Woofer777 - OSCAR Analysis

[Woofer777]

Cable ordered. thanks Crimson Nape!  I will be sure to mark it once received.  Yes, I recall many different connectors and cables over the years for various electronic uses, and the RJ11 phone cords.

[lightwolf1]

Woofer, CrimsonNape already covered it; I would just add get more -- the oversized end that plugs into the PC creates a great lever and they break easily.  Ask me how I know.  Many reviews online mention this too.

[Woofer777]

Updates to report:  

1. I was able to get O2 report downloaded for night of 3-7.  It is in 5 files (after converting from pdf) so I will attach the balance on a second reply. 
2. The associated Oscar chart for the O2 report night is attached as well.  ( If O2 is still a concern I will follow the steps to import to Oscar.) 
3. I have a new soft cervical collar that fits much better than my old collar.  I've worn the new on with the 2 Oscar charts attached.
4. I also have a new (replacement) mask which took care of the issue I was having of needing to overtighten to prevent leaking. I hadn't realized how much the old seal had compressed.
5. I changed the pressure range to 9-12, and left EPR at 2. 

After 1- 4 above, the night of 3-7 was the best night I've had since treatment.  Almost no obstructive events and I felt very rested the next day.

Now the bad news.  Last night, with no changes made from night of 3-7, my results are back to the being very poor again. 

I've asked this question before but I am not understanding what are some of the reasons why such drastic changes night to night, when I can't pinpoint anything that is different behaviorally?

My observations:
1. When the upper pressure setting was at 18 (vs last few nights at 12), it did not make an impact on the obstructive events, just caused uncomfortable condition.
2. Last night it appears the pressure stayed at upper limit of 12 the majority of the night, vs my "good" night of 3-7.
3. I am ready to test more options.  The prescribed setting had been 8-18 EPR 3. At beginning of treatment numbers started off in the 7-9 range, with minimal obstructive and mostly centrals/hypopneas, then gradually started to rise to the 10-12 range.  That's when I started on my own changing EPR, adding chin strap, new pillow, wearing collar.  At that point I wasn't able to conclude anything.  That's when I joined this forum a few weeks back.

What makes sense for the next steps?

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O2 reports for 3-7

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Last O2 report

[Sleeprider]

Reviewing this thread it is apparent we have not seen improvements in the results with variaitons of CPAP pressure or EPR. Events do not correlate with pressure in any way, however higher event rates do occur at higher pressures, which is likely more a function of the Autoset algorithm than a pressure/apnea relationship. The majority of the events remain central, and there are notable flow limitations and occasional obstructive apnea. The best results have been during periods of lower pressure, particularly on March 7.

Rather than continue with a pressure range, I think we may learn more if we work with fixed pressure. The is to see if we can titrate an effective pressure and minimize sleep disruption. My suspicion at this point is that your problems will require something like ASV to resolve, and it seems your CAI is high enough to justify that. Your respiratory pattern is not typical for central sleep apnea, but might be better characterized as complex sleep apnea syndrome. To be approved by your doctor for ASV, you will likely have to submit to at least another clinical sleep study that evaluates CPAP, Bilevel and ASV. Typically, a study will only look at CPAP and Bilevel at this stage, and you would end up having to also fail bilevel before being considered for ASV. Anyway, we can cross that bridge later, but you might want to start increasing complaints to your doctor that CPAP is apparently failing, and getting that next study scheduled.

For now, I recommend putting the machine in Autoset mode with minimum pressure 9.0, maximum pressure 9.0 and EPR 2. We can collect that data for a couple nights to see how much variation happens, then consider what's next.

[Geer1]

Yeah fixed pressure might help figure things out a bit better, the one thing I would specifically like to test on fixed pressure is the effects of EPR since a significant portion of the issue odes appear to be central apnea. Central apnea is inconsistent night to night so you might have to do 4+ nights at each setting to be able to get an average to compare against, comparing night to night doesn't work as these two nights show.

[Rubicon]

When you are able to import oximetry into Oscar can you focus on this area from oximetry?   That's a brady/tachy pattern, and you probably have significant problem-causing events there.  If you weren't on supplemental oxygen there'd probably be desats there but I would consider that there's at least arousals.



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[Woofer777]

Sleeprider- I appreciate your review and comments.  I will start a 4 night trial beginning tonight at fixed pressure of 9 and EPR at 2, and report results back afterwards.  I am preparing myself for the fact this may be long journey, that will likely involve more testing and potentially different machines.  In the meantime, I'm hopeful something may shake out that can better explain why my numbers are so inconsistent.

Geer1 -  After EPR 2 are you interested in seeing EPR 3, then 1 and 0?  All at fixed 9 pressure. 

Rubicon - I hope to have O2 data into Oscar for the next results postings.  Looking at 3-7 night, the first 2 hours on Oscar chart had very few events, yet the O2 section you referenced has the brady/tady pattern.  I will have to do more research, as I've been focused ( and stressed) on getting some type of stable baseline that might indicate what my root cause issues are.  With many of my results charts, its been noted that I have an odd breathing pattern.  Seeing a pulmonologist is on my to do list, but not till June.

[Geer1]

It depends on what results look like but my thoughts were to compare current EPR of 2 to a lower EPR (0 if comfortable or else 1) as that could have biggest effect on centrals. Too keep things fair we should probably maintain EPAP which would mean adjusting the pressure setting the same amount as EPR setting (since EPAP = Pressure - EPR). For example 7 pressure with 0 EPR is the same EPAP as 9 pressure with 2 EPR. The reason we should maintain EPAP is because it is the constant pressure that helps avoid obstructions.

Do your oximetry heart rate graphs regularly look like that? If so it might be worth bringing them to your doctors attention and seeing about getting a holter monitor test done to see what your heart is doing at these times (far more accurate and more information than an oximeter).

[Rubicon]

June?  That's a drag!

As previously noted, if your oxygen level is that low, you have at least one other issue.

That said, HSTs are often worthless except in uncomplicated OSA.  Can you post the entire results of the HST?  EKG should have been monitored and the results analyzed for Heart Rate Variability (the phenomenon we're talking about here) and other fancy stuff like Cardiopulmonary Coupling, but I'll bet they didn't even monitor basic EKG.

However I wouldn't push the panic button just yet.  Let's take a look at what data the HST showed as that could be spurious data.  If you have no other symptoms it is odd that your baseline oxygen level has been low for weeks, months, years...


Administrator Note: Edited at request of poster.

[Woofer777]

Geer1 -  I will plan on the EPR 2 vs EPR 0 comparisons for this most recent testing period.  Last night was first try at 9.0 fixed EPR2. Results are similar to the night prior when settings were  to 9 - 12 EPR 2   On that night, which I had posted, pressure stayed up near the 12 level most of the night.  I will try another couple nights before changing to EPR 0.  I will attach last night just as a starting point look.  ( My gut feel is a slightly higher pressure is needed, but will follow guidance here.) 

Rubicon -  What I had posted on my HST was the complete report.  As you suspected, they did not have any EGG data from the hook up device provided.  I reread the report and it does note that the respiratory disturbances were related to the oxygen desaturation levels.  That explains why they prescribed the supplemental O2 along with the AS11.  I did test my O2 levels early on without the supplemental O2 while using the CPAP machine, and they fell below 88% at least 3 times.  I use it continually now. 

I do believe my current O2 condition has been occurring for years, although I have no evidence of that.  I only obtained the O2 Ring a few months ago and have only wore it a few times.  I will plan on wearing every night going forward.  Last night, O2 dropped once to 88% around 2 a.m. and some other lesser decreases during the night.  To me, it doesn't appear that the O2 drops directly correlate with the majority of events. 

June is when my new insurance  (Medicare) will cover all of any testing or equipment needed.  Until then I am out of pocket with a huge deductible.  The doctors office indicated that the next step would be the overnight lab study.  I am wanting to move forward quickly with figuring things out however, I can't afford the various testing right now. ( lab tests, follow ups, pulmonary reviews, possibly new machine, etc... it could easily be $3k to $5k).  

That being said about why my delay in further testing, if it is believed that there may be some immediate health concern I would bite the bullet and incur the medical costs.  I will schedule an office visit soon to discuss my current situation with a doctor.  My PCP is the one who ordered the HST.  The sleep center doctor who created my report was the one who setup the AS11 and inline O2 machine prescription.   My first use of the equipment was tail end of December, and I have not been back to a doctor yet.  I did review results with the medical equipment therapist in January to discuss the high centrals, but she mostly dismissed as it takes time to adjust.  At that point I tried some adjustments on my own and then more recently joined this forum for coaching assistance.