understand your frustration in trying to dial in therapy. As others have suggested, the clusters of OA events could be positional. Given that things don't seem to improve at higher pressures you may want to reduce the max pressure to something more confortable.
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#75
RE: OSCAR confusing me with leaks/apneas
(05-07-2021, 01:47 PM)sheepless Wrote: your 'trainwreck' is more than acceptable to your providers with ahi <5. of course lower is better. I do see some tendency toward clustering, the most obvious just after 2:30. you mentioned back sleeping as something to work on & that, fewer/lower pillow(s) & adjusting the cervical collar may reduce your oa.

your leaks aren't terrible but are a little high. leaks frequently disturb me & maybe you so working on that may help too.

at some point (they tell us when ahi <5 but we like to be closer to 2) we have to start looking beyond apnea & pap to identify problems & solutions. e.g., other health issues, sleep hygiene, food, drink, stress, meds, environmental disturbances like temp, humidity, noise, light, pets, etc.

you mentioned something about a full blown bilevel vs the resmed. not sure what you mean by that. it's probably a longshot but you might be able to trade in your pr for the resmed apap with epr that might make you feel  better about your flow limitations which from what I've seen aren't that bad. if you're able to get a resmed vauto, that would be the better (bilevel) solution to oa, obstructive h & flow limitations.

if we ignore user flags, i guess its <5
my first study came back as <5 and they said i was a-okay despite waking up 13 times an hour.
is this logic literally not the problem with the industry?

i'm not really worried about the AHI rather than i am the fact my sleep is constantly disrupted.  Dont-know

(05-07-2021, 01:47 PM)sheepless Wrote: your leaks aren't terrible but are a little high. leaks frequently disturb me & maybe you so working on that may help too.

Leaks are an issue I've been neglecting, if not the cause of half of the issues. "aren't terrible" is a bit of an understatement, considering there are some hours where the leaks are over 60L/min... With no pressure increase to compensate for it. Course the red-line is in a stupid place, the leak rate in that image is actually fairly accurate, big spots where the leak rate is passing a critical threshold are concerning. Those are what I would consider large leaks.

I can't get OSCAR to realize that going over 13L/min is NOT an excessive leak for my mask. But regardless of whatever setting I put in preferences it will not adjust properly. So I've realized the Leak Rate line is completely useless sometimes. Sometimes I just have to go back into Sleepyhead, because it will actually calculate it properly.

After tonight though, I'm probably done. Crummy sleep is better than being tormented with this machine day after day. Nothing's gonna fix it. Another $300, $500, $1000, is just going to be money wasted at this point I feel.
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#76
RE: OSCAR confusing me with leaks/apneas
(05-07-2021, 07:25 PM)godletmesleep Wrote: I can't get OSCAR to realize that going over 13L/min is NOT an excessive leak for my mask. But regardless of whatever setting I put in preferences it will not adjust properly. So I've realized the Leak Rate line is completely useless sometimes. Sometimes I just have to go back into Sleepyhead, because it will actually calculate it properly.
The Leak Rate limit ("Flags leaks over threshold") in OSCAR is only applied on CPAP data import - if you change it later it will only apply to subsequent imports. You can purge data for a given day (or all days for that machine) and then reimport. The machine flagged "Large Leak" appears to trigger at a leak rate of around 40, so you could set the threshold there (don't worry about the "Total Leaks" number - this includes expected leak rate from your mask vents).
I also have PLM, and when experimenting with a PR machine I found that it would often misclassify CAs as OAs and ramp up pressure. I find higher pressures (and any pressure variation like flex/epr) very disturbing to sleep so ended using a fixed lower pressure. I then had a CPAP titration sleep study which found that I should use an even lower pressure as they noted disturbance even at the 7cm I had self titrated too and recommended 6cm (which is enough to treat my mild OSA). I'm also been on a journey to find appropriate an drug regime and diet to reduce my PLM.
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#77
RE: OSCAR confusing me with leaks/apneas
(05-07-2021, 08:42 PM)kappa Wrote:
(05-07-2021, 07:25 PM)godletmesleep Wrote: I can't get OSCAR to realize that going over 13L/min is NOT an excessive leak for my mask. But regardless of whatever setting I put in preferences it will not adjust properly. So I've realized the Leak Rate line is completely useless sometimes. Sometimes I just have to go back into Sleepyhead, because it will actually calculate it properly.
The Leak Rate limit ("Flags leaks over threshold") in OSCAR is only applied on CPAP data import - if you change it later it will only apply to subsequent imports. You can purge data for a given day (or all days for that machine) and then reimport. The machine flagged "Large Leak" appears to trigger at a leak rate of around 40, so you could set the threshold there (don't worry about the "Total Leaks" number - this includes expected leak rate from your mask vents).
I also have PLM, and when experimenting with a PR machine I found that it would often misclassify CAs as OAs and ramp up pressure. I find higher pressures (and any pressure variation like flex/epr) very disturbing to sleep so ended using a fixed lower pressure. I then had a CPAP titration sleep study which found that I should use an even lower pressure as they noted disturbance even at the 7cm I had self titrated too and recommended 6cm (which is enough to treat my mild OSA). I'm also been on a journey to find appropriate an drug regime and diet to reduce my PLM.

OSCAR will import it correctly, but if you make any preference changes even if unrelated to the leak threshold, it will immediately bounce back to 13 L/min flags.
My titration study put me at 7cm, and from what I was told is I had zero issues that night. Can't confirm because they never gave me the study. I felt better after that night but I don't know why.

My sleep is riddled with obstructions, hypopneas, and unflagged arousals and I'm getting super tired of trying to figure out why.
Leaks don't even seem to be the problem, but when a leak dissipates a bunch of events follow.
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#78
RE: OSCAR confusing me with leaks/apneas
(05-07-2021, 08:45 PM)godletmesleep Wrote: OSCAR will import it correctly, but if you make any preference changes even if unrelated to the leak threshold, it will immediately bounce back to 13 L/min flags.
My titration study put me at 7cm, and from what I was told is I had zero issues that night. Can't confirm because they never gave me the study. I felt better after that night but I don't know why.
Can you share a picture of what you are talking about with the 13L/min flags - perhaps start a thread in the software support forum so that we can fix the issue or clarify what the behavior is.
You should ask for reports from any and all studies you have and keep them on file. You should have the right to them under HIPAA.
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#79
RE: OSCAR confusing me with leaks/apneas
Have you found any mask that has reasonable leak rate that is comfortable? With high sensitivity to leaks or something, you really need to address the leaking. It maybe isn't very high, but for you it is important to control them. Get the doc to send your reports so you have your diagnosic study in hand. Titration also if you had one. They may or may not be flagging things that you need addressed. HIPAA requires the doc's office to give you a copy once you ask.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#80
RE: OSCAR confusing me with leaks/apneas
(05-07-2021, 07:25 PM)godletmesleep Wrote: Leaks are an issue I've been neglecting, if not the cause of half of the issues. "aren't terrible" is a bit of an understatement, considering there are some hours where the leaks are over 60L/min... 
Did you consider taping you mouth or using an FFM?  Not only are leaks annoying but they also partly corrupt the therapy.
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