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OSCAR and Watchpat Results - Need Help w Treatment
#1
OSCAR and Watchpat Results - Need Help w Treatment
I received my Watchpat results.  AHI = 20 and RDI = 40.  I'm 36, tall and thin.  I've felt so bad for so long but never suspected a SBD.

What I'm really having trouble with is getting the right settings dialed in.  I had an AHI of 9.49 last night while on BiPap.  I have a Philips Dreamstation BiPap.  It's set to BiPap mode.

Any help would be greatly appreciated!


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#2
RE: OSCAR and Watchpat Results - Need Help w Treatment
A couple more closeups.


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#3
RE: OSCAR and Watchpat Results - Need Help w Treatment
I wonder if you have PLMS.

From a WatchPAT Webinar:
Quote:Q4: How does WatchPAT distinguish arousals from PLMs vs those from respiratory events?

A4: The autonomic arousals in the reciprocal pattern (peripheral vasoconstriction and pulse rate acceleration) are different in PLMS than respiratory arousals. On the report and raw data, there will typically be an elevated RDI that is less prominent in REM sleep and also goes away in the last 1/2 of the study.

Your WatchPAT study certainly appears to have fewer events in REM periods as well as in the latter half of the study...

Why did you end up on BiPAP?
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#4
RE: OSCAR and Watchpat Results - Need Help w Treatment
Why are you on BiPAP? Do you have any underlying respiratory issues? Based on your watchpat results I thought UARS as a possibility. With no mention of centrals in your watchpat I assume that it does not look for them.
My immediate concern is the centrals. So I am going to suggest a drastic change to the settings as an experiment. We need to better see what kind of central apneas that you have.

DO NOT DO THIS IS YOU HAVE ANY OTHER RESPIRATORY CONDITIONS!!!

You are running with a ramp set at 4 cmw, turn the ramp off. If you need it we will work it back in.
We are going to reduce your IPAP to 9.5, This will reduce your PS to 1. The higher PS, in YOUR case, maybe driving your centrals, This will either prove or disprove that.



As BiPap is often used to treat other medical, respiratory, conditions it is very important to know if you have any, thus the question on Why are you on a BiPAP?
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#5
RE: OSCAR and Watchpat Results - Need Help w Treatment
I'm pretty sure I do have PLMS.  I didn't know the Watchpat study could reflect that.  Good to know and thanks for sharing.  Reason I suspect PLMS is because when I wear my Wellue O2 ring on my toe, there is a lot of movement (screenshot attached) that looks exactly like PLMS.  I did video myself one night and I couldn't see the movements though so I suspect they're very minor flexes of my toes that can't be seen under the covers.

I'm on BiPap for two reasons.  I initially suspected UARS and I found one used for cheap.  Thought it was worth a try.  Is this stupid lol?

I also had a full polysomnogram done recently and am waiting on the results from that.  It's been weeks.  In the mean time, the sleep dr. put me on .5mg pramipexole with no data to work from other than my legs get a bit restless at night.  He wasn't interested in any data I collected myself.  The minor RLS in no way prevents me from falling asleep though.   The pramipexole did very little.  Movements still recorded, though slightly reduced.  I didn't feel any better.

To be honest, I've just been getting impatient.  Been years feeling like trash every day and I can't wait for some sort of relief.

I don't have any underlying respiratory issues.  My nose get stuffed up at night but that's about it.

I didn't get the Watchpat version that checks for centrals.

I'll try those settings tonight and post the results tomorrow.  Really appreciate the help!


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#6
RE: OSCAR and Watchpat Results - Need Help w Treatment
I wrote a reply last night beginning with "I'm going to go waaaay out on a limb here" but didn't finish it before my bedtime. in a nutshell, I also wonder why bipap and not asv (and why bipap and not apap as is more typical) and I also see possible plm breathing in zooms. given that you're young and thin, experience few obstructive events (although they may be treated out; no way to know without knowing what your test results were), having predominantly central events (although they may be treatment emergent; no way to know without knowing what your test results were) and the flow rate pattern looking like potential plm breathing, frankly I wonder if you need pap at all and the source of your sleep issues is plm. not needing pap may be wishful thinking but IF plm is present, it strikes me as a better than an even proposition that treating it successfully will significantly improve your pap results.
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#7
RE: OSCAR and Watchpat Results - Need Help w Treatment
I didn't even know PLM breathing was a thing.

I don't see anything in the Watchpat literature that says PLM's show in the AHI.  Just says it can affect the RDI.  I would imagine I am experiencing hypopneas, obstructive apneas (I don't snore at all though) and/or centrals (not treatment induced) if my AHI is 20.  

Really sounds like I need more data though.  The PSG should give me a pretty definitive answer.  Been waiting weeks for the results!

I'll try Gideon's settings suggestion tonight and see if the centrals are still there.  Will hopefully shed some light on if the centrals are treatment induced or not.  The centrals are generally quite short btw.  Around 10s.  Although, they do sometimes appear in clusters with very shallow breaths in between.
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#8
RE: OSCAR and Watchpat Results - Need Help w Treatment
Using the O2ring on a toe is a good idea. I might try using my SleepU on my foot and compare with my accelerometer/rotation sensor I wear on my ankle, although a sample every 4 seconds isn't great (compared to 5/second).

I agree with Gideon about switching off ramp and reducing PS, but I would go further and try moving to straight CPAP mode without PS/Flex and reducing the pressure so that it's just high enough to avoid obstructive events.

I suggest you do some research on treatments for RLS/PLMS. Dopamine agonists (such as pramipexole) can work well but have a high risk of augmentation at some point. Other drugs such as pregabalin have their own risks. Have a read of this article on first line treatments for RLS. Have your ferritin levels been checked (you want that >75ug/mL) ?
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#9
RE: OSCAR and Watchpat Results - Need Help w Treatment
I don't know that plm necessarily shows up or doesn't show up in ahi. it can trigger apnea events, however, so reducing plm can have a positive effect on ahi. but I agree it's not as clear an association as plm causing arousals. and I'm probably being too optimistic that treating plm (IF you have it) will make cpap unnecessary (but it will make it easier to optimize your pap settings, and will improve your pap treatment and how you feel).

doctors, even sleep doctors, seem to know little about plm. just as they don't know about soft cervical collars reducing clusters of oa and helping with mouth leaks, I doubt most doctors know enough to recognize the plm in a cpap flow rate pattern. most aren't even very good at prescribing the correct machine and arriving at optimal pressure settings.

it's not certain you have plm without looking further in the flow rate and better if it's confirmed in the psg, by witness reports or video. you can search my username for examples of the plm flow rate pattern to look for in your oscar charts. scroll through at a 10 minute view scale (adjust by slider at bottom of the daily/events tab) looking for uniformly repetitive patterns of inhale spikes roughly 10 to 60 seconds apart. if you have trouble locating an example I'll post another here.
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#10
RE: OSCAR and Watchpat Results - Need Help w Treatment
I've attached the precious night's OSCAR data along with a couple close ups.  Much lower AHI of 1.45 when on cpap with pressure set at 9.5.  Still feel pretty tired with a mild headache today though.  Also found the CPAP to be uncomfortable, although I was able to sleep most of the night with it on.

You can see it looks like PLMS at the beginning of the night.  The movement is coming from my right toe.  Again, probably very mild PLM as I can't see them on video.  likely just flexing toes.  I don't see any correlation between the PLM's and breathing/apneas.

I did have my Iron levels tested recently.  Should have the results back any day now.


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