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[Diagnosis] Help with reviewing OSCAR results
#1
Help with reviewing OSCAR results
Hi,

I have been on CPAP since june.
When I first started I was averaging an AHI of 1-2 most nights, with a night here and there a little higher. I suspect some of those values were artificially low due to the sheer amount of wake-ups I had back then (adjusting to CPAP life).
But over the past few weeks my AHI has been climbing into the 7's, and I can't figure out why.

My apnea's seem to come in clusters throughout the night.
Ive done some reading but i cant figure out what might be the issue.
I suspect possibly positional apnea? Most likely rolling onto my back (normally a side/stomach sleeper).

I use a Resmed Airsense 10 and a Resmed Airfit N20 mask.
Pressures are 6 - 15.
I have only just turned EPR on (level 3). Previously it was off. The AHI started increasing before I turned EPR on. I turned EPR on to see if that made any changes (it was turned on 3 nights ago). And to answer that: I see no noticeable changes in AHI.
Yesterday I had an AHI of 3.88. The night before that, 6.99. If of any interest, can post those graphs as well. The 3.88 night I had 2 major clusters, then a handful of events, rest smooth sailing.


There is this fuzzyness on the Flow Rate and Mask Pressure graphs before an OA event. Is this normal or is it indicative of something?

I used to use a pillow mask when I first started, but found the N20 nasal mask to be much nicer from a sleeping perspective - but whenever I use the N20, my AHI increases from the 1-2 range to 3-4. And of course, lately 7 or so.
Is this normal for AHI to increase between types of mask? Or is it indicative of say a leak issue resulting in not as good of a result?
I also swear I can feel a significant difference in pressure between nasal and pillow masks, when set to the same pressure. Might just be me though.

These graphs are typical of a normal night for me - the first hour or so is smooth sailing, then the clusters start. Sometimes - another hour, or two or three go by before another cluster. Other times, 20mins between clusters.

Cheers.


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#2
RE: Help with reviewing OSCAR results
Hi Sequest,
Welcome to Apnea Board!

All of your AHI are Obstructives.  When we see Obstructives clumped together as in your graph, then what we're looking at is "positional apnea".  This simply means you are sleeping in such a way that you are tucking your neck into your chest, which in turn cuts off your air supply.  This is pretty common and can happen whether on your back or side.  

In order to rectify this, many here use a "soft"  cervical collar to help keep their neck properly aligned.   One other thing you might want to try is to use a thinner pillow.  Really  tall or high bed pillows can also tilt your neck and cause chin tucking.

See this link for more information:
http://www.apneaboard.com/wiki/index.php...cal_Collar

Using EPR is fine as you are not experiencing Clear Airways, so I would leave it at 3.

Flow Limitation look good. I don't see a problem there.

One thing... you are not getting the full benefit of EPR with a minimum pressure of 6.
I suggest that you raise your minimum pressure to 8 with EPR 3, that gives you an
EPAP of 5.

Sleep a couple nights with these settings and see how it looks.

When you post a new chart, follow the instructions below in my signature line for chart organization. If you just use the F12 key to take a screenshot, that will put the graphs in order as what we need to see. If we want more, we would request it.

Good luck!
OpalRose
Apnea Board Administrator
www.apneaboard.com

_______________________
OSCAR Chart Organization
How to Attach Images and Files.
OSCAR - The Guide
Soft Cervical Collar
Optimizing therapy
OSCAR supported machines
Mask Primer



INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE.  ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA.  INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#3
RE: Help with reviewing OSCAR results
Thank you for the review!

Overnight I set my pressure to 8 - inconclusive for 1 nights worth of data, but the AHI was 4.74.
Clustering is still occurring - however I believe I had a high percent of awakenings during the night, mostly due to noise generated by the exhalation port.
I had two Clear Airway events last night as well, which is new to me.
I may turn off EPR and move back to 6 as the starting pressure.

I will grab a cervical collar today if i can find one in stock, may also try and grab a Caldera Releaf neck rest, although they are not available in Australia, need to import.

Thank you again, will report back.
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#4
RE: Help with reviewing OSCAR results
Post an updated chart so we can see what events you were having.
A couple CA's is not anything to worry about, and one night does not make a trend.

I do think you'll see a difference with a collar. The Obstructives could be the cause of you waking or could be something unrelated to apnea.
OpalRose
Apnea Board Administrator
www.apneaboard.com

_______________________
OSCAR Chart Organization
How to Attach Images and Files.
OSCAR - The Guide
Soft Cervical Collar
Optimizing therapy
OSCAR supported machines
Mask Primer



INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE.  ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA.  INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#5
RE: Help with reviewing OSCAR results
Hi,

Last nights graphs attached. Used F12 this time.

Thanks.


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#6
RE: Help with reviewing OSCAR results
How is the fit with your mask?  Your leak rate is low number wise, but
even small leaks that persist for a good part of the night can disturb sleep.  It looks like there is some mouth breathing going on, which the collar may also help with by keeping the jaw/mouth from opening.   
Also, look at the spikey areas on the leak graph.  This usually indicates mask movement.

Going back to your first post... when you changed from a pillow mask to a nasal mask, did you also change the setting from pillow to nasal?
OpalRose
Apnea Board Administrator
www.apneaboard.com

_______________________
OSCAR Chart Organization
How to Attach Images and Files.
OSCAR - The Guide
Soft Cervical Collar
Optimizing therapy
OSCAR supported machines
Mask Primer



INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE.  ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA.  INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#7
RE: Help with reviewing OSCAR results
I have no noticeable leak before sleep, or when waking up at night. I see the graphs show leak, but it seems to be fairly consistent, and increases/decreases with pressure. Although I thought Resmed zero's out the leak rate depending on mask type selected? Something like that.
So it may be a legit, but if it is its not noticeable.
If anything - going through history, leak rate appears to be better than when I was getting an AHI of 1-2 (when using nasal mask).
Maybe worth adding - I am a side/stomach sleeper normally.

Mask sizing - I appear to be between a medium and large mask. Both work, but i notice some leak with the large mask. But the medium feels like it could be just a bit too small (height wise, width is fine).

I have a chin strap on order as well - will try that as well.


I am a bit of a toss and turn person, so mask movement could be me turning over. Also I route my tubing up over my head behind the pillow to keep it out of the way. Sometimes i end up in bad spots which yanks the hose. No idea how i can position the hosing to not cause issues, when it is in the normal position ontop of the sheet its often falls off the bed and also yanks the mask. Ive tried multiple tube supports, but all have their pros and cons.

And finally - yes I make sure to change the machines mask selection when i change my mask.

Two more days attached -
15th November - I was using a full face mask. I rarely use one as i find leaks to be a big problem. AHI was 1.5, but i would rate it as my worst night on CPAP since starting. I woke up many times, and the next day was horrendous. Incredibly tired.
23rd October - Normal day for me. No EPR


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#8
RE: Help with reviewing OSCAR results
Even though I believe you need a slightly higher minimum pressure with EPR 1 or 2, at this point, I won't recommend pressure changes until you can get the positional apnea under control.  

The low level continuous leak (which doesn't affect the machines ability to detect apnea), but can and probably does cause arousals. And I think you might be knocking your mask around when sleeping on your stomach.  

I don't know many stomach sleepers or how to advise with that.  Maybe you could try to sleep on your side or be more aware of position. Once you try out a collar, you might find it harder to sleep on your stomach.   Dont-know
OpalRose
Apnea Board Administrator
www.apneaboard.com

_______________________
OSCAR Chart Organization
How to Attach Images and Files.
OSCAR - The Guide
Soft Cervical Collar
Optimizing therapy
OSCAR supported machines
Mask Primer



INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE.  ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA.  INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#9
RE: Help with reviewing OSCAR results
Hi,

Collar was on last night. EPR was turned off and pressure set back to 6.
I ended up with an AHI of zero.
The only result was a false positive at the start of the night when I was cleaning and didn't have the mask on.
So i certainly think we can mark this down to positional apnea!

Anything before 1:50am can be ignored as I was not asleep (trying new positions).
My sleep was hardly uninterrupted though - that collar was painful.
And yes - stomach sleeping with a collar is impossible.
Is the positional apnea caused by a the neck/face falling forward, or can it also occur with sideways movement? Thinking some sort of collar with smaller side walls will go a long way to making it more comfortable for side sleeping.

If i was a back sleeper, it wouldn't be too bad.
I also needed a larger pillow as the collar pushes the neck up when side sleeping, if the pillow isnt high enough your head is supported mostly on the collar, which starts to dig in after a few mins.

I noticed an increase in snore and leak rate last night as well. I also had to turn humidity level from 2 to 4 - which resulted in a rain out, which caused my wake up this morning.
The mask is about due for replacement (one of those memory foam ones), so ill chalk some of the leak rate to the deterioration of the foam - but also the new pillow and positioning.

Now to try and find a collar that might be better for sleeping in.

Thanks so much for your assistance so far! It is much appreciated. My doctor's simply looked at the AHI and said "all good" and didn't seem interested in looking further.


Cheers.


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#10
RE: Help with reviewing OSCAR results
Even though your collar was uncomfortable, the results can't be argued with.  

Finding a good comfortable fit is key.  Measure the circumference of your neck, add a couple inches.  (You don't want it too tight)  We're not putting you in traction... you should be able to move your neck.   Smile
Also, measure the bottom of your chin to your chest to get an idea for height.  If you have a longer neck, you'll need probably a taller collar 3-4".  If you have a short neck, maybe 2-3".  

Positional apnea can happen if on your side or back.  Anything that tilts your head forward will cause apnea clusters.  Even if your bed pillow is too tall and fluffy.
Look for something thinner... not too tall.
OpalRose
Apnea Board Administrator
www.apneaboard.com

_______________________
OSCAR Chart Organization
How to Attach Images and Files.
OSCAR - The Guide
Soft Cervical Collar
Optimizing therapy
OSCAR supported machines
Mask Primer



INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE.  ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA.  INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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