[Treatment] Advice on OSCAR report

[airoutlaw]

Hi all,

Attached are 2x snapshots from my oscar report. I am wondering if any changes are recommended. The machine says I have a good AHI, however I feel tired most days.

I get a couple of centrals, but nothing major. I just picked a typical night here:







I have also tried BiLevel, but found the pressure differences caused a LOT of centrals which made me feel worse. Wondering if I can/should tweak any of the basic CPAP settings to try and help me feel more reseted?


Thanks for any suggestions!

[SarcasticDave94]

Can you show us a Daily that's not zoomed for context sake? This would give us an overall night's view. And verify settings as well.

[Sleeprider]

You are using a fixed pressure of 15.0 with no EPR. It appears you might tolerate lower pressure without significantly increasing events. What pressure alternatives have you tried in the past, and how did they affect your therapy? For example, have you tried using low PS of 1 or 2 or have you tried lower pressure? When you tried bilevel pressure, what pressures were used?

[airoutlaw]

Yep, here is a zoomed out view:




I have tried CPAP mode in other settings, I started off with 12cm which also resulted in low reported AHIs, but I noticed a few more "flow limitation" events so gradually increased it to 15 where it generally seems good -- although looking at this graph there are still some spikes in flow limitation. Here's a zoom in on a cluster of flow limitations:



On BiLevel mode I tried various settings and pressures. Typical was EPAP 6cm with 8cm of support. But it would give me AHIs of around 30+ because it triggered centrals.

I dont know whether to try that again and maybe play with the settings some more.

I have also tried CPAP with EPR -- again the more pressure support I dial in here, the more centrals I get

[SarcasticDave94]

I can't say what numbers would be good, but the ones when using a Bi-Level of 6 with 8 PS would need some editing to be within a reasonably good range. I'd think you'd need to add something to that 6 and also take some PS off. Especially so, if as it sounds, the CA event rate was going up.

[airoutlaw]

Yeah I might get BiLevel another try and use a smaller pressure range like you suggest. I feel like I probably have UARS which I hear is helped by using BiLevel.

I also read that tweaking the Trigger and Cycle settings might help me. I think I may need a more sensitive trigger so that the machine supplies a breath easier -- thinking this may result in less centrals?

[airoutlaw]

Graphs from last time I tried BiLevel:

[sheepless]

oof. that's brutal. much worse than fixed cpap mode at 16 cmw. what was wrong with ahi of 0.56? even an asv won't do better than that. if you're still feeling bad, it isn't likely from apnea.

[airoutlaw]

Yeaah, fixed CPAP I certainly seem to do better on. The doc said he has seen some people who do not tolerate pressure differentials and that it can trigger the centrals.

Problem is, even on fixed CPAP I'm still feeling tired most days. Drs done all kinds of test and cannot find anything else wrong.

At a loss of what to do. I don't wanna feel like this forever

[sheepless]

yes, believe me, I hear you. if your 0.56 ahi is typical rather than a one-off, apnea may not be your ongoing issue. lots of things can disrupt sleep. it looks like those inspiratory spikes are 4-6 minutes apart so initially I chose not to mention periodic limb movement, but I don't know that movements can't come at longer intervals than I typically have. maybe something to look into. try scrolling through your flow rate at a 10 minute view scale. we might see some lesser spikes at closer intervals. other than that, all I can suggest based on what you've provided so far is to concentrate on sleep hygiene. how long have you been papping? what did your sleep test (in the details, not the summary) report about central apnea and periodic limb movement (and arousals in general)?