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Opportunities for improvement?
#1
Opportunities for improvement?
Hello all,

I was diagnosed w/ OSA 5 years ago and have been using a CPAP since then. I was hoping I'd post some of my OSCAR data and solicit feedback for a better sleeping experience.

This is the first time I've seen my sleep data from my machine as my CPAP supply company only looks at AHI basically and has told me that as long as I'm under 5 I'm good. Recently I've had my AHI go as high as 9 but average around 3. Is the mask leakage I'm seeing in the data something to be concerned about? Can a CPAP get me down to 0 events per night with the right configuration? I would appreciate any and all feedback and look forward to learning more about my sleep data.

Thanks!

   
   
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#2
RE: Opportunities for improvement?
On ResMed the pressure raises when you have flow limits (take a look at your flow limits chart). To help with flow limits we use EPR (exhale pressure relief), the pressure is set for 1, 2 or 3. 

I would try settings
Min 7
EPR 3 FULL TIME ( yours is set to ramp only)
Leave the max where it is. 

Give it a night and see how you feel. It is not the AHI that is as important as how you feel.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#3
RE: Opportunities for improvement?
(04-01-2022, 01:29 PM)staceyburke Wrote: On ResMed the pressure raises when you have flow limits (take a look at your flow limits chart). To help with flow limits we use EPR (exhale pressure relief), the pressure is set for 1, 2 or 3. 

I would try settings
Min 7
EPR 3 FULL TIME ( yours is set to ramp only)
Leave the max where it is. 

Give it a night and see how you feel. It is not the AHI that is as important as how you feel.

Thanks for the quick response. I've made the changes and will report back - aside from feel are there any data points I can look at in the OSCAR data to indicate success criteria?

Any comments on the lack of obstructive apnea but prevalence of hypopnea & central apnea? (or am I reading it wrong?)
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#4
RE: Opportunities for improvement?
While it's likely for new PAP patients to develop treatment emergent Central Apnea, yours may be idiopathic. Five years from diagnosis of Apnea, this sounds like you've also had five years of PAP therapy too. This scenario you're dealing with is a great reason for every person that takes the diagnosic and Titration sleep studies make the request to get their own copy of the detailed reports. Maybe it would show you actually need CA therapy which is on a specialized PAP called ASV. Again this is just a maybe without evidence.

The best you can do with this PAP is work to avoid CA. This means balancing the therapy teeter-totter between Obstructive on one side and Centrals on the opposite. Those sides do require opposing actions.

To avoid CA, you need to avoid Ramp, have enough pressure to address Obstructive but with minimal pressure Auto adjustments, and probably limiting EPR. But some to all those actions may hinder Obstructive based Apnea and Hypopnea events, and flow limits, therapy effectiveness.

And no we're not trying to get zero events, just low enough to be able to gain restful sleep. For most that's less than AHI 5, maybe about 3 or so.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#5
RE: Opportunities for improvement?
I tried your recommended settings and overall felt better the next morning. I had trouble adjusting to EPR3 though because it felt like I couldn't get enough oxygen but it could just be something I need to acclimate to. Would you recommend trying EPR 2 or 1?

I think when I read my Resmed SD card on my Mac I disabled my machine from reading it so hoping to get some good data on the changes soon as it's not communicating with My Air at the moment.

Has anyone approached ENT / Sleep Doctor about an ASV system if the Central Apneas are persistent? Can an ASV cure both OA and CA?

Thanks again!
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#6
RE: Opportunities for improvement?
Post your data so we can see the effect of the changes made.

Note: MyAir transmission has nothing to do with your SD card. The Cpap should still write the data to the SD card regardless if MyAir is working or not.
OpalRose
Apnea Board Administrator
http://www.ApneaBoard.com

_______________________
OSCAR Chart Organization
OSCAR - The Guide
Soft Cervical Collar
Optimizing therapy





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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#7
RE: Opportunities for improvement?
(04-04-2022, 09:57 AM)OpalRose Wrote: Post your data so we can see the effect of the changes made.

Note:  MyAir transmission has nothing to do with your SD card.  The Cpap should still write the data to the SD card regardless if MyAir is working or not.

Thanks for the tip - I've attached this weekend's data to this post. Friday I slept until early morning until my partner got up to run then went back to sleep. After waking up the second time I felt like a million bucks despite the high AHI. I was immediately awake and in a great mood.

Note: My partner was a little restless last night so I'll be eager to see tonight's data & tomorrow night's data - will be sure to post as well.


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#8
RE: Opportunities for improvement?
At least on these charts, I'm seeing the consistently inconsistent component to the CA. This means the CA component is variably up then down per night, swinging between trainwreck bad to not as bad. OK I think your best bet due to CA is turn back EPR. You could try EPR 2 and see if it helps.

Lowering EPR may need repeated to see where your best balance between Obstructive and Central based events in relation to comfort and rest is found. If it cannot be found, then with persistent CA your best bet is ResMed 10 ASV or the older ResMed 9 VPAP Adapt. I think you should try the lower EPR before you run off to get ASV though.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#9
RE: Opportunities for improvement?
It looks like it is going to be a balancing between higher EPR - giving you less flow limits and less H events and getting more central on this model Cpap. 

It is really which one makes you feel better. We tried EPR 3, you can try 2 and 1, to see which is best for you.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#10
RE: Opportunities for improvement?
I tried EPR on 1 and still felt like I couldn't breathe enough - is it a setting that takes some getting used to? Basically, when on EPR since it feels like I'm not getting enough oxygen I stay awake and cannot fall asleep as I try to get used to it. Here's my data from last night.


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