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

OSCAR data review - Low AHI Still tired
#1
OSCAR data review - Low AHI Still tired
Hi All,

I'm hoping someone could take a look at my OSCAR data to see if they can see anything that may still be causing my excessive daytime fatigue? My initial numbers look good and the hospital are washing their hands with me stating that my OSA is treated based on what they can see however i do not feel this way and often still need to nap and no longer have the energy to do anything at all despite using my CPAP for the entirety of my sleep time, i have had no issues adjusting to CPAP use and took to it right away. 

I am 5 foot 11, 106kg and had an untreated AHI of 34 consisting almost entirely of hypoapneas according to the polysomnography sleep test i had.

Happy to answer whatever questions you may have.
Thank you


Attached Files Thumbnail(s)
   
Post Reply Post Reply






Donate to Apnea Board  
#2
RE: OSCAR data review - Low AHI Still tired
I see lots of flow limitation. If there are no problems tolerating a higher pressure you could try either lowering EPR or raising your pressure by 1.
Sleepster
Apnea Board Moderator
www.ApneaBoard.com


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
#3
RE: OSCAR data review - Low AHI Still tired
(08-23-2019, 05:58 PM)Sleepster Wrote: I see lots of flow limitation. If there are no problems tolerating a higher pressure you could try either lowering EPR or raising your pressure by 1.

Thank you for the quick reply, im not sure what EPR is could you explain or provide me with a link? Also i can raise my pressure, which one of the two would be best? Also could you advise what flow limitation actually is.

Thanks
Post Reply Post Reply
#4
RE: OSCAR data review - Low AHI Still tired
See http://www.apneaboard.com/wiki/index.php...limitation

And
http://www.apneaboard.com/wiki/index.php..._and_BiPAP
Post Reply Post Reply






Donate to Apnea Board  
#5
RE: OSCAR data review - Low AHI Still tired
Thank you, i have just read those myself i also found a resmed video on youtube called Understanding SDB - Flow Limitation (cant link it due to being a new member)

Although i feel like i now know what a flow limitation is, to me it appears to be exactly the same as what a hypoapnea is? Or am i missing something.
Post Reply Post Reply
#6
RE: OSCAR data review - Low AHI Still tired
On a simple level yes, Flow Limit is very similar to hypopnea but smaller.

To a degree, EPR is currently acting as a mini BiLevel that is limited to 3 cmw of PS/Pressure Support.  This is therapeutically helping you so you need to bump pressure up a little and see what happens to your snores and Flow Limitations.  Pressure Support, you are effectively using PS = 3, is used to treat Hypopneas, Flow Limitations, RERAs, and snores.

This is both exploratory and optional since your numbers are excellent.  Daytime fatigue can take a  long time to see relief.  How many years have you had untreated Sleep Apnea?  The effects of sleep deprivation are not going away overnight.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Attaching Charts

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: OSCAR data review - Low AHI Still tired
(08-23-2019, 06:16 PM)cwbolton Wrote: Thank you, i have just read those myself i also found a resmed video on youtube called Understanding SDB - Flow Limitation (cant link it due to being a new member)

Although i feel like i now know what a flow limitation is, to me it appears to be exactly the same as what a hypoapnea is? Or am i missing something.

What is important to understand is that SDB (sleep disordered breathing) have two main bad consequences on your body  :
- Desaturates your blood O2 level
- Wake you up

Fundamentally, apneas and hypopneas are events that desaturates your blood (and also wake you up).

RERAs are all the other breathing events that do not have a significant impact on your O2 level but that are stilll waking you up.

Typically, most doctors only care about the first consequence. I don't know why, probably because it's pretty obvious that lacking O2 is dangerous to your body and it's easy to measure. So they'll fix the apneas and hypopneas and call it a day. And hopefully you feel better and not tired anymore. That's why they are always focusing on keeping your AHI under 5.

But even though, your AHI is under 5,  you may still be experiencing a significant amount of RERA, which means you are still waking up a lot. It can have a big impact on how tired you feel. That's why it's important to get ride of these remaining events and that's why some people still feel tired even though their daily AHI is always under 2.

Adding some kind of pressure support is usually the way you deal with the remaining flow limitations.
Post Reply Post Reply






Donate to Apnea Board  
#8
RE: OSCAR data review - Low AHI Still tired
(08-23-2019, 06:31 PM)bonjour Wrote: On a simple level yes, Flow Limit is very similar to hypopnea but smaller.

To a degree, EPR is currently acting as a mini BiLevel that is limited to 3 cmw of PS/Pressure Support.  This is therapeutically helping you so you need to bump pressure up a little and see what happens to your snores and Flow Limitations.  Pressure Support, you are effectively using PS = 3, is used to treat Hypopneas, Flow Limitations, RERAs, and snores.

This is both exploratory and optional since your numbers are excellent.  Daytime fatigue can take a  long time to see relief.  How many years have you had untreated Sleep Apnea?  The effects of sleep deprivation are not going away overnight.

I see, i've had this CPAP for around 8 weeks now and before this i used a Chinese CPAP called BMC GII for around 6 weeks no overall not too long, i set up the BMC CPAP myself with a constant pressure of 13 and it did not have any EPR settings so it was a constant 13 no matter what, looking back and comparing the 2 i can see that whilst using the Chinese CPAP my energy levels were much higher and closer to what id consider that of a normal person. So everything said here plus the data does sort of make sense and correlate to how ive been feeling.

Its worth nothing that despite the terrible mask fit of the Chinese CPAP i cant honestly say i struggled or that it was uncomfortable, i really do not struggle sleeping with the ResMed as the F20 mask fits beautifully and the pressures and sensations also cause no issues so anything like EPR i do not think i'd struggle without as i do not need the added comfortability options, so if you think removing that would help let me know, would you just suggesting increasing the pressure by 1 for now and leaving EPR then reviewing data?

I have had an untreated apnea i assume all my life, im 26 now but im guessing its gotten worse in the last 6 years due to weight gain and that is when my energy levels had a noticeable impact on my life/work etc, in total ive only had CPAP treatment for 3 and a half months, with you saying daytime fatigue can take a long time to see relief, how long realistically does it take for one to feel better, when i had the chinese CPAP it was a light switch and instantly felt better, when i switched to the resmed with different settings the fatigue started to get worse and has continued to do so.

Thanks
Post Reply Post Reply
#9
RE: OSCAR data review - Low AHI Still tired
(08-23-2019, 06:44 PM)alexp Wrote: What is important to understand is that SDB (sleep disordered breathing) have two main bad consequences on your body  :
- Desaturates your blood O2 level
- Wake you up

Fundamentally, apneas and hypopneas are events that desaturates your blood (and also wake you up).

RERAs are all the other breathing events that do not have a significant impact on your O2 level but that are stilll waking you up.

Typically, most doctors only care about the first consequence. I don't know why, probably because it's pretty obvious that lacking O2 is dangerous to your body and it's easy to measure. So they'll fix the apneas and hypopneas and call it a day. And hopefully you feel better and not tired anymore. That's why they are always focusing on keeping your AHI under 5.

But even though, your AHI is under 5,  you may still be experiencing a significant amount of RERA, which means you are still waking up a lot. It can have a big impact on how tired you feel. That's why it's important to get ride of these remaining events and that's why some people still feel tired even though their daily AHI is always under 2.

Adding some kind of pressure support is usually the way you deal with the remaining flow limitations.

One thing to note is the initial test i had was the oximetry but they found no real oxygen desturation throughout the night, i think they said they look for a 6% drop to be a candidate for CPAP but they did not see that with myself, they only saw pulse rate irregularities hence the need for a polysomnography which is what confirmed the diagnosis, the doctor did comment on how my oxygen saturation levels hardly dropped during sleep, not sure if you need to know that? 

RERA's would show up in OSCAR though wouldnt they, or is a flow limitation an example of a RERA? 
I dont understand your last line, when you say pressure support, is this EPR? 

Thanks again im doing my best to learn, i thought i knew a fair bit until i looked into OSCAR!
Post Reply Post Reply
#10
RE: OSCAR data review - Low AHI Still tired
I see, prima facie, that your flow limitations are highly co-incident with leakages that were recorded and with snoring.  There may be no correlation at all, but I wouldn't bet on it.
Serial Tapist
Post Reply Post Reply






Donate to Apnea Board  


Possibly Related Threads...
Thread Author Replies Views Last Post
  Sanity check on next steps (still tired) TSomm 63 1,641 10-14-2020, 10:38 AM
Last Post: TSomm
  Please help me to understand OSCAR data DotLove 90 1,675 10-13-2020, 08:48 PM
Last Post: DaveL
  Data Review Appreciate! youbetcha 13 371 10-06-2020, 02:34 PM
Last Post: becker44a
  Please help with treatment review DaveL 294 7,657 10-01-2020, 08:36 PM
Last Post: DaveL
Arrow AHI < 1.0 now, but still tired? Is it UARS, RERA, arousals or FL in your FR peaks? 2SleepBetta 1 211 09-28-2020, 11:06 AM
Last Post: sheepless
  Help understanding Oscar Data tonyt64 5 179 09-27-2020, 07:17 PM
Last Post: bonjour
  [CPAP] New to APNEA, struggling to get full nights sleeps, appreciate review and advice. new2paphopeful 5 202 09-26-2020, 06:33 PM
Last Post: OpalRose


New Posts   Today's Posts






About Apnea Board

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