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Need guidance for complex sleep apnea and leaks follow-up
#41
RE: Need adult guidance for complex sleep apnea follow-up
Regarding leaks my guess is you leak through your mouth so fidgeting with nasal masks is unlikely to help.

Have you tried a full face mask?
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#42
RE: Need adult guidance for complex sleep apnea follow-up
(11-27-2021, 03:48 PM)Geer1 Wrote: When you post overview/full night data make sure to zoom out view port so seeing the full night.

You still haven't posted any 2-3 minute examples of apnea, hypopnea or what you would consider regular breathing. Don't worry about trying to interpret Oscar on your own, post examples and let us help you interpret them.

I'm obviously not understanding how to manipulate graph size, contents, etc.  I cannot seem to only capture "2-3 minutes" on the Events graph which is the only way I have found to zoom out the other charts needed.  My tiniest highlight seems to mark a minimum of 1/2 hour and not 2-3 minutes.  I'm missing something very basic.  

And I truly hate to show more ignorance, but I have no idea how to accomplish your request on the first line???  Doesn't showing the entire night's data automatically prevent zooming in for a closeup of a tiny porti0on of the night?  

Here is last night's sampler. I purposely did not strap down so tightly and sure enough my leaks skyrocketed.  

   

   
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#43
RE: Need adult guidance for complex sleep apnea follow-up
jmayer180 - OK! 2 down 'n dirty ways to zoom in.  Well, not really down 'n dirty...it just sounded neat in my head.

All of these start with you viewing the Daily screen.
  1. Using the Zoom factor in the Event Tab
    • Go to the Events tab on the left side of the screen.
    • At the bottom, you will see a slider that has a value to its right.  This value represents the time window to zoom to.
    • Set it to the time frame you wish to view.  
    • Go up to one of the events that listed and expand it.
    • Click on one of the events in the selected group.
    • All your graphs on the right will now be located on that even and zoomed to the time frame you selected with the slider.

  2. Using your pointer to zoom
    • Go to either the starting or ending time desired on any graph and hold down the left pointer button.
    • While holding the left pointer button, drag the pointer in the desired direction.  
    • A little box popup that will list the time in hours-minutes-seconds and .000 of a second.
    • Drag until this value is the desired time or close.
    • You can repeat the steps to fine tune the desired time on a zoomed graph.

Once you have zoomed in, you can now move to different areas of your sleep session by clicking on the time or an event.in the Events graph.  Additionally, you can use the Left and Right arrow keys on the keyboard to move though the timeline.  Using the Up and Down arrow keys will change the zoom factor as well.

To remove the zoom, either change to a different day and return or press and hold the Escape ( located in the upper left side of the keyboard, usually labeled Esc.

The Event graph never zooms.  If desired, you can use this graph to set another zoom factor with the pointer.

Play around with this, you will not harm OSCAR or your data.

- Red
Crimson Nape
Apnea Board Moderator
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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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#44
RE: Need adult guidance for complex sleep apnea follow-up
You have to zoom in/out for each individual screenshot you want to create. So first zoom all the way out (can hold down key to do this) and create a screen shot of overall night then zoom in to detailed views and create screenshots at each one.

Arrow keys are the easiest way to fine tune zoom imo. Up zooms in, down zooms out, left moves left, right moves right. You can click keys once or hold down if desired. Once you get zoom to the level you want (say 3 minutes) you can click anywhere on events tab to move the flow rate charts etc to that area and then use left/right keys to fine tune.

Left clicks in one spot will also zoom in and right clicks will zoom out. Play around with mouse and arrow keys and figure out what seems easiest for you.

That 5 minute view of hypopneas is a decent view. I am pretty sure those would have been central apnea but the machine was doing its job trying to make you breath and it was pushing little partial breaths of air into you but not kickstarting spontaneous breathing effort. The leaks might be mask leaks at the high pressure but it is hard to tell for sure.

You really need to figure out a way to improve the leaks as they are the biggest thing affecting your treatment right now. Rather than getting adequate treatment you are just blasting air across face our out mouth limiting machines effectiveness. If you haven't tried a full face mask I would do that to see if you can find one that is nice and secure and can handle the higher pressures.
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#45
RE: Need adult guidance for complex sleep apnea follow-up
It seems difficult to find an event with associated wave graphs within 2-minute zoom.  Seems like to my untrained eyes, I get better wave sampling with a longer time interval??  It looks to me like the waves disappear when zoomed?  Here's another shot in the dark. 

#1-All nighter,  I was sure I had a better mask seal and was comfortable, but see the Leaks!  #2 - 7 minute or so snip with 4 H's.  #3 - three minute or so snip with one UA and one H.  

Compared to early years when I was on BiPAP at 24/20 or so, I am much more comfortable with the leaks I still have with the lower average ASV pressures.  I have nevertheless tried numerous full-face masks over the years, with all of which my leaks were larger that with most of the nasals I have tried.  I have started taping my lips with a good stretch-tape which has so far stopped entirely my mouth leaks and aggravating morning dryness.  I'll continue the quest - every time a brand-new, best yet ever mask appears I'll probably try it.  

   

   

   
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#46
RE: Need adult guidance for complex sleep apnea follow-up
Just my opinion.

Part of the problem is flow rate should "flow" smoothly something like ocean waves. It shouldn't be jagged asymmetrical like yours if I've got it right. The other problem then comes in to play havoc. Your leaks are pretty bad and they not only would disrupt your rest, they also bring the accuracy of events and the ability for the ASV to follow your therapy needs into question, with both severely hindered.

An example that maybe helps, suppose that you had 60 events in that 8 or so hours of sleep. Maybe due to the high leaks, there's another 30 events not reported because the machine is overwhelmed with the leaks. If even close to true, this already trainwreck will become truly terrible looking. No I can't be certain there's another 50% more events it missed, but I'm certain it missed quite a few.

Another thing, with the multiple events cluster after another cluster, I wonder how many might be attributed to Positional Apnea? Maybe it doesn't count because as I said, I can't trust the report with continual leaks. It's not on OSCAR, it only reports what the ASV tells it.

Your highest priority still is get a mask that fits well and will not leak this much. It's not an issue of too high pressure overall or too much pressure for the mask, because my own RT said that when we were expecting to put me on a ventilator I'd use the same masks I have now. And that ventilator goes up to cmH2O 50, 25 over the ASV. Your issue is the mask isn't the right size, shape, or type.

Parallel if it helps: your throat is like a car tire we're trying to inflate but there's a big hole leaking most of the air out right at the connector valve. It's literally blown the therapy. The compressor just can't keep up.
Dave

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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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#47
RE: Need adult guidance for complex sleep apnea follow-up
The 3 minute view you posted makes it easier to visualize exactly what is happening with flow rate and mask pressure. In the 9 minute view you can get an idea of what is happening but it is too hard to really dig into the specifics like say trying to determine if the pressure wave is being triggered by spontaneous breathing effort or by backup rate/machine. If I had to guess I think you are looking for patterns in this data which is why you think the larger view is more helpful whereas what we are looking for is the ability to interpret each and every breath (up and down of flow rate chart) and that can only be done at high levels of zoom (let's say under 5 minutes).

To be frank not a single example posted so far indicates a semblance of normal breathing pattern or even a common obstructive or central apnea situation. Either you have some sort of uncommon breathing issue or the leaks and perhaps some sort of mouth breathing are making data near impossible to try and determine what is going on.

What masks do you currently have and use primarily? A full face mask would be a nice trial because then we know any leaks are the mask and that you just need to figure out how to get a better seal.
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#48
RE: Need adult guidance for complex sleep apnea follow-up
Back to the basic in horse-beating-to-death!  Last night's Large Leak Rate was just over 13%.  As I under- or mis-understand ResMed only reports leaks above the "25%" allowable and expected mask leak rate.  My Min Leak Rate was 0.00: Med was 4.80; 95% was 34.80; and 99% was 46.80.  I cannot compute why my entire flow rate and other charts are apparently completely dominated by a leak only 13% higher than the 25% rate, less than half the time that is not supposed to distort the other graphs.  

I'll review and retry some of my collection of old masks.  Perhaps my facial tone or whatever has changed over the years.  

Anyway, here are another three strikes:  

   

   

   
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#49
RE: Need adult guidance for complex sleep apnea follow-up
I've not yet taken Large Leak into consideration, so my comments on leaks do not bring that data into the equation. Your 95% currently at 34.8 means you were at or below that number 95% of the session. 24 L/min leaks is the ResMed leak redline, this is a factory set measurement, stating above that 24, the leaks are above what the ASV can be compensated for.

Your leak of 99.5% means your highest was at 46.8. Since we have no leak graph showing, we can't tell how long or really how bad these leaks are now, or the leak pattern. I'm thinking the standard OSCAR with Events, Flow Rate, Pressure or Mask Pressure, and Leaks needs to be seen as well as the zoomed ones others requested. We need the leaks chart to see what's going on.

See, some can have the same stats as your leak, 34 95% and so on, but maybe only hit that briefly. Recently your own pattern was not that way, large long leak blows instead.
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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#50
RE: Need adult guidance for complex sleep apnea follow-up
Large leak grey covers a large portion of the events graph and median leak rate was 4.8. I guarantee his leak rate graph looks pretty much identical to the ones posted previously (bad).

Optimal leak rate statistics are median leak rate of 0, no large leaks and a low single digits 95% leak rate. OP might struggle to get leaks resolved that well but needs to make some progress.

Those are a few interesting zooms. Definitely a central apnea aspect in a couple spots where machine is trying to kick start spontaneous breathing, appears to be a few obvious cases of expiratory mouth breathing as well.

Also again you have the same interesting pattern of high amplitude breaths in with minimal exhale present, decreasing amplitude each breath and concurrent leaks. I really think this is a case of nearly continuous leaks due to mouth expiration. I think you take big breaths in nose from CPAP, exhale out through your mouth (and have some leak at same time), seem to over ventilate yourself doing so and this then causes a central apnea and then you repeat the process all over again.

Imo you need to try a full face mask to see what that does.
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