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[Treatment] Not so newbie OSCAR help request
Not so newbie OSCAR help request
I have been on CPAP for 5 years for mild OSA.  My sleep study AHI 5.2. Given a Dreamstation set at CPAP 5. My sleep and daytime symptoms improved some. Since I slept so poorly in the study(common I know) I suspected I might be 'undertreated'. My AHI was generally 1 or below, but creeping up in the last year. Thanks to recall and DS age, I recently got a Resmed Airsense11 - set at CPAP 4, I suspect as factory defaults. 

Thanks to this website, I started investigating auto options. When set to "Auto for Her" pressure 4-20, I  was wakened by the 'firehose of air' once or twice per night; max recorded pressure was 12 or 12.8 (max 14.42 per OSCAR). Also high leak, dry mouth. Tried chin strap - helped leak, but couldn't tolerate. Reduced pressure to max. 10, helped somewhat. Increased EPR from 1 to 3 - this has been most helpful, saw reduced flow limit, but I still have leaks. Currently using P10 pillows; trying to get an alternative like the F30i from my DME to see if that helps.

At this point, I'm confused as to the best course.  Since the leaks correlate to the increased pressure, should I reduce that more? My AHI at static pressure of 4 (or 5 with DS) seemed comparable to what I'm seeing with the auto, so is it not helping?

I believe  positional apnea(side sleeper tendency to roll on back) may be part of my problem, so I'm playing with different pillows, looking at collars, etc. I want to say the increased pressure has improved my quality of sleep, which is of course most important, but it's hard to tell.

I'm attaching last night's graph, which felt like pretty restful sleep. As my Airsense shipped without a card, I don't have data for the first week or so at static pressure, but AHI ranged 0.1 to 2.2 per MyAir. I can provide other days if helpful, or from my Dreamstation card for comparison.

Note on the Airsense settings: the pressure is set max. 10, not 20 as OSCAR displays.

I'd greatly appreciate any observations or suggestions. Many thanks to all of you who contribute so much information and expertise to this site.

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RE: Not so newbie OSCAR help request
You said "helped somewhat. Increased EPR from 1 to 3 - this has been most helpful, saw reduced flow limit, but I still have leaks."

If your charts are correct your EPR is doing NOTHING.  Let me explain, EPR (exhale pressure relief) can be set to 1,2 or 3.  Yours is set to 3.  Your min is set at 4..

Your exhale pressure is the min (4) - EPR (3) can not happen because the Abslolute lowest pressure the pap machine can go is 4 (so you can not subtract 4-3 it will still be4)

I would suggest you raise the min to 7 that will give EPR enough room to allow EPR 3.
7-3=4 giving you an inhale of 7 and an exhale of 4... 

Your flow limits are high and the resmed raises pressure on the Flow Limits.  EPR is how we treat flow limits.  By making the changes above you should have lower flow limits and your pressures will not go up as much.
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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RE: Not so newbie OSCAR help request
SDcat - You are one of a very few AS11 users using the 'forHer' mode, and it appears I may have made some wrong assumptions about the file information. I'd appreciate it if you would create a zip file of your SD card and upload it to to the OSCAR team. You can use the OSCAR menu: Help->Troubleshooting-> Create zip of CPAP data card Use your username as part of the filename, and then upload it to https://www.dropbox.com/request/REp6AH7LCGyeOcXfOokH and I will correct the problem for the next release.

Thank you
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RE: Not so newbie OSCAR help request
I'm going to second what you've been told, EPR3 really needs a minimum of 7 to show any real effect. Also, starting off at 4 is usually too low for most adults, that's the paediatric level of press ure too.

The answer to leaks isn't usually to reduce pressure, but to fix the leaks.

Have you tried fitting and altering your P10 while the machine is blowing at maximum pressure and in the positions that you sleep, in the meantime? Also, be sure that you're using the right size pillows. I have the P10 and both too large and too small result in leaks for me, but with the right size, I can run at a pressure of 16-20 without any significant (or bothersome) leaks. My impulse at first was to go with a smaller size as it fitted better inside my nostrils... but you need to have them not going TOO far in, otherwise the seal will break.
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RE: Not so newbie OSCAR help request
@staceyburke, Thanks for the feedback, I increased min. pressure to 7,  (max still 10) OSCAR attached.

@pholynyk: I uploaded the zip file, please advise if I need to send anything else. Do you think my charts are accurate, notwithstanding the left-hand 'stats'?

Leaks: I did not waken with dry mouth, but realize at least some of this could be mouth leaks. I did notice @ ~0300 a loud sound/leak that seemed to come from the mask frame, i.e., if I pressed and jiggled the pillows/frame, it dissipated, for a while at least.

Mask: My DME is supposed to send a different mask to trial, I think I'm going to just order on-line OOP.  I will try larger pillows as Ratchick suggests: when I first got the P10 (5years ago) I used XS, at tech's suggestion I moved up to S, I will try the M.  When the leaks wake me, though, it is only rarely that it seems to be coming from the pillows.

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RE: Not so newbie OSCAR help request
Mouth leaks could definitely be part of it (I'm not so great at spotting mouth leaks on a chart but I'm sure someone else will tell you what they'd need to check). If it is, then there are ways and means to ameliorate that.

Personally, I like the P30i if you are going for another pillows mask. It's chunkier and I find it less likely to slip when I move, plus it's a lot quieter because it moves the exhaust to the top of your head rather than right beneath your nose. It's a shame that COVID has put a cosh on the ability to go and test-fit masks in person, I know I would have loved that option.
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RE: Not so newbie OSCAR help request
Thanks for the reply. The mask I have 'on order' is actually the F30i, since it is sort of a minimalist FFM. I like the idea of top routing hose; I actually tried the Dreamwear when I was first dx'd, and had trouble with the P10 pillows. The Dreamwear was very comfortable, but I woke with headaches in the morning. So many options now, I think I'm just going to have to buy a couple and try them.
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RE: Not so newbie OSCAR help request
Yep, a lot of people love the F30/F30i too. I didn't get along with it, personally, but I think I'm in the minority. Hopefully it'll do the trick for you with regards to stopping those leaks and better sleep. Smile
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RE: Not so newbie OSCAR help request
Areas that I'd call mouth leaks, one example would be 00:30-01:00+ area. It's elevated from the prior half hour's low squiggly line leak trace, has a somewhat flattened, rounded bookends look. Other areas that are the spikey jagged stuff is mask leaks.

I have the F30i mask and I don't care for it. The nasal cradle top half needs smashed into my nose to seal. Used during a Titration. Not at all my ideal mask. Once I get a machine again, I'll go back to my Fisher and Paykel Vitera. If your F30i didn't work out, look at F&P masks, high comfort with low strap tension.

Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
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RE: Not so newbie OSCAR help request
Thanks for your input. I think before ordering any mask, I'll try the dreamwear tonight and see what happens, then larger pillows on the P10.

EDIT: Just tried Dreamwear - big leak at pressure 7, couldn't eliminate even with a breatheright strip. No leak with Med P10 pillows, so I'll use that tonight.
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