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First Night of CPAP Therapy - Oscar Help?
#1
First Night of CPAP Therapy - Oscar Help?
Hey all, my husband just got diagnosed and had his first night of treatment with a BIPAP machine. His AHI/RDI was 92.1 and we used these settings from his doctor: 
IPAP Max 25 
EPAP Min 6 
PS 4 cm 
7 humidity 
76 degrees heating 

Seems he got a mask that is too big and we had trouble forming a good seal. Have a smaller one on the way. In the meantime though, is it possible to get some help looking at the data from last night and see if his pressures need adjusting? Or if the leak is too big, I can post new results in a few days. 

I'm very happy with the results so far - though he doesn't like the machine, he fell asleep quickly and had it on 6 hours and his AHI dropped dramatically. I noticed a big leak around 5 am and readjusted the mask for him. I did notice some snoring throughout the night though it was minimal compared to what it normally is, so I thought it might need a bit of tweaking. I also thought his average EPAP was pretty high, I was under the impression it should be much lower to be comfortable exhaling.


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#2
RE: First Night of CPAP Therapy - Oscar Help?
I think your UA events are obstructive in nature. And I think that that cluster of UA and OA events indicates that his chin is tucking.
Before we do anything else let's see what happens tonight and do post results again tomorrow. If it is not there we will chalk it up to a one-off and not worry about it.
If it recurrs you need a soft cervical collar to remedy that. See my signature for details. If this is the case it is typically fixed the next day.

FYI, that chart says that the EPAP should be 11. I would like to see a night without the chin tucking before acting on it.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Attaching Charts

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#3
RE: First Night of CPAP Therapy - Oscar Help?
(10-09-2020, 04:32 PM)bonjour Wrote: I think your UA events are obstructive in nature.  And I think that that cluster of UA and OA events indicates that his chin is tucking.
Before we do anything else let's see what happens tonight and do post results again tomorrow.  If it is not there we will chalk it up to a one-off and not worry about it.
If it recurrs you need a soft cervical collar to remedy that.  See my signature for details.  If this is the case it is typically fixed the next day.

FYI, that chart says that the EPAP should be 11.  I would like to see a night without the chin tucking before acting on it.

Thanks for your input! I do agree with them being obstructive - during his sleep test no central apneas were discovered, and prior to therapy I observed him constantly breathing without any air coming through, followed by large gasps of air.  

When he had the episodes from 4-5AM I had assumed he moved positions which caused a leak in the mask. I will post some results tomorrow, and then the medium size mask will hopefully come on saturday.

So as you recommended I won't change anything yet, but are you saying the correct EPAP pressure looks to be about 11? If I change it to 11 later do I also need to adjust the 4 cm PS as well?
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#4
RE: First Night of CPAP Therapy - Oscar Help?
No. keep the PS = 4, but wait and let's see report without the chin tucking. That could really change what we see and I would expect the pressures to be lower without the chin tucking, thus wait to make the change.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Attaching Charts

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#5
RE: First Night of CPAP Therapy - Oscar Help?
Awesome thanks! I'll update again when we have more data.
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#6
RE: First Night of CPAP Therapy - Oscar Help?
Good morning, here is an update. Unfortunately last night didn't go as well and he had an average of 15 AHI. We couldn't get a great mask seal and I woke up around 7 because the machine was beeping with the mask seal alert. His chin did not look tucked at that time but is still possible he was doing this. I gave him my pillow last night which has an oval indent for his head to try and keep it in place.

The last screenshot, wouldn't fit in one post. Please let me know if you need it. Has AHI/Time at pressure charts. 

He was also complaining about waking up with dry mouth both nights, even though I have set the humidifier at 7 and 8.


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#7
RE: First Night of CPAP Therapy - Oscar Help?
We only need the 1st chart unless we ask otherwise. Shrink the leak rate a bit and the others to add the Flow Limit chart to the first.
Your flow limits are high and they are very important for a ResMed.
You need to get that chin tucking under control.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Attaching Charts

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#8
RE: First Night of CPAP Therapy - Oscar Help?
(10-10-2020, 01:55 PM)bonjour Wrote: We only need the 1st chart unless we ask otherwise.  Shrink the leak rate a bit and the others to add the Flow Limit chart to the first.
Your flow limits are high and they are very important for a ResMed.  
You need to get that chin tucking under control.

Thanks for the quick response Fred! I have been talking about the collar with him but he is a bit resistant as he feels claustrophobic with the FFM already. I would still like him to add it but he may need a few more days to adjust. I did see your article on the collar options and we will try to find him one that is less bulky and hot (he's a hot sleeper). So I guess I will update after we find one for him. Should we leave the settings as is until then?

Also, Do you think the high leak rate is due to the chin tucking or because of the mask?
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#9
RE: First Night of CPAP Therapy - Oscar Help?
Show him the charts where the collar eliminated all that apnea overnight. Several users have been able to remove the collar after their body 'learned the new cervical collar.

What is used for pillows? Some have resolved the issue by going from two pillows to one pillow. We are not fussy about how it is eliminated, but the collar has been by far the most successfull.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Attaching Charts

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#10
RE: First Night of CPAP Therapy - Oscar Help?
(10-10-2020, 02:45 PM)bonjour Wrote: Show him the charts where the collar eliminated all that apnea overnight.  Several users have been able to remove the collar after their body 'learned the new cervical collar.

What is used for pillows?  Some have resolved the issue by going from two pillows to one pillow.  We are not fussy about how it is eliminated, but the collar has been by far the most successfull.

He is using a single memory foam pillow with a 1 cm memory foam support added. 

Last night I let him use my pillow which has a head shaped indent for back sleepers and elevated neck ridge, to try and keep him in position. However last night seems he slept even worse than the night before. The indent in the middle is for back sleepers and the indents on the sides are for side sleepers. I don't think he moved to his side last night.

It is unfortunately not letting me attach a picture as I have maxed out or letting me post an imgur link as I'm a new member, but it is called the "Sleep and Glow Omnia Pillow."
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