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Median doesn't tell the whole story?
#1
Median doesn't tell the whole story?
I have an OSCAR to ask about, but first some background....

I have been using an APAP for about a month and struggling with it. My home sleep study found an AHI of 57 and my O2 dropped into the mid-low 80s several times and once to 73. I had a mixture of OAs and CAs. My OAs have cleared up for the most part with fairly low pressure (typically under 9) but my CAs continue. I have had a few nights with CSR. I had noticed this breathing during naps in the day at times before I had this study done over the last couple of years. I had a full heart work up (for unrelated reason) and it came back good.

I can't seem to get past about 4 hours before I wake struggling to breath and take it off. My right nostril becomes so clogged I can't breath through it while my left is a pipe (had second deviated septum surgery done in the early 2000s and I think the left side took out a lot of turbinate). I don't know if my N30i gets pushed in some way to block my only working nostril, but I wake struggling to breath. I tried an F30i and woke feeling suffocated, though my minute vent and tidal vol was much improved. I am going to try out a different size to see if I can get a better seal on my goatee.

I have an O2 Ring on the way (wished I had had it last night) because I wake in the night with cold feet and legs unless I wear two pairs of socks and long johns.

Am I reading the Min Vent wrong?  My last night chart (attached) looks like I was not getting nearly enough to breath with sub-2 Min Vent. that went on for an hour, yet my median Min. looks ok at 4. What am I not getting (other than enough air)?

I am afraid my apnea has been going on so long (I don't snore much) that I have some nerve damage in my feet. They often tingle during the day (like they are now) and I don't have diabetes. 

I am afraid not to continue until my Dr. appt to review my progress (March 9th) in order to be insurance compliant, but I am also concerned about low O2.


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#2
RE: Median doesn't tell the whole story?
I added a zoomed image for the low min vent period and included flow, mask pressure, etc. I am not sure what mask pressure is telling me, but it jumped for the corresponding low min vent period.


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#3
RE: Median doesn't tell the whole story?
Your pressure is far too low Set minimum 8.0, maximum 12.0 and EPR 3. You need to include the flow limitation chart, but From 2:50 to almost 4:000 your flow rate is extremely constrained. This is either due to the high leaks, or flow limitation. Zoom in on the flow rate in a 3-minute segment would let us see the shape of the flow rate wave. I strongly suspect you are chin-tucking and cutting off your airway. We can see high flow limits during the entire period of that low flow rate. Read:
Positional Apnea: http://www.apneaboard.com/wiki/index.php...onal_Apnea
Soft Cervical Collar: http://www.apneaboard.com/wiki/index.php...cal_Collar

Read the Organizing your Oscar Charts in my signature links. We want to see:
Events
Flow Rate
Pressure
flow limitation
Leaks
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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#4
RE: Median doesn't tell the whole story?
Thanks for the speedy reply. I have included a three second segment.


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#5
RE: Median doesn't tell the whole story?
I just realized I didn't zoom in enough. I reset the scale on the Flow so that you could see the waveform better. Hope that doesn't mess it up too much.

I REALLY appreciate your help. I changed my pressure to 8-12. My ERP was already 3.


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#6
RE: Median doesn't tell the whole story?
Your first zoom was the correct one. I expected it to look worse through there. If you see periods of time where flow limit is very high and other times when it is minimal, that is most likely positional.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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#7
RE: Median doesn't tell the whole story?
I tried again last night and the same thing happened. I had a long stretch of very low flow rate. I had the pressure set to 8-12. It doesn't show a flow limitation for the most part. What I did get were a lot of leaks. I suspect mostly mouth, as the med N30i seems to fit pretty well. I wear a chin strap, but I can't handle the higher pressure without my lips leaking air. Wish I could handle mouth leaking well so I could try the BLEEP mask.

I am going to switch from a Small F30i to a Medium (appt next Wed), but in the meantime I am trying to make this N30i work. The F30i leaked like a sieve with my goatee (it kept trimmed fairly close by request ;-).

I got a notice that my O2 ring arrives today, so I am going to try again tonight, but since it went to near 12 (11.94) and I had large leaks, I am not sure if I can do much with higher pressure at this point. At least the ring will wake me if my O2 gets too low. My concern has been that I am getting into the 80s or below with this long stretch of low flow.

My original thread subject was titled to raise the issue of median Min. Vent. concealing long periods of really low values. Are the Tidal Vol. and Min. Vent. values trustworthy or do other things like leaks, etc. mean they can be bogus?

Any insights would be appreciated.


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#8
What to take to my Dr visit?
I have my first follow up with the pulmonologist since going on CPAP on March 9th. I am still learning so much, but clearly OSCAR data and groups like this forum have opened the lid to a world of things to learn and apply.

I called the Dr's office and the assistant had not heard of OSCAR or an overnight pulse oximeter, like the Wellue O2 Ring, and just said my Resmed numbers were ok. So I am afraid taking my laptop and asking for feedback on things on the charts will be too much. I am concerned that the "magic" AHI number and compliance is all that will be considered.

What print outs from OSCAR should I take to discuss? If I can't get the Dr. to look at the details, where should I turn for success with my therapy?

I am on a Medicare Advantage plan, so I am wondering if Medicare is going to be a disadvantage to get detailed treatment.
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#9
RE: What to take to my Dr visit?
You are thinking this appointment may be about optimizing your therapy, and in reality, it is about fulfilling an insurance requirement for a follow-up that determines the CPAP therapy is beneficial and should be continued. Your doctor is not going to want to look at your computer charts or Wellue O2 results unless they show something alarming and important. Your job is to go in and say "I feel better but have some pretty serious leaks from my mask". You can summarize your experience with data, but this is really an opportunity to ask questions and work out some issues.

Since I had to go look at your other thread to even know something about your results and issues to date, I'm combining them into one thread. It really helps if therapy and questions stay in one place. I still think you need a minimum pressure of 7.0, and to resolve the problems we see on your charts you will have to significantly lower the leak rate.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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: Median doesn't tell the whole story?
According to this article, normal minute ventilation is 5-8 litres per minute. If I was to speculate, your extremely low minute ventilation and tiny tidal volumes during these periods would suggest that you are defeating the chin strap and almost 100% mouth breathing while your nose is almost fully blocked so the machine isn't seeing much air flow.
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