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[CPAP] OSCAR confusing me with leaks/apneas
#81
RE: OSCAR confusing me with leaks/apneas
My knowledge is primitive compared to others here.

Before I got my asap S10 I found that mask life was much shorter than I expected.  I have used many cpap masks. Without fail, when I started to feel worse and worse I always benefited from replacing my mask.  I'm talking about every 9 months or so.

That's why I asked the questions I did about your mask use.  

When I was a baby engineer a long time ago I was taught to ask some questions when I had to solve a problem.

1. Did it ever work?
2. If it did, what has changed?

And from years and years of experience (over 30 with cpap)--solve the simple things first.

Going now.  I'll let others help.  Be safe.  Take care.
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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#82
RE: OSCAR confusing me with leaks/apneas
(05-07-2021, 09:11 PM)kappa Wrote:
(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.

Heyo, check post number 6 in this thread, I went over it more concisely there. 

(05-07-2021, 09:29 PM)SarcasticDave94 Wrote: 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.
I'll see if I can get ahold of it. The regular leak rate is fine, I guess I'm just moving around at night and its causing issues. I actually slept decent-ish, compared to most nights last night. I took the Soft Cervical Collar off and that seemed to help. Also turned of C-FLEX.

(05-08-2021, 03:18 AM)multicast Wrote:
(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.
I tape my mouth shut every night, leaks are probably coming from movement.
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#83
RE: OSCAR confusing me with leaks/apneas
(05-08-2021, 12:28 PM)godletmesleep Wrote:
(05-07-2021, 09:11 PM)kappa Wrote: 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.
Heyo, check post number 6 in this thread, I went over it more concisely there. 

Can you share a less concise version along with a screenshot of your OSCAR CPAP preferences tab. OSCAR gets the total leak rate from the machine, as well as Large Leak flags. From what I can see for DreamStation, unintentional leak is calculated as it is not reported by the machine. This occurs on import, so if you change the values later they will only take effect for future imports.
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#84
RE: OSCAR confusing me with leaks/apneas
(05-08-2021, 12:28 PM)godletmesleep Wrote: I tape my mouth shut every night, leaks are probably coming from movement.

Please be aware that mouth taping doesn't prevent mouth leaking in case the mouth isn't properly sealed -- a piece of tape is not sufficient.  If, e.g., if some saliva is able to escape from your mouth it undermines the sealing.  If you use a tape which isn't strong enough -- 3M Micropore wasn't strong enough for me -- use another brand.  I recommend Fixomull stretch; skin-friendly and strong.  (Be sure to pull it off slowly!)  Furthermore avoid wrinkles when taping: the air will escape through them almost certainly.  

Draw in your lips a little before applying the tape.  Not only it prevents the lips to be taped but is makes a better sealing as well.

My crystal ball tells me that in your case mouth leaks are present.  Do you have a dry mouth in the morning?

Maybe it's also worth considering to decrease the lower pressure a bit.
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#85
RE: OSCAR confusing me with leaks/apneas
(05-08-2021, 06:54 PM)kappa Wrote:
(05-08-2021, 12:28 PM)godletmesleep Wrote:
(05-07-2021, 09:11 PM)kappa Wrote: 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.
Heyo, check post number 6 in this thread, I went over it more concisely there. 

Can you share a less concise version along with a screenshot of your OSCAR CPAP preferences tab. OSCAR gets the total leak rate from the machine, as well as Large Leak flags. From what I can see for DreamStation, unintentional leak is calculated as it is not reported by the machine. This occurs on import, so if you change the values later they will only take effect for future imports.
[Image: da4c5279b6fa8fc21b82a31c9962540f.png]
When the leak rate is recalculated, all imports revert to 13 L/min as excessive. I do not know how else to put it, that's what its doing.

(05-09-2021, 03:10 AM)multicast Wrote:
(05-08-2021, 12:28 PM)godletmesleep Wrote: I tape my mouth shut every night, leaks are probably coming from movement.

Please be aware that mouth taping doesn't prevent mouth leaking in case the mouth isn't properly sealed -- a piece of tape is not sufficient.  If, e.g., if some saliva is able to escape from your mouth it undermines the sealing.  If you use a tape which isn't strong enough -- 3M Micropore wasn't strong enough for me -- use another brand.  I recommend Fixomull stretch; skin-friendly and strong.  (Be sure to pull it off slowly!)  Furthermore avoid wrinkles when taping: the air will escape through them almost certainly.  

Draw in your lips a little before applying the tape.  Not only it prevents the lips to be taped but is makes a better sealing as well.

My crystal ball tells me that in your case mouth leaks are present.  Do you have a dry mouth in the morning?

Maybe it's also worth considering to decrease the lower pressure a bit.

The pressure doesn't seem to be causing an issue, the current setting its at has given pretty low AHI compared to other nights. I'm still waking up 30+ times a night, but I don't know how to deal with the parasomnias causing that. I'm having quite a few confusional arousals, reaching my hands across myself very strangely. I find myself having back pain in the morning and I'm oftentimes very disoriented when I wake up.

Yes I wake up with a dry mouth, but I figured that was due to having apneas?
I also use 3M micropore... How can you tell if mouth leaks are happening? I see mouth movement happen when I have OA's, but I figured that was some sort of Bruxism.

EDIT: I assume thats what these plateaus are then?
[Image: 9063e585667cb97cef3e18a9ee312153.png]
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#86
RE: OSCAR confusing me with leaks/apneas
(05-09-2021, 08:29 AM)godletmesleep Wrote: Yes I wake up with a dry mouth, but I figured that was due to having apneas?
I also use 3M micropore... How can you tell if mouth leaks are happening? 

Well, as I remarked, I don't use 3M anymore but that Fixomull stretch instead. (Actually, I've trained my tongue so I'm using only a minimalistic chin strap by now with great success.)  

For the leaks; it's that plateau thing which is an indication for a mouth (that whats my crystal ball tells me) leak *and* you suffer from cottonmouth ...  See here for example:


   

Leak rate about 15; have a look at 01:42:45, the horizontal crossing of the zero line.  

A dry mouth has few to do with apneas but it's about the hair-dryer-effect: plenty of air is leaving your mouth and it takes nearly all the humidity with it.

Mike
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#87
RE: OSCAR confusing me with leaks/apneas
(05-09-2021, 08:29 AM)godletmesleep Wrote: Yes I wake up with a dry mouth, but I figured that was due to having apneas?
I also use 3M micropore... How can you tell if mouth leaks are happening? 

Well, as I remarked, I don't use 3M anymore but that Fixomull stretch instead. (Actually, I've trained my tongue so I'm using only a minimalistic chin strap by now with great success.)  

For the leaks; it's that plateau thing which is an indication for a mouth (that whats my crystal ball tells me) leak *and* you suffer from cottonmouth ...  See here for example:


   

Leak rate about 15; have a look at 01:42:45, the horizontal crossing of the zero line.  

A dry mouth has few to do with apneas but it's about the hair-dryer-effect: plenty of air is leaving your mouth and it takes nearly all the humidity with it.

Mike
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#88
RE: OSCAR confusing me with leaks/apneas
(05-09-2021, 08:56 AM)multicast Wrote:
(05-09-2021, 08:29 AM)godletmesleep Wrote: Yes I wake up with a dry mouth, but I figured that was due to having apneas?
I also use 3M micropore... How can you tell if mouth leaks are happening? 

Well, as I remarked, I don't use 3M anymore but that Fixomull stretch instead. (Actually, I've trained my tongue so I'm using only a minimalistic chin strap by now with great success.)  

For the leaks; it's that plateau thing which is an indication for a mouth (that whats my crystal ball tells me) leak *and* you suffer from cottonmouth ...  See here for example:




Leak rate about 15; have a look at 01:42:45, the horizontal crossing of the zero line.  

A dry mouth has few to do with apneas but it's about the hair-dryer-effect: plenty of air is leaving your mouth and it takes nearly all the humidity with it.

Mike
Horizontal Crossing of the zero line happens constantly in these, there's also the plateaus after inhale. Honestly never thought of those as leaks, figured it was DreamStation being weird. So do those sort of mouth leaks have a knock-on effect and cause arousals after a period of time?

[Image: 18d0bb47f5af196915972b87af3514b4.png]

Cause some of these plateaus just look crazy to me.
[Image: 3cdbbeafe4b917734c635f3ff988ee92.png]

EDIT: Unsure if I posted this one or not, but this one is also pretty prevalent
[Image: 9063e585667cb97cef3e18a9ee312153.png]

Just confuses me because the overall leak graph isn't plateauing, its going up yes, but not plateauing. Seems like I have these sort of plateau waveforms and horizontal zero crossings every night though. Then after a mouth leak or plateau leak ends, a respiratory arousal of some sort happens?
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#89
RE: OSCAR confusing me with leaks/apneas
(05-09-2021, 08:29 AM)godletmesleep Wrote:
(05-08-2021, 06:54 PM)kappa Wrote:
(05-08-2021, 12:28 PM)godletmesleep Wrote: Heyo, check post number 6 in this thread, I went over it more concisely there. 

Can you share a less concise version along with a screenshot of your OSCAR CPAP preferences tab. OSCAR gets the total leak rate from the machine, as well as Large Leak flags. From what I can see for DreamStation, unintentional leak is calculated as it is not reported by the machine. This occurs on import, so if you change the values later they will only take effect for future imports.

When the leak rate is recalculated, all imports revert to 13 L/min as excessive. I do not know how else to put it, that's what its doing.

I'm not sure where you're getting the 13 L/min number from. Can you clarify?

OSCAR only gets the total leaks number from the import. It calculates "intentional leaks" by using the current pressure and scaling between the preference values for leaks at 4 and 20 cmH2O (I see you have tweaked this from previous leak screenshots). This intentional leaks is subtracted from the total leaks to give the "Leaks" (i.e. unintentional leaks) value. It then uses the "Flags leaks over threshold" preference to draw the "Leak Rate Upper Threshold" line (if enabled) and to calculate the "Time over leak redline" value.

The machine also directly reports "Large Leaks" - prehaps this is a better guide as to if there is a real problem here.

I don't see what the issue is with the "Horizontal Crossing of the zero line" you are highlighting - it's just a brief period after exhale where you are relaxed. I doubt this is indicative (one way or the other) of mouth leaks.
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#90
RE: OSCAR confusing me with leaks/apneas
(05-09-2021, 05:46 PM)kappa Wrote:
(05-09-2021, 08:29 AM)godletmesleep Wrote:
(05-08-2021, 06:54 PM)kappa Wrote: Can you share a less concise version along with a screenshot of your OSCAR CPAP preferences tab. OSCAR gets the total leak rate from the machine, as well as Large Leak flags. From what I can see for DreamStation, unintentional leak is calculated as it is not reported by the machine. This occurs on import, so if you change the values later they will only take effect for future imports.

When the leak rate is recalculated, all imports revert to 13 L/min as excessive. I do not know how else to put it, that's what its doing.

I'm not sure where you're getting the 13 L/min number from. Can you clarify?

OSCAR only gets the total leaks number from the import. It calculates "intentional leaks" by using the current pressure and scaling between the preference values for leaks at 4 and 20 cmH2O (I see you have tweaked this from previous leak screenshots). This intentional leaks is subtracted from the total leaks to give the "Leaks" (i.e. unintentional leaks) value. It then uses the "Flags leaks over threshold" preference to draw the "Leak Rate Upper Threshold" line (if enabled) and to calculate the "Time over leak redline" value.

The machine also directly reports "Large Leaks" - prehaps this is a better guide as to if there is a real problem here.

I don't see what the issue is with the "Horizontal Crossing of the zero line" you are highlighting - it's just a brief period after exhale where you are relaxed. I doubt this is indicative (one way or the other) of mouth leaks.

Take the total leaks, that the machine gives you.

Take that number, and then disable then re-enable the red line as calculated through unintentional leaks as you said.

A proper calculation, would take the expected leak rate and subtract it from the total leak. The difference making up the leak rate.

If you look at the image in Post #6. You will see that, the excess leaks, are always 13/L MIN below the total pressure.
Doesn't change with pressure. 

Which is not how it's supposed to act, I figured? As you said, it's supposed to subtract expected leaks on the scale as put in preferences, based on pressure.
I just assumed the software gets confused and defaults to 13 as some sort of default number.

[Image: attachment.php?aid=31759]  [Image: b3b0d0681a56b9b5b1f8c03fbec8bb98.png]
If I re-import everything, it resolves itself, but otherwise it defaults to this 13 L/min expected leak.
I don't know how else to explain it, it just seems to be a software malfunction. I don't have the problem on SleepyHead 1.1.0

Apologies if my previous explanations were too vague, it's hard to describe for me to be honest.

---

As for the flat line issue, multicast has done a few experiments regarding it and it seems to be his conclusions. They seem to be reasonable conclusions to me, because its only during flat top moments or leak plateaus that you see these weird flat lines running a second or two long between breathes.

Even if the flat line is meaningless at zero, it's hard to ignore the flat lines as the top of breathes, so either way it seems we've got a mouth leak problem.
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