Hello Guest, Welcome to Apnea Board !
As a guest, you are limited to certain areas of the board and there are some features you can't use.
To post a message, you must create a free account using a valid email address.

or Create an Account


New Posts   Today's Posts

New User - Help interpreting Oscar data
#1
New User - Help interpreting Oscar data
Hi everyone - I was diagnosed with mild OSA in 2014 with an AHI of 5.0.  While the doctor indicated this was very mild and that CPAP yield would be low, initiating CPAP therapy was revolutionary for me, increasing my energy and reducing napping after work.  My wife was the one who noticed it saying I snored often and "stopped breathing" for long periods of time during sleep.

That said - I moved shortly after and never really picked up with a specialist in my new city.  I stumbled upon this site recently and am amazed with the content - I am nerding out on the data aspect realizing I can look at the numbers and make adjustments to tweak.

Any thoughts on these two data samples?  My wife has noticed more snoring recently, but I am not sure if this is because my nasal mask (AirFit N10) is coming unhooked or if I need to up the pressure a bit.  I'm using a ResMed S9 AutoSet APAP.

Thanks in advance!

[attachment=13788]
[attachment=13789]
Post Reply Post Reply
#2
RE: New User - Help interpreting Oscar data
Here is a snapshot of the usage statistics screen.  What is EPR?

[attachment=13791]
Post Reply Post Reply
#3
RE: New User - Help interpreting Oscar data
G'day GeauxBears. Welcome to Apnea Board.

Those results look pretty good overall - almost perfect in fact. You had one episode of snoring combined with flow limitation on Saturday night. At this time the pressure was maxing out. I'd be inclined to raise the maximum pressure to give the machine more leeway to address these events. Try 15 as a start. You might want to bump up the minimum pressure to around 8.0 to 8.5 so the machine can respond quicker to incipient events.

EPR is expiratory pressure relief. As you exhale the pressure drops to make it easier and more comfortable. EPR can be set as 0 (off), 1, 2 or 3 cmH2O.
Post Reply Post Reply
#4
RE: New User - Help interpreting Oscar data
Here is the excerpt from the Apnea Board Wiki;
"EPR (Expiratory Pressure Relief) is a ResMed brand-specific term for CPAP exhalation pressure relief.
According to the ResMed website: "EPR (expiratory pressure relief) is an effective alternative to continuous positive airway pressure (CPAP) therapy. It features several options that enable you to reliably and predictably control patient therapy while delivering a higher level of patient comfort"."

Its use is based on a setting of Off  (0) to 3.  The values stand for the amount of pressure in cmH2O that will be reduced from the set pressure.  The EPR pressure can not still go below the CPAP minimum of 4 though.   This means in order to have the full use of the value set in the EPR,  will require an initial pressure setting that will equal 4 or greater when the EPR value is subtracted from CPAP's set pressure. While the EPR works in reverse, it is akin to the PS value in a Bi-Level machine.

An example would be setting the EPR to 3 and the CPAP pressure is set to 10-13cmH2O will result in an expiratory pressure range of 7-10cmH2O.
Crimson Nape
Apnea Board Moderator
www.ApneaBoard.com
___________________________________
Useful Links -or- When All Else Fails:
The Guide to Understanding OSCAR
OSCAR Chart Organization
Attaching Images and Files on Apnea Board
Apnea Helpful Tips

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.
Post Reply Post Reply
#5
RE: New User - Help interpreting Oscar data
(07-22-2019, 09:45 PM)DeepBreathing Wrote: G'day GeauxBears. Welcome to Apnea Board.

Those results look pretty good overall - almost perfect in fact. You had one episode of snoring combined with flow limitation on Saturday night. At this time the pressure was maxing out. I'd be inclined to raise the maximum pressure to give the machine more leeway to address these events. Try 15 as a start.  You might want to bump up the minimum pressure to around 8.0 to 8.5 so the machine can respond quicker to incipient events.

EPR is expiratory pressure relief. As you exhale the pressure drops to make it easier and more comfortable. EPR can be set as 0 (off), 1, 2 or 3 cmH2O.

Thanks so much for the quick reply, DeepBreathing.  I’ve felt like the pressure might be a tad low, so will make these changes and post back in a few days.  Thanks again!
Post Reply Post Reply
#6
RE: New User - Help interpreting Oscar data
Welcome to the forum. EPR is exhale pressure relief. You are using it full-time at 3, so during exhale your pressure drops by 3-cm from your CPAP pressure. With 7-12.4 pressure, your EPR results in a starting pressure of 7.0/4.0 (IPAP/EPAP). You will be able to visualize this easier with the Mask Pressure graph. It is blue, and if you zoom in you will see it mirrors your respiratory flow rate graph. EPR is the same as a limited bilevel, so if your CPAP was an Aircurve, we would say you are using a starting pressure of 4.0 and Pressure Support (PS) of 3.0. EPR helps with comfort, and has a therapeutic benefit to reduce flow limitations and even hypopnea.

You are using ramp as well, and I would suggest you simply turn it off. In your results from 7/20, you can see that pressure starts out at 5.0 and gradually rises. At 18:45 ramp ends and your pressure skyrockets in response to the flow limitation that had built up. My guess is that after 5-years, you don't need ramp. Your results are very good, and nearly all of your residual events are obstructive apnea. These mostly occur as your CPAP approaches minimum pressure of 7.0. I think you could reduce the number of events with a minimum pressure of 8.0.

Last suggestion is the hardest. You are five years into this machine and will qualify for a replacement soon. You should get copies of your diagnostic sleep study, any titration study if there is one, and copies of your prescription. You can ask your current primary doctor to request these from the clinics or doctor that cared for you before. Having these records can save you a lot of time, money and hassle when you replace your S9 with an Airsense 10 Autoset. It may take some time, so you want to get this started. If you have a primary doctor you like, ask if he will take over management of your sleep apnea care. Avoid a sleep specialist if at all possible. Check with your insurance about DME (durable medical equipment) coverage and obtain a list of in-network suppliers in your area. It's time to decide who you want to provide your equipment needs next time around.
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.
Post Reply Post Reply
#7
RE: New User - Help interpreting Oscar data
(07-22-2019, 09:55 PM)Crimson Nape Wrote: Here is the excerpt from the Apnea Board Wiki;
"EPR (Expiratory Pressure Relief) is a ResMed brand-specific term for CPAP exhalation pressure relief.
According to the ResMed website: "EPR (expiratory pressure relief) is an effective alternative to continuous positive airway pressure (CPAP) therapy. It features several options that enable you to reliably and predictably control patient therapy while delivering a higher level of patient comfort"."

Its use is based on a setting of Off  (0) to 3.  The values stand for the amount of pressure in cmH2O that will be reduced from the set pressure.  The EPR pressure can not still go below the CPAP minimum of 4 though.   This means in order to have the full use of the value set in the EPR,  will require an initial pressure setting that will equal 4 or greater when the EPR value is subtracted from CPAP's set pressure.  While the EPR works in reverse, it is akin to the PS value in a Bi-Level machine.

An example would be setting the EPR to 3 and the CPAP pressure is set to 10-13cmH2O will result in an expiratory pressure range of 7-10cmH2O.

Thanks Crimson - I should have noted that I did read the Wiki and had trouble understanding the mechanics, which you helped address in this post.  Based on my new settings of Min-8 & Max-15, is the EPR setting appropriate or does it need to be adjusted?
Post Reply Post Reply
#8
RE: New User - Help interpreting Oscar data
(07-22-2019, 09:56 PM)Sleeprider Wrote: Welcome to the forum.  EPR is exhale pressure relief.  You are using it full-time at 3, so during exhale your pressure drops by 3-cm from your CPAP pressure. With 7-12.4 pressure, your EPR results in a starting pressure of 7.0/4.0 (IPAP/EPAP).  You will be able to visualize this easier with the Mask Pressure graph.  It is blue, and if you zoom in you will see it mirrors your respiratory flow rate graph.  EPR is the same as a limited bilevel, so if your CPAP was an Aircurve, we would say you are using a starting pressure of 4.0 and Pressure Support (PS) of 3.0.  EPR helps with comfort, and has a therapeutic benefit to reduce flow limitations and even hypopnea.  

You are using ramp as well, and I would suggest you simply turn it off. In your results from 7/20, you can see that pressure starts out at 5.0 and gradually rises. At 18:45 ramp ends and your pressure skyrockets in response to the flow limitation that had built up.   My guess is that after 5-years, you don't need ramp.   Your results are very good, and nearly all of your residual events are obstructive apnea.   These mostly occur as your CPAP approaches minimum pressure of 7.0.  I think you could reduce the number of events with a minimum pressure of 8.0.

Last suggestion is the hardest.  You are five years into this machine and will qualify for a replacement soon.  You should get copies of your diagnostic sleep study, any titration study if there is one, and copies of your prescription.  You can ask your current primary doctor to request these from the clinics or doctor that cared for you before.  Having these records can save you a lot of time, money and hassle when you replace your S9 with an Airsense 10 Autoset.  It may take some time, so you want to get this started.  If you have a primary doctor you like, ask if he will take over management of your sleep apnea care.  Avoid a sleep specialist if at all possible.  Check with your insurance about DME (durable medical equipment) coverage and obtain a list of in-network suppliers in your area.  It's time to decide who you want to provide your equipment needs next time around.

Thanks Sleeprider!  Good news... I have the initial prescription, initial sleep study + subsequent one, etc!  So I am ready to go - how much longer until I qualify for a new machine?

Thanks for the point on the ramp also - I will adjust this along with the recommendations above to adjust the min/max to 8/15, as well!
Post Reply Post Reply
#9
RE: New User - Help interpreting Oscar data
This might have been mentioned but I'm in a typing mood tonight.  First the EPR will help if you are experiencing Flow Limitations.  The downside is it may cause CO2 washout causing CA's.  These can diminish as you adept.  Second, since OA's usually occur during exhale and you're subtracting pressure from you prescribed pressure, you might experience an increase in OA's or hypopneas.  If so you just raise the desired pressure range until they clear up.  

Bottom line is that you can worry about all this later. I just wanted to make you aware of them.

Good luck!
Crimson Nape
Apnea Board Moderator
www.ApneaBoard.com
___________________________________
Useful Links -or- When All Else Fails:
The Guide to Understanding OSCAR
OSCAR Chart Organization
Attaching Images and Files on Apnea Board
Apnea Helpful Tips

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.
Post Reply Post Reply
#10
RE: New User - Help interpreting Oscar data
Most insurance allows for replacement after 5-years of use. Sometimes they require the machine to be malfunctioning, but that is not very practical since the replacement process can take several weeks to months based on the need to assemble the diagnostic history, prescription and secure insurance authorization. That is why I suggest you identify the DME you want to work with now. Be clear what your want as a replacement machine, and let them start working to put together the authorizations. I would think by January, you will be in your 6th year with the S9, and that may be a good time to execute the replacement, especially if you have significant deductibles or must rent for 3 to 13 months. It's really a decision based on your insurance, and starting now may be best to avoid being in a position where you are trying to replace a machine on an emergency basis. Keeping the old machine as a backup is not a bad idea.

As far as EPR causing CA, that is true for some individuals, but not an apparent problem in your case. You seem to be well-adapted to the therapy, and the small increase in minimum pressure should stop the snores and occasional OA you are experiencing at your current minimum pressure.
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.
Post Reply Post Reply


Possibly Related Threads...
Thread Author Replies Views Last Post
  First night CPAP + OSCAR data Ostrich 1 40 2 hours ago
Last Post: Ostrich
  oscar data sleeper2460 0 57 Yesterday, 09:13 AM
Last Post: sleeper2460
  New user OSCAR data after one week Everlong 2 108 03-26-2024, 09:04 AM
Last Post: Everlong
  Help Interpreting Charts to ID Potential Palatal Prolapse - Deep Sleep Issue reedro287 5 113 03-26-2024, 08:39 AM
Last Post: G. Szabo
  Current OSCAR Data Tylermdugan 0 72 03-26-2024, 07:06 AM
Last Post: Tylermdugan
  Need help with OSCAR data Abhi 5 406 03-26-2024, 05:31 AM
Last Post: BigWing
  First night done, now what? (OSCAR data attached) Stephaniea0213 5 150 03-20-2024, 02:35 PM
Last Post: Sleeprider


New Posts   Today's Posts


About Apnea Board

Apnea Board is an educational web site designed to empower Sleep Apnea patients.