UARS CPAP setting? Help me interpret OSCAR data

[Dormeo]

Leaks: If you're still taping, I'm puzzled how you could be mouth leaking. In general, the leaks are nothing to worry about, but if they're waking you up, they are a problem. Is the tape loose in places after the first hour or so? What kind of tape are you using?

Flow limitations: They are somewhat better with the EPR of 2. Given that all those centrals occurred while you were awake (common enough; awake breathing is much less regular that breathing during sleep), I'd suggest raising EPR to 3 after another night or two at 2.

More information: It would be useful if you would zoom in on three places, zooming in to about one minute. (a) An area with flow limitation flags; (b) an area without flow limitation tags; and © an area that has one of those heart-rate spikes, with the spike somewhat to the right so we can see what happened before it.

[throwaway0815]

Thanks Dormeo!

What kind of tape are you using?

I'm using 3M Micropore Paper Tape - White, 1" x 10yds, which I got from Amazon.

It keeps my mouth closed, but I can still breathe out against it, especially when the pressure builds in my mouth due to a leak.

I'd suggest raising EPR to 3 after another night or two at 2.

Will do that.

More information: It would be useful if you would zoom in on three places, zooming in to about one minute. (a) An area with flow limitation flags; (b) an area without flow limitation tags; and © an area that has one of those heart-rate spikes, with the spike somewhat to the right so we can see what happened before it.

1. No flow limits:


2. Flow limits:


3. HR spike 1:



4. HR spike 2:



5. HR spike 3:

[jaswilliams]

Both the HR spikes look like Arousals to me the flow form goes all over the place (typical wake breathing) then possibly a roll over whilst holding your breath the CA and then back to sleep.

[Dormeo]

The flow rates with no FL flags look pretty good, although perhaps slightly flat on top. The flow rates with flags are clearly flow-limited. You will find that the flags don't always appear exactly where the limited breaths occurred; sometimes they are a little bit later.

In general, you are looking for breaths with nice, smoothly rounded tops on the inhalations (the positive flow rate traces). Flow limitations can show up in several ways: plateaus, dents, single peaks, or very small inhalation rates compared with your normal.

It'll be a little easier for you to see what's going on if you change the y-axis for the flow-rate graph. You might try -50 to +50. You can also add a dotted line at 0. To make these changes, right-click on the left side of the graph where the "Flow Rate" label appears.

It might be worth your while to check zoomed-in segments of non-FL and FL flow rates, just to get a feel for what's going on.

About tape: it sounds as though your current taping isn't quite doing the job. You might try using overlapping strips of the micropore tape to see if that helps. Another option is to invest in a box of Somnifix strips to see whether they work for you.

[throwaway0815]

Both the HR spikes look like Arousals to me the flow form goes all over the place (typical wake breathing) then possibly a roll over whilst holding your breath the CA and then back to sleep.

So do we know if this arousal is a RERA (caused by some flow issue) or something else?

About tape: it sounds as though your current taping isn't quite doing the job. You might try using overlapping strips of the micropore tape to see if that helps. Another option is to invest in a box of Somnifix strips to see whether they work for you.

I tried Somnifix before, but the 3M tape seems to be working better. The Somnifix tape has a little hole in the middle that would also let the air through.

I also noticed that I tried to keep my tongue on the roof of the mouth to enforce nose breathing, but my tongue frequently comes down and then my mouth fills with air which eventually escapes. I'm thinking about trying out a full face mask.

[Dormeo]

Are the arousals related to respiratory effort or are they spontaneous? -- That's the million dollar question, and without polysomnographic study, you probably won't get a definitive answer. The best you can do is address the conditions that can cause respiratory effort, e.g., FLs, and the conditions that can make spontaneous arousal more likely. Those might include e.g. noise, light, pain, high temperature.

I'm curious: I can't breathe through the little slot in the Somnifix strips. Were you pursing your lips before sticking the strips on?

At any rate, do try overlapping several micropore strips to see whether that helps.

[throwaway0815]

I'm curious: I can't breathe through the little slot in the Somnifix strips. Were you pursing your lips before sticking the strips on?

Yeah, I can breathe through them. It doesn't happen normally, but it works when my body really wants to breathe. (nasal congestion?)


Anyways, here's one night with using double the usual tape.

At one point I woke up because of something, disconnected the mask to start breathing through my mouth and then realized it was all taped up. Not sure what was going on there. Maybe acid reflux? (I added a zoom in of that event, and also added the pulse and SpO2 data from my Contec CMS50F)

I also noticed that my mouth is very dry in the morning.  





Zoom in:



I'm starting to think that the nasal mask might not be for me.

[Dormeo]

Yes, I agree that it might be time to try a full-face mask. Take a look at pictures of them and give some thought to what you might adapt to best. Supplier #1 (see list at the top of the page) has a very nice return policy for FFMs that don't work out. Do be sure to change the setting on your machine for mask type if you start with a FFM.

Your O2 levels look good; some of the downward spikes might be brief losses of contact for the device.

Hard to know what caused the arousal before you took the mask off. There were some flow-limited breaths that preceded it, but they aren't by any means your worst of the night.

FLs are still profuse. If you're feeling adventuresome, you could try raising your EPR to 3 to see whether that knocks them down some. Be on the lookout for increases in CAs.

[throwaway0815]

I went to my supplier today and they gave me the Dreamwear full face mask (they said they have very limited supplies and don't do fittings because of COVID). At least it was free.

I was also told to never enter the clinical menu of my CPAP machine (could void insurance coverage) and to never use mouth tape (quote "people have died doing that"). Well too late for that

[Dormeo]

You could not possibly void your coverage by entering the clinical menu. That’s completely false! Your supplier could get in trouble making changes in that menu without a doctor’s order, but that’s a different matter.

Best of luck with the new mask. Let us know how it goes.