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Interpreting OSCAR, Clusters of Central Apnea
#41
RE: Interpreting OSCAR
Doctor told me that if what he sees on Monday isn’t improved, he would order a sleep / Titration study. We will again review my data on May 28, eleven days from now.

At minimum, I am going to ask for an Oximeter to record my O2 stats, either borrowed from the sleep lab or purchased through Medicare. I've been tracking O2 stats since I got my Garmin February 14. As I learn more about my health I understand the urgency, but I can't call on Saturday afternoon and make demands. I talked to him twice last week and he seems more than willing now to discuss my concerns.

Attached is a graph of my O2 stats since February 14. Most of the lows points (red) are spikes that only last for brief periods, a minute or two. But some of them, many of them last for a half hour or longer and repeat for several hours. The blue line is the nightly average. Pretty pathetic! My daytime numbers are 95% – 99%.

Thank you all for your valuable input, I really appreciate your knowledge and I hope you don't mind educating me (and others too).


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#42
RE: Interpreting OSCAR
In my opinion, the doc is being overly cautious on progressing at the risk of your health. If this were myself, this is not acceptable and I'd be acting to make things happen immediately. 2 things: tell the doc he must act on this NOW, if not, find someone else that actually cares about patients and then consider reporting doc for incompetence.

Note, realizing this is a weekend, Monday would be the "do something now deadline." Some definitive action must begin Monday or the above suggestion applies.
Dave

OSCAR
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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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#43
RE: Interpreting OSCAR
I believe I’m almost at my sweet spot. The differences between the May 12 screenshot and  May 18 is the air pressure is now set at a constant 10 rather than auto between 7 and 18, the ramp pressure and time are a little different, and the EPR is set to 1. The main problem with last night was itching under the FF mask keeping me awake. If I can get past that I’ll be happy.

           

First screenshot        AHI = 25.29    203 CA Events  0 OA Events
Second screenshot    AHI =    2.69      16 CA Events  0 OA Events  ( I took a short nap in the afternoon, but don't think I really got to sleep.)

Any ideas why increasing the pressure and the other changes caused such a dramatic improvement?

Thanks
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#44
RE: Interpreting OSCAR
If this is improvement, I hope to never experience it. Your therapy is fractured into 9-attempts, most too short to show up as a sesson. What caused you to restart so may times?  There is nothing normal about the flow rate chart where the exhale looks like a fast puff of air to get started on the next inhale.  This has artificially increased the tidal volume because of the high flow rate, but the time of expiration is really short.  In your zoomed shot, the cluster of CA was proceeded by a series of breaths with really unusual morphology at 01:33 that would be interesting to see closer. 

Don't fall for the trap that it's all about AHI. Yes, the pressure at 10 reduced that, but this is not what good sleep and respiratory health looks like.  The most difficult obstacle between you and the ASV you need is the fact CA is consistently inconsistent, and a technician is trained to call any period of time with low apnea events a success.  This is not a success. Let's see if tomorrow looks similar, or if this is another example of consistent inconsistency.

[Image: attachment.php?aid=23036]

[Image: attachment.php?aid=23037]
Sleeprider
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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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#45
RE: Interpreting OSCAR
Using your number of 16 CA on what you're calling number 2, if this were me, 16 CA is too much. I don't care if the AHI is 2.xx. I had 16 events. I know for me, this would not be restful.

Doc, I'm not sleeping well. I can't get rest with these events going on still. What's plan C D E or wherever we are now? We do have a next plan right Doc? I do not accept having to keep trying this. Here's the results so far. It's really not changed how I feel. It is time to change direction now. Before I leave the office, we will agree on a new direction. So what is that new direction that does not include continue using a square machine to fix a round hole Doc?
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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#46
RE: Interpreting OSCAR
Hey guys, thanks for your input, I very much appreciate your comments and advice. I guess I don’t know enough about reading individual breaths, I’m learning.

I spent the night removing the connection on the F20 mask (machine turned off) and trying to scratch my nose through the hole, or by pushing my finger up from the bottom (machine on) to scratch. I know this all sounds pretty silly, but at 1:30 AM or whatever time it was, I was still half asleep. It was not a good night in that respect.

I felt good about this because I was told I had “moderate obstructive sleep apnea, 25 + events per hour”. Last night I had 0 OAs, and compared to last week down from 203 CAs to 16 CAs. In that regard, it seems like an improvement to me.

I will be talking to my doctor tomorrow about these last two nights. I’m pushing for a real sleep study so I can get to the bottom of this.

Thank you again, please bear with me.

Sleeprider, is this what you wanted to see?

       
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#47
RE: Interpreting OSCAR
I know where you're coming from. What I said isn't negatives about you or your thoughts on this. Look at what I said as ammo to fight to get something much better than the current situation. To get this fixed.
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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#48
RE: Interpreting OSCAR
Point taken.

Thank you Dave, et al.
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#49
RE: Interpreting OSCAR
I have not posted for a month now mainly because the advice I was given seemed to be the final solution. I am trying to implement that solution, which was to convince my doctor that ASV is the correct treatment.  I saw him on May 28, not much was accomplished during that visit except my insistence that I get a lab sleep study. He is in agreement that I get the study but so far, three weeks later, I am still waiting for that appointment. I am told the sleep lab is starting to conduct tests again after closing due to the pandemic. I called his office again today and made another request for the sleep study.

In the mean time, I have been concerned about my low O2 stats. I had been measuring and relying on my Garmin 245 Fitness Tracker to give me those stats. I have since bought the Contec CMS50F and have used it the last two nights. The Garmin has been, and still is reporting lows in the neighborhood of 80% with averages around 90%. One night the low was 72%. The CMS50F reports lows of 90% and averages of 96%. Needless to say, I no longer trust the Garmin for sleep data. The low of 90% from the CMS50F was only for a brief moment and then back up to the average of 95%.

I have also reduced the pressure from doctor recommended 10, to forum recommended 8 and EPR = 0 in an effort to reduce the CAs. I still do not understand the odd looking flow rate.  Any ideas or suggestions? I seem to be sleeping well, except for the annoying nose itching that I experience every night. This has been reduced some when I lowered the pressure from 10 to 8 and reduced the humidity to 2, but still wakes me up three of four times every night.

   
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#50
Clustered Centrals
Any ideas what would cause so many clustered CAs after 5:30 am? I don’t think I was in very deep sleep from 5:30 to 6:20 when I woke up, but I sure don’t recall any difficulty breathing. Maybe pressure is too high?

All the leak spikes throughout the night are from trying to scratch my nose under the F20 FF mask, very frustrating and my main difficulty with CPAP.

           
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