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

RERA? First time using Oscar Data
#11
RE: RERA? First time using Oscar Data
Sorry for the constant updates. I had a good night last night but did take a zopiclone to help me drift off.

I slept without my MAD and with the settings up to 8. Interestingly, I tried a soft cervical collar after waking up around 6 (I didn't go to sleep with it because it's all new to me and I'm trying to ease the changes) and my events were very low following, although I was awake a little while and it's unlikely I go into very deep sleep.

I did have some issues with vibratory snores and flow limitations. The first snores (on the first image) stopped me falling to sleep, but by the second cluster I was asleep - the second cluster had a lot of snores/flow limitations and a RERA clustered however, so thought was worth highlighting as a potential area of concern? Would you recommend any adjustments to pressure or the Flex setting (currently at 2)?

   

   

   

Sorry for all the queries - just want to make sure I get this right! As always, greatly appreciate any support!

Kind regards, 
Stuart
Post Reply Post Reply






Donate to Apnea Board  
#12
RE: RERA? First time using Oscar Data
I don't think Flex will be helpful in dealing with the flow limitations, RERA or snoring. It just doesn't act like bilevel pressure like the Resmed EPR, and as you can see, as flow limitation increases the Flex offers less pressure relief. That is almost the opposite of what we wold like to see. The flex algorithm is designed to provide pressure relief proportional to respiratory flow, so this is in fact the intended behavior, and it has been that way since Flex was used in Respironics machines 20 years ago. Try alternate settings and see what feels best to you. I found Flex at 1 or 2 worked best for me, and that Flex at 3 caused more problems. YMMV.

The trend of efficacy has improved with higher minimum pressure, and I think continuing to titrate pressure upward in 0.5 cm increments will lead you to the optimum treatment. Once you reach the point of diminishing returns in terms of comfort and efficacy, that is where we back down to the best 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
#13
RE: RERA? First time using Oscar Data
(05-07-2020, 07:20 AM)Sleeprider Wrote: I don't think Flex will be helpful in dealing with the flow limitations, RERA or snoring. It just doesn't act like bilevel pressure like the Resmed EPR, and as you can see, as flow limitation increases the Flex offers less pressure relief.  That is almost the opposite of what we wold like to see.  The flex algorithm is designed to provide pressure relief proportional to respiratory flow, so this is in fact the intended behavior, and it has been that way since Flex was used in Respironics machines 20 years ago.  Try alternate settings and see what feels best to you. I found Flex at 1 or 2 worked best for me, and that Flex at 3 caused more problems. YMMV.

The trend of efficacy has improved with higher minimum pressure, and I think continuing to titrate pressure upward in 0.5 cm increments will lead you to the optimum treatment. Once you reach the point of diminishing returns in terms of comfort and efficacy, that is where we back down to the best pressure.

Thank you! I'll keep Flex at 2 and titrate up to 8.5 and see how it goes tonight!
Post Reply Post Reply
#14
RE: RERA? First time using Oscar Data
Sorry to keep pestering but had a really tough night last night. I didn't use any zopiclone or mirtazapine and the had constant wake-ups with sharp breath intakes just as I'm falling asleep (beginning to think these are like sleep onset apneas).

I've also notice my inspiration time is a lot higher than my expiration time on average (2.34 to 1.7), suggesting I'm hypoventilating?

I did a couple of breath holds after these incidences to highlight them when I looked back, so this is why there are a few random pauses in breathing, but was curious as to what might be causing these random spikes as I start to drift off:
   
   
   


I use the 8.5 pressure last night, with  a humidifier for the first time and Flex of 2. I started without my MAD but put this in mid-way through the night and still had these issues. 

As always, any help would be hugely appreciated!

Kind regards, 
DTBetter
Post Reply Post Reply






Donate to Apnea Board  
#15
RE: RERA? First time using Oscar Data
When posting charts, please be sure to provide one of the whloe night. I don't see anything unusual in thee zoomed images that consist of normal, steady sleep breathing ending in arousal. Not all arousal is RERA and in this case, I don't see flow limitation or other issues that would result in a respiratory effort related arousal, you just arouse. This may not be related to the CPAP therapy, but arise from external issues that were present before therapy. There is not a significant difference in therapy with and without MAD, and I think you can safely leave that out of the mix. Based on the very clear charts, low event rates, lack of snores, this therapy looks excellent. I don't see any pressure changes during the periods you focused on, however, it is possible that you are sensitive to slight pressure changes, in which case you can try CPAP mode to force a fixed pressure. This often works well for people with unexplained arousal.

Your breathing rate, and inspiratory time are all normal. OSCAR reports inspiration and expiration time, but the Philips machines are notoriously inaccurate for I:E time and ratio, so it's best to simply ignore that metric. I think a future version may improve on this.
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
#16
RE: RERA? First time using Oscar Data
(05-08-2020, 08:16 AM)Sleeprider Wrote: When posting charts, please be sure to provide one of the whloe night. I don't see anything unusual in thee zoomed images that consist of normal, steady sleep breathing ending in arousal.  Not all arousal is RERA and in this case, I don't see flow limitation or other issues that would result in a respiratory effort related arousal, you just arouse.  This may not be related to the CPAP therapy, but arise from external issues that were present before therapy.  There is not a significant difference in therapy with and without MAD, and I think you can safely leave that out of the mix.  Based on the very clear charts, low event rates, lack of snores, this therapy looks excellent. I don't see any pressure changes during the periods you focused on, however, it is possible that you are sensitive to slight pressure changes, in which case you can try CPAP mode to force a fixed pressure. This often works well for people with unexplained arousal.

Your breathing rate, and inspiratory time are all normal. OSCAR reports inspiration and expiration time, but the Philips machines are notoriously inaccurate for I:E time and ratio, so it's best to simply ignore that metric.  I think a future version may improve on this.

As always, I really appreciate you taking the time to respond.  

I guess it's a relief to know nothing's wrong with the therapy! Sorry to always ask questions, but just to clarify: you don't think there's anything wrong here like a sleep onset apnea, hypopnea or RERA or anything of that sort? I was in a bit of a panic this morning (partly driven by sleep deprivation I guess) worrying this was something central and could mean I need alternative treatment (BIPAP, ACV)

I've attached the whole night overview below and the other stats that aren't visible, but it doesn't seem like there were any huge pressure changes bar one spike around 2:30: 
   
   
 
I know it's not really within the scope of the responses you usually give and I know you've already helped massively, but do you mind me asking, in your experience, do you ever see people having issues with taking to CPAP/APAP and their body almost fighting it or having an anxiety? I don't have a conscious anxiety of it, but I guess it's possible my subconscious doesn't like the sensation of the APAP blowing into it. 

As always, thank you again for your support. 

Kind regards,
Post Reply Post Reply
#17
RE: RERA? First time using Oscar Data
I think the major things that work against good sleep is the fragmentation of your night into 6-sessions, less than 7-hours of bed rest and judging from some of your concerns (reading between the lines here) anxiety. Time will take care of any sense of your subconscious not liking CPAP/APAP. Finding a way to get the time and consistency needed for good sleep comes under the sleep hygiene category and good health maintenance, not therapy. In these unusual times I think it can be challenging to deal with anxiety, get the exercise you need and feel normally distracted as opposed to turning inward. As your bartender, I recommend relaxing more and worrying less. Smile

I still think you should give fixed pressure a try, whether you do it n APAP mode with equal minimum and maximum pressure or in CPAP mode. I have mentioned the Resmed machine is more comfortable, but your results certainly don't require that change, and I think a lot of users would be very happy with what you have accomplished.
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






Donate to Apnea Board  
#18
RE: RERA? First time using Oscar Data
(05-08-2020, 09:59 AM)Sleeprider Wrote: I think the major things that work against good sleep is the fragmentation of your night into 6-sessions, less than 7-hours of bed rest and judging from some of your concerns (reading between the lines here) anxiety. Time will take care of any sense of your subconscious not liking CPAP/APAP. Finding a way to get the time and consistency needed for good sleep comes under the sleep hygiene category and good health maintenance, not therapy.  In these unusual times I think it can be challenging to deal with anxiety, get the exercise you need and feel normally distracted as opposed to turning inward.  As your bartender, I recommend relaxing more and worrying less. Smile

I still think you should give fixed pressure a try, whether you do it n APAP mode with equal minimum and maximum pressure or in CPAP mode.  I have mentioned the Resmed machine is more comfortable, but your results certainly don't require that change, and I think a lot of users would be very happy with what you have accomplished.

Thabk you! I will try and stay calm and hope my body adapts to it!

If you don't mind me asking, wgat fixed pressure would you recommend I try? Sticking to the current minimum of 8.5?

Kind regards 
DTBetter
Post Reply Post Reply
#19
RE: RERA? First time using Oscar Data
It's looking like your best therapy is in the range of 8.5 to 10.0. As long as you're comfortable, anythng in that range is going to be effective in stopping most events. If you're looking for a single answer, then 9.0 should be good.
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
#20
RE: RERA? First time using Oscar Data
(05-08-2020, 12:27 PM)Sleeprider Wrote: It's looking like your best therapy is in the range of 8.5 to 10.0.  As long as you're comfortable, anythng in that range is going to be effective in stopping most events.  If you're looking for a single answer, then 9.0 should be good.

Thank you!

A random other thought, and sorry to keep pestering you, but do you think it's possible my symptoms may be related to UARS (low AHI readings but hypervigilance and arousals?)

Thanks again - really can't thank you enough for your advice!
Post Reply Post Reply






Donate to Apnea Board  


Possibly Related Threads...
Thread Author Replies Views Last Post
  Please help me to understand OSCAR data DotLove 92 1,781 10-21-2020, 02:04 PM
Last Post: SarcasticDave94
  Oscar Data Help LEEMH 7 158 10-21-2020, 10:53 AM
Last Post: LEEMH
  number of time i stop breathing kerm007 6 142 10-17-2020, 11:39 PM
Last Post: Jeff8356
Question First time poster, long time CPAP user with an OSCAR report. Afasterme 8 201 10-13-2020, 09:29 PM
Last Post: Afasterme
Arrow AHI < 1.0 now, but still tired? Is it UARS, RERA, arousals or FL in your FR peaks? 2SleepBetta 1 222 09-28-2020, 11:06 AM
Last Post: sheepless
  Help understanding Oscar Data tonyt64 5 184 09-27-2020, 07:17 PM
Last Post: bonjour
  OSCAR Data Review bukinnutz 6 231 09-25-2020, 03:24 PM
Last Post: Cpapian


New Posts   Today's Posts






About Apnea Board

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