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[Treatment] struggling, help interpreting OSCAR data and possible adjustments?
#1
struggling, help interpreting OSCAR data and possible adjustments?
Hi all, 
First some background. I was diagnosed 22 AHI 26 ODI in 2018. Im a 30 year old man, BMI 18. I tried APAP for a year but ended up struggling to wear it for more than 2-4 hours a night (no adjustments or data checking). I then tried a MAD which gave me headaches so have been back on APAP (resmed airsense 10 autoset) for the last month and have been making a big effort to understand my treatment and data. 

My sleep apnea symptoms have got gradually worse since diagnosis, exhausted, full body aches, chest pains, anxiety (dozens of other things). unfortunately I also got a bad case of COVID last year and am struggling big time with the long haul symptoms (housebound) - increased fatigue, chest pain, tachycardia among others (currently i take 80mg propranolol daily). I am desperate to make the treatment work and get my life back at least somewhat, so I'd really appreciate your guys help.  

I struggle with breathing through my nose so have been using a Quattro Air FFM so far (deafult 4-20cm pressure EPR 2 humidity 4), it took me almost two weeks to be able to fall asleep with it on, and I ended up bumping my minimum to 6 and then recently to 7 to aid with breathing comfort while awake (and enable EPR at minimum Pressure).

When asleep i seem to consistently see an increasing Leak followed by plateau and then eventually a quick drop (coinciding with irregular flow rate). based on reading here, and waking up sometimes with my lower jaw out of the mask it seemed to me my mouth was the issue. I am currently playing around with chin straps to solve this issue and have had some success with leaks (e.g. 12th june profile). Either way I am still back to the pattern of last time, when i would wake up after an hour or a few hours and take the mask off. Sometimes due to dry mouth, sometimes waking up feeling like im not breathing or just general discomfort whether a leak causes it or not doesnt seem to correlate (although obviously leaks need to improve). Sleeping without the APAP i dont wake up at all during the night. I've tried an F20 FFM the last few nights but that seems to generally just leak worse.

I've attached some examples of my "best" nights sleep so far and I'm confused by how disordered and disrupted my sleep seems to be compared to others on here, I am asleep typically after the first 20 minutes of a profile, and have periods of very ordered rounded breaths, and long periods with much larger exhale peaks and very distorted inhale peaks (see attachments). 9th and 12th i am wearing some form of chin strap, 15th i am not.

Sorry for the long post but any help or insight would be greatly appreciated.

here are some additional OSCAR outputs of close up breathing from the night of the 12th June:
The first shows sleep breathing where it looks relatively normal the 2nd is a typical profile (varying severities) from the regions where my exhalations are significantly larger than my inhales.


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#2
RE: struggling, help interpreting OSCAR data and possible adjustments?
here are some close ups on june 12th of the less frequent more normal looking sleep breathing and the more distorted kind - which are consistently observed during these long periods of increased exhale flow (REM sleep?).


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#3
RE: struggling, help interpreting OSCAR data and possible adjustments?
managed to post the same profiles twice... here are the 3 full days of OSCAR output from the 9th 12th and 15th (no chin strap).


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#4
RE: struggling, help interpreting OSCAR data and possible adjustments?
Hi and welcome!

Those leaks are such a pain and I feel you about the chin drop - I've been struggling with it myself and stopping leaks with an FFM is so difficult (especially as I have a particularly small face and head) and getting it snug enough to not spring leaks all the time means overtightening it, which means a pressure sore on the bridge of my nose that I'm currently trying to heal, and/or mask slipping around.

There ARE some FFMs that come with a chin cup to help keep the jaw closed (though I haven't tried one, but they're definitely on my list). I have found that a chinstrap definitely helps prevent my jaw dropping.

What I can see is that it seems like your leaks are worsening as your pressure increases (and then either reduces again as the pressure drops or plateaus if your chin has popped out completely), so your mask might need to be refitted while under full pressure (the mask fit should let you do that, just ignore the happy face). Lie in your sleeping position and gently hold the mask against your face with your fingers, no straps. Turn on the mask fit and find out just using your hand how much pressure you need to keep the mask in place without leaks. Then, when you know that, THAT is the pressure you need to aim for with your straps. Another trick I've found is that sometimes tightening the opposite strap might correct a leak - so if you are leaking at the top left, try snugging up the bottom right a little. And with the F20, make sure it's definitely placed high up enough, it has to sit just underneath your lower lip and with the top peak pretty much between your eyes.

The other trick I have been trying to do is to train myself to fall asleep with my tongue touching the back of my top teeth. This forces the air through my nose and reduces mouth breathing... but I'm struggling to get it to stay there without a chinstrap. LOL

If you absolutely have to breathe through your mouth, I would perhaps play with the humidity a bit more. Turn it up higher, get a heated tube if necessary to help prevent rainout... but I suspect that you'll always have a certain amount of dry mouth when you mouth breathe, with or without CPAP. There are also some xylitol melts that you can use to help your mouth stay healthier, though I personally didn't get on with them (I already have no space in my mouth for all my teeth, let alone anything else).

For what it's worth, I just tried out nasal pillows with a chinstrap and mouth taping and I'm astounded how well it actually worked for me. I don't think it'll replace my usual mask full time because my skin is going to have plenty to say about the tape after a while, but it's definitely enough to give the bridge of my nose a rest. And I would have sworn I could never sleep only with my nose to breathe.


See my comparison of Viatom/Wellue and CMS50F oximeters here.

Not a doctor, definitely not your doctor, all advice is given as-is and represents simply my own understanding as a fellow patient and OSCAR user.
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#5
RE: struggling, help interpreting OSCAR data and possible adjustments?
Thank you so much for the comprehensive reply regarding leaks Ratchick, The leaks do at least some of the time seem to correlate with pressure you are right. I will try your mask fit technique tonight to see if that helps with leaks, I do try and do the machine mask fit each time (seems to peak at 10cmH2O) but it is often while sat upright.

I have tried nasal breathing and tried a nasal mask on my last CPAP attempt but always seem to revert to mouth breathing as it always feels restricted. I'm ok with dry mouth in the morning as long as I can sleep the whole night with the APAP first! As i get better leaks at the moment with the quattro I will keep trying that a few more nights first, its a shame as the F20 is comfier (although the airflow feels a lot less with it on and 2 out of 3 nights i have woke up gasping for air with it on).

If that doesn't help much with getting me to sleep through the night with the APAP then I will think about the humidification next, and maybe a heated tube, I had naively kind of assumed being in the UK that it would be unnecessary given how humid it is here. I have a very crowded mouth and throat too so the melts would definitely be a last resort!

Do you have any opinion on the possible flow limits in my close up shots of my breathing?
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#6
RE: struggling, help interpreting OSCAR data and possible adjustments?
I also forgot to ask - which chin strap do you use?
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#7
RE: struggling, help interpreting OSCAR data and possible adjustments?
Ahh, I thought the same thing re: humidity, as another UK resident, but nope. Tried the first night without it and my LORD it was horrible. LOL Definitely ask your sleep clinic for a heated tube if you need it.

The chinstrap I use is sold by a seller on Amazon called Magik, and it's just labelled pretty generically. If you search for "Snore Stop Belt Anti Snoring Cpap Chin Strap Sleep Apnea Jaw Solution TMJ Blue (Blue)" you should find it, and it looks like this: 

[Image: 511-B-F30ih-L-AC.jpg]

I'm a terrible mouth breather too and needed the combination of taping and a chinstrap to keep from mouth leaks and chipmunk cheeks but it depends what works. Normally I use the F20 Airtouch (memory foam) mask but my nose is sore and needs a break. You may well find this chinstrap interferes with a FFM because it does sit kind of high on the front of the chin. And some people find that a chinstrap can pull the chin back which can worsen obstructive events as a result. 

Definitely try fitting the mask while lying down and then make sure to test it on your sides or front or whatever positions you tend to sleep in. Make sure it's snug in all of those. 

If you feel like you're not getting enough air, you may need to increase your minimum pressure. 6 or 7 is still on the low end, and a good number of people need more than that to feel like they aren't oxygen-starved.

There are a variety of things that can effect the shape of your flow graph. It could be that you're in a certain stage of sleep, it could be that you're partially disturbed by either leaks or changes in pressure, so I think at first it might be good to get those leaks under control so we can figure out what is down to the disturbed sleep, what is down to the affected therapy, and what is actually disordered breathing if that makes sense? I'm sure that some of the others might have other ideas, though, if they spot something I don't (I'm definitely not the champion at chart reading!).


See my comparison of Viatom/Wellue and CMS50F oximeters here.

Not a doctor, definitely not your doctor, all advice is given as-is and represents simply my own understanding as a fellow patient and OSCAR user.
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#8
RE: struggling, help interpreting OSCAR data and possible adjustments?
Thanks! I have a similar Chinstrap (although mine is much less sturdy looking), it is tricky with overlap on the bottom of the FFM, balancing having my mouth open to breath but not too mobile to escape is difficult. I'll go chin strap and Quattro Air this evening (7-20cm, EPR2, humidity 4) with tests on the side and back and report back in a day or two Smile I'll also try and be more aware of what exactly wakes me up/makes me take off the mask.

Thanks again for the advice, it will make an insane difference to my quality of life if I can work this APAP thing out.
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#9
RE: struggling, help interpreting OSCAR data and possible adjustments?
No worries and good luck!


See my comparison of Viatom/Wellue and CMS50F oximeters here.

Not a doctor, definitely not your doctor, all advice is given as-is and represents simply my own understanding as a fellow patient and OSCAR user.
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#10
RE: struggling, help interpreting OSCAR data and possible adjustments?
Welcome to the Apnea Board,

The comment about you feeling like you've not gotten enough air seems to point to your Min. pressure. Maybe try raising it up a bit from 7. You can go to 8, but you can also go up fractional steps. ResMed does 0.2 steps, so raise it a bit and see if it helps. Repeat if needed.
Dave

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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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