New CPAP User- HELP with OSCAR

[tiredmom1]

Hi,  

I am newish to the CPAP.  Can anyone tell me if this report from OSCAR provides any insight about if my cpap is benefiting me at all.  My husband thinks that I do not need to be using a CPAP (he doesn't think my sleep apnea is "bad enough" to need it). My sleep study did show that I only had mild sleep apnea (AHI 7 or 8).   So, I am not sure if CPAP is beneficial or ever going to be beneficial.  I was hoping that it would help with fatigue and tiredness, but I have been using the CPAP for four months and I am still tired all the time.   I downloaded OSCAR to see if it would give me any insight, but I have no idea what I am supposed to be looking for! I looked at the basics and about what information is most useful to show (essential information) on OSCAR, and I think I have them ordered right.  But, I really have no idea about OSCAR, so please let me know if I need to do something different or what else I can provide to help.     

Background about me:
I have been using my CPAP since December 25, 2019.  I was concerned that I may have sleep apnea for a multitude of reasons: always tired being the one I was most concerned with at the time and the one that I thought may be able to be fixed if I did have sleep apnea and started treatment.  I also had snoring reported by my husband and then recorded by me, heart issues (high blood pressure, mitral regurgitation, arrythmia-- atrial flutter and pvc's mainly), anxiety, headaches, low concentration, and I am sure there were more reasons, but that is all I can remember now.  I am now 34 years old.  I have been tired for as long as I can remember and concentration issues for my whole life(if I am not interested in something, I have to find something I am interested in or I want to go to sleep-- and pre-kids, I did go to sleep).  Hypertension was diagnosed when I was 26, in 2012, but I'm pretty sure I had it before then.  Heart palpitations and other heart diagnosis came between 2014-2018.  Anywho, I basically referred myself to a pulmonologist for a sleep study and had one in November and was told I had mild sleep apnea (ahi of 7 or 8, i cant remember).  The doctor said that I should try and see if the CPAP would help with my issues (main one at time was fatigue/tiredness). They have changed the pressure on it twice, once from 7 to 9 (was on 7 for about three months and then 9 for one month) and from 9 to 11 (only been on 11 for one night). So this is why my pressure says 9 on the OSCAR printout and 11 in my Apneaboard profile, just fyi.... But, I have not had any luck.  Thanks so much for anyone that has read this far or who just wants to look at the chart and tell me anything about it!

Thanks,

One Tired Mom
   

[tiredmom1]

           

Here are the last three nights.  I am still tired.  Any help?. I can post the ones from when I first started at the end of December.  I have no idea what specifically I need to be looking for.  Thanks!

[tiredmom1]

              Here are my first three.  I do have two young kids, and they were not sleeping very well through the night.  So, any gaps are probably contributed to them or to me getting up to go to bathroom (I have tried to start journaling).

[Sleeprider]

Tiredmom, welcome to the forum. Like my wife, you have a dagnosis of a fairly mild sleep apnea, that probably consisted of mostly hypopnea events. This, along with the snoring and fatigue is pretty common for upper airway restriction syndrome UARS. Your CPAP treatment has lower your events to be consistently less than 2 per hour, and sometimes less than 1/hour, so the therapy is effective in reducing events. Reading between the lines, it is less successful at making you feel rested. The disadvantage is that you were issued a Philips Dreamstation Auto instead of a Resmed Airsense 10 Autoset, because the Resmed is capable of delivering up to 3-cm of bilevel pressure called "exhale pressure relief" (EPR). EPR is important to people like you because the higher inspiratory pressure supports your respiratory flow, while the lower exhale pressure is comfortable and allows for a complete exhale. I doubt you can swap your machine, but that is the difference between your therapy and my wife's which is effective and comfortable to the point she does not want to sleep without the machine.

You can read this wik article about UARS and why bilevel pressure is helpful http://www.apneaboard.com/wiki/index.php..._and_BiPAP If you zoom in on you flow rate to where you can see the individual breaths, are the tops of the waves flattened? That is inspiratory flow limitation. While you don't have the "best" machine for this situation, you have a good one, an we can do some adjustments to perhaps improve results. You are using your CPAP in fixed CPAP mode. I would like to suggest switching to Auto mode so that the machine can make pressure changes as needed. In your case, a minimum pressure of 9.0 and maximum pressure of 12.0 should encompass all of the pressures that you are currently working with, but the machine will decide when to raise and lower pressure. In addition, you machine has AFlex which is the comfort feature that lowers pressure ahead of exhale an raises pressure when you inhale. You should try a setting of 2 or 1 and see which feels best. AFlex is considered a comfort setting, but you have to access it through the clinical menu. With auto pressure and AFlex you will probably get more comfortable therapy which is a big part of the goal. Here is a quick tutorial on how to access the settings https://www.apneaboard.com/dreamstation-...structions

[tiredmom1]

Thanks so much for taking the time to reply.  I changed my flex setting, so I will be interested to see if this changes anything.  I am going to figure out how to change it to auto and will be interested to see if this helps as well.  Update: I changed the auto setting to the pressure you recommended. And I saw when I changed that (or just because I was in the clinician setting?) that I now had a-flex available. I had changed the c flex before, not the a flex. So, I now have auto cpap on with min pressure 9 and max pressure 12 and a flex on 2.. Thanks! Hoping this helps.. How should I tell the doctor or the dme lady that I changed these settings if they asked? Like what is a nice way to say it, without offending them?
You asked, " If you zoom in on you flow rate to where you can see the individual breaths, are the tops of the waves flattened?"  I'm not sure what this exactly means (seem like the waves/patterns change alot).  I will upload some zoomed ones to see if this is what you mean.      

I looked up UARS, and I noticed that it said that RERAs are another name. I exported my OSCAR data to excel, and it says that the average RE Count (I believe this is RERAs) is 2.71.      Should this be more if I had UARS? 

I am attaching one of the nights for which I had the highest occurrence of RERAs (9) to see if this tells you anything more.      Is there anything else I need to upload? Thanks so much again!

Thanks so much for any other information that you can offer.

[Sleeprider]

I think you did great! These are not easy concepts to understand, and you investigted the keywords and did a great job of posting a chart showng your respiration flow rate has flow limitation. Just look how flattened those inspiratory waves are:



All this means is that with airway restriction, you have to work harder on every breath to inhale. That is why pressure support would be so transformative for you, making every breath easier and avoiding the arousals that disrupt your sleep. Even though your AHI is low, the sleep disorder comes from this problem. If we could fix this, your respiratory effort would be reduced, your oxygen levels improved and your night time respiration could return to normal without more effort. I hope we can find a solution that works for you, and of course we have to pursuade your doctor that is the goal.

[SarcasticDave94]

One thing I'll add is that to address this with Doc, note in some way what you suffer from, including complaints and symptoms seen in the OSCAR chart. This the why you adjusted. Settings Sleeprider suggested changing, going to Auto/APAP from CPAP, adding Flex, etc. is what you changed. Viewing OSCAR afterwards is the results.

I don't really know if the doc will ask. A lot will not consider it, just the how are things working? Oh it's fine now.

Assume for a minute it is asked by the doc. Look above here.
This is what I did (xyz), why I did it (abcdef), and I have good results (OSCAR).

Depending on the doc and his/her attitude, you can unruffle feathers by a "the results look good don't they? any changes or additions that you suggest?" You don't have to implement their suggestions, but you'll "consider them" so that it's not an outright No rejection.

If to change to another machine brand/type then it could be here's what I need to address, I can't because this brand doesn't offer setting XYZ, but that one does.

[tiredmom1]

---

Thanks so much for the replies.  Those are good tips for my doctor, if they ask.  I don't have another appointment until June 22, so I have a little bit of time to hopefully get better results. They are suggesting putting me on medicine (Provigil/ Nuvigil) to help with fatigue during day, but I really do not want to treat the symptoms with another medicine.  So, those tips will help better explain some the reasoning (if they do ask).   So, my sleep has been kind of off these past couple nights.  My son has decided to move back into bed with me, and he is a snuggler and a kicker.  

Here are the results from the past couple days.  Can you tell from these if I need to try anything else at this time?  I think the waves are getting less flat, but I can't tell.        [attachment=22424]        

[SarcasticDave94]

I am seeing that graph does look better than the first ones. I've got no suggestions to help out, but I do hope things are beginning to improve. Best wishes you get the rest you need.

[tiredmom1]

I am going back to the doctor on June 22.  I am still having no change with my tiredness while using the cpap on auto. If me being tired was going to benefit from the cpap (I have) being set on auto, would I have already felt  it?  Is there a definitive way to tell if I do have UARS? Do I need to get the other other cpap to see if this works? Will provigil help with tiredness from uars? Thanks so much! 

Still so tired mom