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

Woofer777 - OSCAR Analysis
#11
RE: First Post, requesting Oscar review assistance
Gideon - Thank you for the detailed explanation on the CO2 induced breathing.  Apparently the centrals showing up, on my charts,  are not the typical pattern.  Not sure if this should be a separate thread question, but does the fact that I have in-line oxygen (setting 2) introduce more variables making it more challenging to arrive at a solution to improve my numbers?  And, early on I tried a night without the oxygen attached, using a O2 ring monitor, and my O2 during the night went below acceptable levels several times.  Is it realistic to believe, that once its determined why my numbers are so erratic and if overall numbers ever become normal, that I would be able to eliminate the need for the in-line oxygen? 

Geer1 -  I appreciate your feedback. Based on your comments, I checked my soft cervical collar for fitness.  After measuring again, it would appear it needs to be an additional 1" wide based on the manufactures recommendation.  I can use a quick fix of rotating the collar so that the indented  2" chin area is moved to the side so that I have a 3" support under my chin area. I will try that tonight along with changing the lower pressure limit to 10.  ( overall settings then will be 10 to 18, EPR 2) 

Do you have a suggestion as to what sleep position is most effective with the collar?  Typically, I fall first asleep on my back and then invariably end up side to side after waking up periodically.  It may be difficult for me to stay mainly in one position.

I have not tried a different type mask yet.  I am certainly willing to do so in near future.  I chose the full face mask as I had a fear of mouth breathing possibly being an issue.
Post Reply Post Reply






Donate to Apnea Board  
#12
RE: First Post, requesting Oscar review assistance
Requiring supplemental oxygen always makes me wonder why it's required from a cause point of view. It can be caused by sleep apnea or by some other likely pulmonary condition which may suggest different settings to assist. In and of itself no it matters little. But if, for example, root cause is shallow breathing, I'd be looking at possibly increasing EPR or Pressure Support to help counter
Post Reply Post Reply
#13
RE: First Post, requesting Oscar review assistance
I don't believe the oxygen should be causing any issues, it is just increasing the oxygen content the machine is providing you with. As Gideon mentions the main question is why you are on oxygen?

Picking up a nasal mask would be an interesting test. P10 is the most common but N20 or N30 are options as well.

The main thing about sleep position is trying to sleep in a position your airway is open so using pillows etc to obtain that. In other words if sleeping on your back that usually means one thin pillow, if sleeping on side it might mean a thicker pillow. The collar affects pillow a bit but just takes some figuring to make work. I would expect a proper fitting collar to make some sort of difference, I don't have positional apnea and I noticed a difference in my data when wearing a collar (due to neck fracture).
Post Reply Post Reply
#14
RE: First Post, requesting Oscar review assistance
There were improvements last night from refitting the collar width and increasing minimum pressure to 10.  I have attached results.  Would someone advise if the centrals and overall readings look to be more normal?   I realize it will take more nights to determine if these changes remain at this level.

The higher minimum pressure did not cause any comfort issues.  

Geer1 - The sleep position information is helpful.  I could tell last night that with the collar fitting more proper, changing positions from on my back to side, seemed to maintain a more consistent alignment.  I can adjust my pillow accordingly.  

Regarding the supplemental oxygen, the reason I have it is based on the home sleep study and the resulting report where both CPAP machine and in-line oxygen were stated as needed.  My O2 levels were below threshold levels on the sleep study.   I have no other preexisting conditions that I am aware of.  I was/am  curious why the machine alone would not provide the additional O2 needed, as I had thought the levels went low due to not breathing proper, and that is what the CPAP machine was to address. I tried a night without the supplemental O2, using a O2 ring monitor and it indicated that my O2 were still falling below 88% at different times of the night with the CPAP machine only.  Therefore, I have continued with the in-line O2 machine.  It would certainly be desired to eliminate that need, and have the CPAP machine provide enough O2. However, with the high centrals and inability to get my overall AHI down to acceptable levels, the O2 issue has become secondary.

Advice on next steps would be appreciated.


Attached Files Thumbnail(s)
           
Post Reply Post Reply






Donate to Apnea Board  
#15
RE: First Post, requesting Oscar review assistance
This does show some improvement. Most of the periods of high flow limitation are gone and there weren't any obvious positional apnea cases. Are the changes you made adequate or do you think you need a different collar to get the best results? If there is still some room for improving fit I would continue with that for now.

The examples of central apnea do now look more like central apnea with only some slight oddities. Not like CO2 driven central apnea but rather idiopathic or medication induced central apnea. The only medication on your list that I think could possibly be having an effect is the Gabapentin but I don't know why you take it or if trying a lower dose is something that could be trialed to see if it helps. Part of me wonders if you have idiopathic central apnea that snuck through the original study due to obstructive features also being present (as was muddying the OSCAR data).

All we can do is try to treat any and all obstructive aspects and hope the centrals go away when doing so. If they don't go away then you probably need a more advanced machine to treat the central apnea (ASV). If going this route you might need to ask doctor for a titration study including ASV because of your high number of central apnea and inadequate results so far.

With proper treatment I don't think you should need the supplemental oxygen but supplemental oxygen is a treatment form for idiopathic central apnea and it will be helping keep your oxygenation up while you still have mild to moderate apnea each night (currently). If you can consistently get results down to 1-2 ahi each night then you could try going without the oxygen again.
Post Reply Post Reply
#16
RE: First Post, requesting Oscar review assistance
A couple of basic things first.
1. Add supplemental oxygen to your profile, Other is a good place.
2. O2 levels are a prime concern, these should be incorporated into your OSCAR charts and included in charts you display here.
3. Get a pulmonologist for a full specialist workup of your pulmonary system. This maybe m elimination appointment but exore and see if other pulmonary issues are at play.

Increasing the amount of pressure support (EPR) should improve O2 levels in addition to better management of your obstructive events
I'd like you to try EPR=3 but want to see your O2 levels first and how they respond after
Post Reply Post Reply
#17
RE: First Post, requesting Oscar review assistance
Geer1 -  I have ordered a new collar with the increased width.  The changes I made to my existing collar, should be OK short term.  The fit is now such that the collar is snug, not tight, and my jaw/chin rest on the collar when facing forward in natural head position.  Prior I had about an inch of vertical play from my chin to the collar.  The new collar will have a section for the chin area so possibly this will reduce potential side to side movement.

If I am ever able to get to 1-2 AHI I would be thrilled as I anticipate that overall I would feel better than I do currently.  Eliminating the supplemental oxygen machine would be a nice bonus.

The Gabapentin is optional.  Ironically, it was prescribed off label, to help with anxiety and provide a better nights sleep.  The prescribed dosage is 300 x4, daily however, I never increased from 300 x 2 daily.  I had been wondering if actually increasing to 4x as a trial might be helpful.  My thought is that it might reduce the number of times I wake up reducing the number of times I am changing sleep positions.  I am not dependent on the medication and would be open to either increasing or decreasing, or staying the same as it relates to possible effects on my sleep.

Gideon - 

1. I have updated my profile to include the supplemental oxygen and also changed the pressure to 10-18 which is where I am now.
2. I will start wearing my O2 ring each night and synchronize the results into Oscar charts.  ( hopefully! )   I'll post for your review once completed.
3. I believe it is excellent advice to have a full pulmonary review completed.  When I first saw the sleep study with the low O2 events it did cause a lot of anxiety.  Checking the levels with my O2 monitor, when using the supplemental oxygen and CPAP my levels stayed above critical levels, which I was obviously relieved to see.   I'd like to consider holding off until June for this review, unless we see something obviously wrong once O2 data is in the Oscar charts.  The reason is I won't have any assistance from insurance on the costs until then.

I'll keep EPR at 2 for now, and pressure at 10-18, until it is suggested otherwise.  In the past, I had tried EPR at all the different settings and was able to tolerate each from a comfort standpoint.  I was not able to conclude proper impact of each as things were all over the place, so went back to 2 which seem like it may have been best.   Before this thread, I tried on my own to research changing different settings but quickly became overwhelmed with all the variables and various trade offs.   I am appreciative of those taking time to help me.
Post Reply Post Reply






Donate to Apnea Board  
#18
RE: First Post, requesting Oscar review assistance
Do you believe the Gabapentin has helped?

Gabapentin has a fairly short half life and would be out of your system in 2 days. I think it is a long shot it is the problem but if you feel up to trying 2-3 days without it that is all that should be needed to see if it has any effect on the central apnea.

I would wait to do that until you are seeing consistent results with the collar though.
Post Reply Post Reply
#19
RE: First Post, requesting Oscar review assistance
The current dosage seemed to help some with overall general anxiety, but not a dramatic change. I don't think it improved my sleep. I am willing to trial going without, however, it might be best to wait at least another week.  The reason being, last night results were even more improved compared to my last attachments.  Total AHI =5.7 and obstructive was .72, and no heavily clustered periods. 

I'll keep current settings and collar the same for another week, and report back results on this thread.  If things stabilize at these lower levels then we will have a new baseline for trying additional changes.
Post Reply Post Reply
#20
RE: First Post, requesting Oscar review assistance
Yeah I would wait until your results appear to have plateuaed again. It seems clear that the collar is having an effect and potentially it could have a cumulative effect over time as you get better quality sleep.
Post Reply Post Reply






Donate to Apnea Board  


Possibly Related Threads...
Thread Author Replies Views Last Post
  ASV user request for analysis Labromaniac 40 1,037 06-15-2022, 06:50 PM
Last Post: Labromaniac
  [split] New member - Analysis Request PLM, limb movement arousals Eddi3p 9 429 04-13-2022, 01:12 PM
Last Post: Geer1
  Timmo - Therapy Analysis Timmo 9 556 04-09-2022, 07:45 PM
Last Post: Timmo
  sfr79's Treatment Thread // Analysis, Opinions, Suggestions Welcomed sfr79 7 506 02-14-2022, 01:54 PM
Last Post: Dormeo
  koy23 - Flow Rate Analysis koy23 55 2,743 02-08-2022, 06:02 PM
Last Post: koy23
  [CPAP] Need help with OSCAR analysis neostarsky97 0 230 02-06-2022, 12:41 AM
Last Post: neostarsky97
  Data Analysis brownrabbit34 9 519 01-28-2022, 07:21 PM
Last Post: Dormeo


New Posts   Today's Posts






About Apnea Board

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