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Heracles - Therapy Thread - Heracles - 09-08-2022
Hi,
It did not took me long to notice that my new girlfriend had sleep apnea. It took us a little while before seeing a doctor who was so convinced by the evidence I collected that he prescribed the CPAP machine right away, without any test in lab or more than the improvised tests and data I had.
One of such data was a video where she is wearing an oxymeter while sleeping.
She starts at 97% and snoring.
She keeps snoring and oxygen drops to 92%.
She then stop snoring and become silent.
Oxygen raises back to 97%
Snoring re-starts and here we go for a second loop.
She had 2 cycles in a 50 seconds video and 7 cycles in a 3 minutes one. That is about 140 incidents per hour!
Thanks to Oscar and all the stuff I learned from this forum and Youtube videos, I started to adjust her therapy.
We started with the For Her algorithm. Unfortunately, she ended up with some poor sessions when the device refused to go any higher than 12 cm. Not sure why because the device did go above 14 a few time before. Anyway, we need a reliable way to ensure she will receive the pressure she needs, so we switched to the regular algorithm in Soft mode and are using that since.
As for the maximum pressure, I saw her above 14 cm a few time, even with the For Her algorithm. I allowed up to 18 with the regular algorithm but it ended too much for her. She was not comfortable and woken up by the pressure. When I lowered the max to 15, she had one terrible session with an AHI over 80 when the CPAP was unable to compensate with enough pressure.
Since that, I configured it at 16 and it looks good. She is confortable and her numbers are good.
For the ramp, she likes to have a strong support from the very moment she puts her mask on. As such we are now up to 9 cm for ramp, configured as automatic. Minimum pressure is 9.6, so I can see clearly when ramp is over and therapy begins. That 9.6 really looks like a minimum because it almost never takes more than 2 minutes before she is above that and never yet she came back in the 9.x.
Despite we got the tube for automatic heat and humidity, she prefers colder air. As such, we are at 21 for temp and 4 for humidity. She got rain drops when we tried 5...
As for EPR, she does not tolerate it. From the very first moment she tried the mask, she described the feeling from the EPR saying that it was not comfortable. I turned EPR off and indeed, she confirmed she was better. I tried once to turn it back On and only 1 cm but No, she asked to turn it Off again.
Now, I noticed what looks like CSR. I know it can be induced by the therapy but I can detect the pattern by listening to her when she does not have her mask. She has fibromyalgia and she frequently stops breathing when awake as a pain-management reaction. What I think is strange is that after a month, the CPAP still did not flagged a single Clear Airway event.
Her terrible session with AHI over 80 was the CSR pattern that stayed forever. Most time, with enough pressure, there can be a cycle or two but soon enough, the pattern disappears or at least, there is no more apnea between two cycles. During that one, she remained in apnea for over 40 minutes in a 2 hour session : one third of the time she was not breathing! Should sleep apnea be a sport, she would be an olympic champion!
So my questions for now are :
Would it be better for her to get used to EPR or if she is better to stay comfortable as she is ?
What should I look in her data to determine if she is having CSR or not ?
Thanks for you input,
RE: New to the board - OpalRose - 09-08-2022
Hi Heracles,
Post a couple charts from the daily page in OSCAR. Without seeing the actual graphs, we would only be guessing.
Follow the link below in my signature line to guide you in organizing the graphs.
To start, we need to see the following graphs: Events, Flow rate, pressure, flow limitation and leak rate. Eliminate the calendar.
To take a screenshot, use the F12 key (on a Mac, Fn+F12) (Standard View).
Then use the Attachment feature to post your charts here.
RE: New to the board - Jeff8356 - 09-08-2022
Heracles,
There is a wiki page that may help explain CSR (or periodic breathing) a little better, http://www.apneaboard.com/wiki/index.php/Cheyne-Stokes_respiration.
and
http://www.apneaboard.com/wiki/index.php/Periodic_breathing
Also one fro EPR http://www.apneaboard.com/wiki/index.php/Expiratory_Pressure_Relief_(EPR)
and flow limitations: http://www.apneaboard.com/wiki/index.php/Flow_limitation
They may help you find some answers....
RE: New to the board - Heracles - 09-10-2022
Hi,
So here is the catastrophic session over 80
[attachment=44485]
plus a zoomed section of it.
[attachment=44486]
There is also another trace where we see the crescendo - decrescendo without apnea episodes between them.
[attachment=44487]
Thanks for your opinion,
RE: New to the board - Jeff8356 - 09-10-2022
Heracles,
The screenshot should look more like this:
Everything in one shot, one overview of the whole night and one zoomed in to the area you are questioning. Note the left sidebar is visible and the other graphs are also included. The left sidebar contains very important machine settings info needed for others to offer you advice.
And your graphs in the order that OpalRose had suggested in this post http://www.apneaboard.com/forums/Thread-New-to-the-board--37711?pid=454063#pid454063
Use the built in screenshot function of OSCAR. For Windows F12, for Mac fn+F12, or from the OSCAR menu bar View > Take Screenshot.
RE: New to the board - Heracles - 09-10-2022
Hi,
You asked to do as OpalRose requested ; OpalRose requested as the Wiki and you ask for something different than the Wiki... Sorry but there is clearly some misunderstanding here...
The Wiki says to turn off the side bar...
http : //www(.)apneaboard(.)com/wiki/index.php/OSCAR_Chart_Organization
Organizing your OSCAR chart
The OSCAR Daily Details charts provide a wealth of information that can allow the forum to help you analyze and improve your results. To get the most out of a chart, it is important to organize it with the most important information. When you upload your data from the Welcome screen, the details of your therapy can be viewed by clicking the Daily tab below the Menu Bar. However, the default view in OSCAR 1.0.1 hides a lot of valuable information, so it's important to set up the page correctly. The best way to ensure your charts contain useful information, use the View menu to Reset Chart View to the Standard or Advanced view as discussed later in this wiki.
Turn Off The Calendar, Pie Chart and Right Side-Bar
And the order in which data are listed is also in that wiki...
How to order the data charts
The most useful charts for diagnostic purposes are:
- Event Flags
- Flow Rate
- Pressure
- Leak Rate
- Flow Limit (Resmed only. Respironics includes Flow Limitation in Events)
- Snore
So here is one more with the side bar as well.
[attachment=44495]
RE: New to the board - OpalRose - 09-10-2022
The wiki says to turn off the "right" side bar, calendar and pie chart.
http://www.apneaboard.com/wiki/index.php?title=OSCAR_Chart_Organization#Turn_Off_The_Calendar.2C_Pie_Chart_and_Right_Side-Bar
We do want to see the "left" side bar.
Use the directions that Jeff posted: For Windows F12, for Mac fn+F12, or from the OSCAR menu bar View > Take Screenshot.
http://www.apneaboard.com/wiki/index.php?title=OSCAR_Chart_Organization
RE: New to the board - Gideon - 09-10-2022
You have very obvious positional apnea. Get a soft cervical collar to prevent you from most likely tucking your chin. Read the link on Soft Cervical collar link in my signature. And in that article the link to positional apnea. Do note that no amount of pressure will correct this, it is your physical position.
RE: New to the board - Heracles - 09-10-2022
Oups ; wrong right here.... My bad.
So here are the 2 screenshots : full session
[attachment=44496]
and 3 minutes zoom.
[attachment=44497]
RE: New to the board - Jeff8356 - 09-10-2022
(09-10-2022, 10:27 AM)Heracles Wrote: Hi,
Turn Off The Calendar, Pie Chart and Right Side-Bar
The LEFT sidebar is the one that is most needed
EDIT: I see you got it already. Great job!