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What are these in my OSCAR graph, how to interpret? - Printable Version

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What are these in my OSCAR graph, how to interpret? - nbritton - 05-04-2020

How would I interpret these graphs? Thank you in advance! I'm mainly interested in knowing if these are central events, or somehow related to a central event... because I'm wondering why putting my AirSense 10 AutoSet into ASVAuto mode is working so much better for me.

Graph #1:
[Image: gkmAzuV.png]
Graph #2:
[Image: aLx6akn.png]
Graph #3:
[Image: ogPjph2.png]
Graph #4:

[Image: kCsrGCI.png]

Graph #5:
[Image: 7RyWsBr.png]
Graph #6:
[Image: eBTKJLm.png]
Graph #7:
[Image: wdmgMrC.png]
Graph #8:
[Image: p86G972.png]

RE: What are these in my OSCAR graph, how to interpret? - Sleeprider - 05-04-2020

Just to help out a bit, what are our settings for PS Min?

RE: What are these in my OSCAR graph, how to interpret? - nbritton - 05-04-2020

(05-04-2020, 08:15 PM)Sleeprider Wrote: Just to help out a bit, what are our settings for PS Min?

EPAP 4-14, PS: 5-14

Looking through my historical graphs on my DreamStation I found a good amount of periodic breathing, I uploaded several of the graphs here:

http://imgur.com/a/ehPYOwb

Regarding these historical graphs, I computed a 100 day average and 31.57% of my sleep duration time is flagged as "Variable Breathing".

RE: What are these in my OSCAR graph, how to interpret? - Sleeprider - 05-05-2020

Interesting how much pressure support you seem to get throughout your therapy and how low EPAP is staying. Your settings are ASVauto, EPAP min 4, EPAP max 14, PS min 5.0, PS max 14.0. With your Dreamstation Auto CPAP you had pronounced flow limitation and periodic recovery breathing that the machine sometimes flagged for periodic breathing. You often had a positive flow "blip" during exhale that we see in a lot of Philips users that I have thoguht might be poor sync with the Flex algorithm, or a false-start to inspiration.  I'll post an example below.  This pattern is really disruptive to sleep and requires pressure support to clear up, which the ASV is providing. The ASV is providing considerably more than the minimum PS and is taking the tidal volume variations and snores out. Your CPAP therapy looked chronically restricted (UARS) and you had a lot of sleep disruption from the need to arouse and recover.

Many of the same problems are apparent in your ASV charts, but they are being met with pressure support up to the maximum resulting in protection of tidal volume.  I don't see the ASV pacing your respiration rate, but it certainly protects minute vent.   I take back my previous comment you might be equally treated with a Vauto. You are fortunate to have found ASV and worked this out on your own. Your symptoms and root cause of airway restriction would never have been considered for ASV if you had not done this yourself.  Even with the ASV working fairly hard to maintain respiratory volume, you still have considerable variations and occasional recovery breathing.  I think you should try gradually increasing EPAP min to see if those obstructive features can be resolved.  The ASV only increases EPAP min when you have a UA event which is deemed obstructive, but with the amount of flow restriction you chronically display, followed by spontaneous recovery breathing, I think higher EPAP may be a solution.


[Image: vHeDKx1.png]

RE: What are these in my OSCAR graph, how to interpret? - nbritton - 05-05-2020

(05-05-2020, 07:54 AM)Sleeprider Wrote: Interesting how much pressure support you seem to get throughout your therapy and how low EPAP is staying. Your settings are ASVauto, EPAP min 4, EPAP max 14, PS min 5.0, PS max 14.0. With your Dreamstation Auto CPAP you had pronounced flow limitation and periodic recovery breathing that the machine sometimes flagged for periodic breathing. You often had a positive flow "blip" during exhale that we see in a lot of Philips users that I have thoguht might be poor sync with the Flex algorithm, or a false-start to inspiration.  I'll post an example below.  This pattern is really disruptive to sleep and requires pressure support to clear up, which the ASV is providing. The ASV is providing considerably more than the minimum PS and is taking the tidal volume variations and snores out. Your CPAP therapy looked chronically restricted (UARS) and you had a lot of sleep disruption from the need to arouse and recover.

Many of the same problems are apparent in your ASV charts, but they are being met with pressure support up to the maximum resulting in protection of tidal volume.  I don't see the ASV pacing your respiration rate, but it certainly protects minute vent.   I take back my previous comment you might be equally treated with a Vauto. You are fortunate to have found ASV and worked this out on your own. Your symptoms and root cause of airway restriction would never have been considered for ASV if you had not done this yourself.  Even with the ASV working fairly hard to maintain respiratory volume, you still have considerable variations and occasional recovery breathing.  I think you should try gradually increasing EPAP min to see if those obstructive features can be resolved.  The ASV only increases EPAP min when you have a UA event which is deemed obstructive, but with the amount of flow restriction you chronically display, followed by spontaneous recovery breathing, I think higher EPAP may be a solution.

Thank you for that, I'm glad I'm not the only one who thought something didn't look right. I sent a message to my doctor last night with the same graphs I included here and also summarized my experience on ASV, I'm thinking he'll be receptive to making some changes. I'll keep you posted. Thanks again!