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Need help with OSCAR Chart newbie here!
#1
Need help with OSCAR Chart newbie here!
Hi forum!

     So I was diagnosed last month with mild Sleep Apnea. The number during my test resulted in 11.4 events per hour. I was put on a ResMed Airsense 11 that I've been using a little over a month now. Got an SD Card and uploaded my results in OSCAR because I love charts and information. I have to admit it was a rough start, until my Uncle gave me a Philips Respironics DreamWear Nasal Cushion mask. Originally, I am a mouth breather 100% by far. But I made the switch to a chin strap and nasal pillow from Philips and it is just amazing. It brought my number to under 2.0 the last few days and it's sooo much more comfortable than the Resmed full face and half face masks I've been trying!

     So I think one part of my journey in finding comfort with the headgear has come a long way. The chin strap I would like to get rid of some day, but for now it's definitely helping keep my mouth shut. I no longer wake up with a dry mouth or headache anymore. Sleep is so much better as well. Anyways, that's just a quick introduction for me. On to the chart!

     I would appreciate it if you guys can clarify if there's anything that really needs addressed or if everything looks A-ok? Thanks again and I'm so excited to start this journey of getting good sleep. It's been since High School that I remember waking up with this much energy and feeling refreshed and I am so thrilled by this piece of technology.. I am 37 yo. now.

     I hope I can give back to others someday who are feeling the same frustrations for sleep as I was because it is very important.


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#2
RE: Need help with OSCAR Chart newbie here!
Welcome to Apnea Board, and congrats on a good start to therapy. Finding the right mask is one of the biggest challenges we face, and learning to use a nasal interface is one of the best ways to be more comfortable and get effective PAP therapy. Your pressure settings are on a default 4-20 pressure and you are using EPR 3. Ramp is in use on Auto with a minimum pressure of 4.0. This means when you start therapy, you do not get the benefits of EPR until the pressure rises, and the machine is unable to properly respond to obstructive events because the exhale pressure will not rise until the pressure rises above 7.0. You can see this in your mask pressure graph which varies from a thin line to a fully functional inhale / exhale pressure.

When EPR is set at 3, we recommend a minimum pressure of 7.0. This will stabilize the pressure on the machine and put you ahead of events. This is also more comfortable. If you prefer a lower pressure, then a minimum of 6.0 with EPR 2 or 5.0 with EPR 1 is also possible. Your results show mainly obstructive events with some flow limits and RERA from your settings being too low. I recommend you reset the minimum pressure to 7.0 and try using the machine without ramp. If you need ramp, then the auto ramp feature is probably best, with a higher pressure you tolerate. A higher starting pressure will improve results and help you get your leak rates controlled as you will be awake to make adjustments at your nominal pressure.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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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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#3
RE: Need help with OSCAR Chart newbie here!
Thank you sleeprider that is very informational and I will give it a try. Most of what you said I could interpret and I will make use of it. What is EPR exactly though? I will try the auto ramp off tonight and a low setting of 7.0.
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#4
RE: Need help with OSCAR Chart newbie here!
It is an abbreviation for, Expiratory Positive Relief".  This feature and name are only used on Resmed CPAPs.  The Philips CPAP have a different name and operational behavior.  EPR is the reduction in exhale pressure, expressed as a whole number (1-3) that is measured in cmH2O. The only caveat is the lowest pressure that a Resmed can go is, 4cmH2O, so the EPR value setting is dependent on not exceeding the 4cm minimum.

While the EPR feature is listed a comfort option in Resmed literature, it can be used as an aid in addressing the reduction of flow limitation.
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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#5
RE: Need help with OSCAR Chart newbie here!
EPR=exhale pressure relief. It is a bilevel pressure meaning that it provides inhale and exhale pressure channels. In your case when the pressure rises above 7.0, the bilevel pressure is 7.0/4.0 (inhale/exhale).  EPR is the same as pressure support in bilevel, it is just expressed in a manner that lets the machine be sold as a CPAP.  The delivered mask pressure is identical to the Aircurve 10 set to EPAP 4.0 and PS 3.0 resulting in a delivery of 7.0/4.0.  Try zooming in on your chart at midnight and look how mask pressure matches flow rate (respiratory flow).  In the example below the blue line is mask pressure and the black line is respiration flow. Where respiration crosses above zero flow is inspiration, and below zero is expiration.  Notice now the pressure varies by 3 cm from about 9.5 to 6.5 in this example.  During exhale pressure drops nearly vertically 3-cm below the peak inhale. That is EPR, and that low pressure is maintained until inhale begins. During inhale, the pressure support comes in behind the user's inspiration effort and makes breathing easier. This can help overcome airway resistance, nasal congestion and other "resistance" that causes increased respiratory effort.  Feels pretty good compared to just constant pressure which is how CPAP is normally defined.  It is one of the best features of your Resmed CPAP that you actually got a bilevel machine.

[Image: attachment.php?aid=4258]
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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#6
RE: Need help with OSCAR Chart newbie here!
Sleeprider, thank you so much. You explained that very well. Thank you also Crimson, it helps.

I attached a zoomed in event right before 4am. Does this mean that I stopped breathing for a few seconds, and the pressure turned up to 7.0 to get me breathing again, then it stabilized again to my normal rhythm? Are all the RERA, obstructive, etc events basically just events. What does clear airway exactly mean? I read on the wiki about these but I couldn't find where it goes into detail what is really happening. Anyways, thank you guys so much I now have a much more comfortable thought process when reading my chart, I hope I can continue learning.


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#7
RE: Need help with OSCAR Chart newbie here!
So I tried the ramp setting OFF and the minimum pressure set to 7.0. Needless to say I struggled tremendously with that much pressure at the start. I tried changing to pressure of 6.0 and moving the EPR to 2.0 and it wasn't great either. I then just put everything back to how I had it and I think my mask was on way too tight to compensate for all the pressure in the beginning. I definitely don't feel great this morning, yesterday I felt fantastic waking up. Should I try to set the Auto Ramp setting on with a pressure of 7.0 tonight?
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#8
RE: Need help with OSCAR Chart newbie here!
(12-20-2021, 05:22 AM)jlsmithseven Wrote: So I tried the ramp setting OFF and the minimum pressure set to 7.0. Needless to say I struggled tremendously with that much pressure at the start. I tried changing to pressure of 6.0 and moving the EPR to 2.0 and it wasn't great either. I then just put everything back to how I had it and I think my mask was on way too tight to compensate for all the pressure in the beginning. I definitely don't feel great this morning, yesterday I felt fantastic waking up. Should I try to set the Auto Ramp setting on with a pressure of 7.0 tonight?

here is my chart sorry I forgot to upload it on previous post.


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#9
RE: Need help with OSCAR Chart newbie here!
@sleeprider, I have a question regarding how FL and OA responds to pressure settings.

Is the best way to reduce FL and OA is by making it easier to exhale? Is it generally the case that the lower exhale pressure is better? For example, PS of 5 would be better than 3?

I'm confused if it's the pressure value of exhale (epap) or is it how much the PS or EPR is, and thus, how much lower the exhale pressure is that treats FL and OA? Is it the relative level of exhale pressure in regards to Inhale pressure that treats FL and OA?

If minimum was 7, and exhale pressure of 2 would be much better than 4? If so, then how come they do not reduce it as lowest possible (or even turn off any pressure during the exhale phase?)? Is there issues with this?

Another question would be, what is the purpose of IPAP? What is keeping the airway from collapsing? Is it the two phases, and must be strong enough for both phases? Strong up phase, and strong reduction phase? So, the differential has to be really wide if the obstruction is greater challenge?
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