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+--- Thread: CPAP newbie trying to interpret Oscar (/Thread-CPAP-newbie-trying-to-interpret-Oscar)
CPAP newbie trying to interpret Oscar - lawilli2 - 05-10-2020
Hello all. I am new to CPAP. Was diagnosed with at home study, 59 apnea events/hr, lowest O2 62%, average O2 89%, open-mouth breather, with a obscenely loud snore. Should have done this years ago, but basically got busy with it when my wife booted me to the guest room. I am on my 3rd week of use, and back in the master bedroom so making progress.. I am still working out kinks with mask fit (the mask fit primer helped immensely). 10 days with Vitera at 7-9 hrs a night, and AHI between 3.5-5. Due to leaks and comfort, changed to DreamWear FFM, with a significant increase on comfort, and a decrease in AHI to below 3. I have been perusing these boards and learned enough to get doc to give me a SD card to add to machine, and his blessing to tweak levels. He set me initially at 4-20, and at 4 felt O2 starved. After reviewing initial Oscar reading I set range to 9-20 2 nights ago, and AHI dropped further.
He is my most pertinent issue. Regardless of mask or settings, I am waking every 2-3 hrs. With the vitera and early with dreamwear FFM i would wake due to high pressure and mask leak. However, now that my leaks are minimal, i still awake. I feel so much better, with not waking in the am feeling tingly, numb, sore throats, etc...But i do feel sleep deprived. I am trying to understand the data to determine if the arousal is due to something that can be controlled or improved with the ACPAP settings. I have been trying to wrap my head around this information, but there is just so much I do not yet understand. Any assistance would be most welcome. Just remember, some of the terms are still foreign, i.e., RERA? But I am learning.
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RE: CPAP newbie trying to interpret Oscar - milboltnut - 05-10-2020
your apnea seems to be under control.... that's great !
As far as waking up every two hours... well, it might be a comfort problem, mattress, pillow, temp in room, dark room? Take any sleeping aids? Melatonin is a good choice or benedryl. Are you congested?
A light snack and a warm shower before bed might help.
RE: CPAP newbie trying to interpret Oscar - lawilli2 - 05-10-2020
Thanks for the quick response. I am using melatonin 10 mg, and 12.5 mg diphenhydramine, but no avail. Before CPAP I slept like the dead, unfortunately the apnea was killing me!I added a cpap pillow and feel pretty comfortable. Rain sounds on the echo creates a nice white noise environ. I just want to be sure it's not an issue with my breathing, or in a perfect world something I could tweak that would help.
RE: CPAP newbie trying to interpret Oscar - Gideon - 05-10-2020
Welcome to AB
Flow Limits are a bit high and since you ask about RERAs, Respiratory Effort Related Arousal is a series of flow limitations followed by arousal. Arousal are the main driver of pressure increase in ResMed machines.
Set your EPR = 2 full time. This will address the flow limitations and RERAs and add comfort to your CPAP use.
RE: CPAP newbie trying to interpret Oscar - milboltnut - 05-10-2020
(05-10-2020, 08:49 PM)bonjour Wrote: Welcome to AB
Flow Limits are a bit high and since you ask about RERAs, Respiratory Effort Related Arousal is a series of flow limitations followed by arousal. Arousal are the main driver of pressure increase in ResMed machines.
Set your EPR = 2 full time. This will address the flow limitations and RERAs and add comfort to your CPAP use.
when you say Res effort...is a series of flow limitations, followed by arousels, how can that be reduced, or should it be a concern?
RE: CPAP newbie trying to interpret Oscar - lawilli2 - 05-10-2020
OK, I will try out the change as you suggest. I had set to EPR to ramp only because I had read in a thread that using full time could cause CA events. But honestly I do not fully understand EPR yet. Regardless, I will give it a try. Thanks!
How about the response setting, soft vs standard. I currently have set to soft.
RE: CPAP newbie trying to interpret Oscar - Gideon - 05-10-2020
Flow Limits and RERAs are best managed with pressure support, the difference between inhale and exhale pressures. On ResMed CPAPS we use EPR to drop your pressure which is really inhale pressure, by the amount of the EPR thus lowering the exhale pressure. We use it as pressure support to treat flow limits and RERAs.
And yes, in a few people increasing EPR does cause Central Apneas.
Question: Since EPR can cause Central Apnea why doesn't it cause CA during the ramp? Because events are not logged during the event and if the are not logged they never happened right? Of course that isn't right.
Most, not all, of the senior people around here do not use a ramp because it takes away from therapy time.
RE: CPAP newbie trying to interpret Oscar - lawilli2 - 05-10-2020
Thank you for the info Bonjour. I look forward to continuing to learn. I have made the changes and will give it a few nights and follow-up.
RE: CPAP newbie trying to interpret Oscar - lawilli2 - 05-11-2020
Ok, so I tried the EPR at 2 full time and awoke 3 times in the first 90 min (first 3 sessions) with large pressure spikes. I then went back to EPR OFF for 4th session, and then tried split difference of EPR 1 for 5th session. Noted significant increase in AHI, RERA, OA, CA. However, after the first 3 wakes, I did also drop the max to 14.4, just a bit over the historical 95% in hope I would not get the spikes in pressure. I am not sure if affected the numbers.
What a mess, It seems large peaks definitely wake me, and I get larger peaks when using EPR. Theoretically I should be more comfortable with EPR on, but events increase, and flow limits seem about the same. I included stats if that helps. I am feeling a bit lost on this.
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RE: CPAP newbie trying to interpret Oscar - lawilli2 - 05-11-2020
Any thoughts or advice is welcome. No sure if I should continue the EPR at 2 or go back to no EPR. Also not sure how to reduce those pressure spikes.