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Lorrubdb Therapy Thread: Fine-tuning therapy with Oscar
RE: AHI CA/UA still high, EPR changes
If it comes to adding supplemental oxygen, it's easy to add it to your PAP airstream via either a special oxy hose with built-in bib or an accessory inline bib.

Keep the docs feet to the fire. You're concerned and they need to check. Best to ya, report back when you find out what they plan on.
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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RE: AHI CA/UA still high, EPR changes
Most likely the docs will not accept your oximeter readings as valid. His meters should be tested for accuracy and yours is not. That's ok. Tell him that you would like to verify more precisely what is actually happening and request an overnight study to validate. And ask if your O2 dips significantly during the day as you think it might without CPAP.
RE: AHI CA/UA still high, EPR changes
Thanks so much for your replies and recommendations. Just wanted to let you know where I'm at with  the doc and his plan to address my low oxygen levels.
I talked to him and explained that my AHI/numbers are improved but I'm having intermittent desaturations with spikes down to the 80s and corresponding difficulty breathing the next day. I have no desaturations during the day unless I take a nap without the mask.

He was concerned and you're right on Gideon- he did not want my oximetry reports, wasn't even interested in looking at them although I sent them to him anyway.
He is ordering an official home oximetry test to see if I quality for supplemental oxygen. He said to qualify I must be in the 80s for around 5 minutes a night. 
I'm a little worried because of the nature of my desaturations. As Dave pointed out it spikes up and down going lower and lower, sometimes to 80 but not sure of the timing.
 So hoping they don't do it on a  relatively good night where I don't desaturate as much. He has no idea why I'm still desaturating with good numbers and what appears to successful PAP therapy.

I'm attaching recent oximetry and chart from last night. The last week has been around the same - even one or two days with no CAs at all!  AHI has been below 1 and pressure limits although not at zero are lower and look ok (to me).

I'll keep you posted on the results of my test.  


Thank You!
RE: AHI CA/UA still high, EPR changes
Just a quick correction and addendum - I meant flow limit is ok not pressure limit. Also thinking on what Gideon said about possible desaturations during day without cpap. Maybe I do have them- just going by my Apple watch app but don’t know how accurate that is and it only measures randomly. My O2 ring doesn’t work if I move around so not an option. Any other ideas? Thanks






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RE: AHI CA/UA still high, EPR changes
Hello? Anybody out there? Anybody? Haven’t heard a peep all day. Oh well, no words of wisdom for me today, guess I’ll just just turn in.
RE: AHI CA/UA still high, EPR changes
You sound a little like me. My stats are all over the place and very often suddenly spike down.

The problem is that most home pulse oximeters are affected by movement, so that's always going to be a problem... I guess you could wear it while you're sitting down or whatnot and at least get some kind of readings? The Apple Watch, AFAIK, doesn't sample often enough and would easily miss those spiky drops if they only last for a short time, then lift again.
RE: AHI CA/UA still high, EPR changes
Thanks Ratchick, I'm having an official oximetry tonight so will see what happens.

I've been doing quite well with good numbers but the last few days my CAs and AHI have been increasing. 
Last night was the highest with my AHI 3.66 and CA 2.93. Yikes!. Had been feeling more energetic with lower numbers but today feel sleepy and tired, very disappointing.

Can someone please take a look at my charts and steer me the right way? Guessing I should decrease EPR to 2 but what about my pressure settings? They seemed perfect for awhile but all of a sudden not working anymore. Why does that happen? 

Also the most CAs last night seem to be around 6-7am when I was half awake, waking up so I thought I heard those don't really count?

Thanks in advance.


[attachment=38863][attachment=38864][attachment=38865]






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RE: AHI CA/UA still high, EPR changes
Correct, those CA events at beginning or end of sessions will likely be chalked up to SWJ/sleep wake junk. As for the varying AHI, it's rarely going to stay exactly at 1, 2, 3, etc. It's going to fluctuate some. You just need to determine what results you can still attain the well rested state afterwards.

It will also depends on recognizing trends. If there's 1 bad night, look at the data. If there's nothing obvious, go to night 2. Anything similar between them? And by night 3, good or bad, there should be some similar things to indicate actions needed.

PS, January 9 had some high leaks, up to a 42 for 95%, concentrated in that one area. That's a reason itself to look at masks and cushions.
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.
RE: AHI CA/UA still high, EPR changes
What Dave says. If your increased CAs are happening while you're falling asleep or waking up, you can probably disregard them. Variability (especially with centrals) is the norm, to a greater or lesser degree. Maybe decide how you're feeling and write it down before looking at your stats, and then see if there is any correlation.
RE: AHI CA/UA still high, EPR changes
Hi Everyone,

I haven't been on for awhile, been doing okay and not panicking anymore about one night changes. Also I've learned (thanks to you!) to adjust my EPR up and down, try to balance my centrals and flow limits. But now not sure what to do and would appreciate your guidance.

The charts are out of order but are for 3 nights in a row. On night 2/3-2/4 my CAs went pretty high so lowered the EPR from 3 to 2. The following night 2/4-2/5 was perfect but last night 2/5-2/6 I felt all night like I was struggling to breathe. Finally I glanced at the AHI on the resmed and it was 2x so thought maybe it's the EPR too low and higher flow limits. So without  seeing the numbers, I raised the EPR back to 3 and for some reason lowered the min pressure to 8.6 from 9.6-which I've been doing well on. Slept maybe a couple more hours and on seeing the chart today, my centrals jumped up after I turned the EPR back up 3 with AHI 4.5.  Also, I forgot my soft collar so had some obstructives which I don't usually have . Also some leaks-the perfect storm!

One more thing is that I have developed tinnitus in my left ear-constant ringing driving me crazy!! Has anyone heard of that to be related to cpap and maybe pressure to high?

BTW, my doc is trying to get me night oxygen. My official oximetry with cpap looked good so I didn't qualify for it. I explained to him that sometimes it's good and other nights  have significant desaturations like last night when it dipped to 88 and I'm having some breathing problems today. Can't seem to download my o2 ring, it keeps saying no data. He repeated the official oximetry without the cpap and is trying to use the results to get me the oxygen. I haven't heard back from him yet though.

Could someone please recommend changes in my settings?

Thank you so much as always!

















[attachment=39663][attachment=39664][attachment=39666]






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