[Diagnosis] My first report here

[Frankiboy]

Hello all, I am posting my first Oscar report and hope everything useful is included.
Please excuse my bad language, I am from Europe and my American is very bad, I hope you can understand.

6 weeks ago I was set by the lab with 7-14 and EPR 1, and have now slowly changed that and the values are getting better, 
I also feel more rested.
It doesn't look too bad to me now, and I suspect position problem in supine position, use a very flat pillow.
Do you have any recommendations for me?
   

[gainerfull]

How did you feel after sleeping this night?

1. You're still recording obstructive events (light blue) this is due to insufficient minimum pressure, consider raising your minimum to 11cmH20
2. The CPAP is maxing out pressure towards the end of the night so you may want to raise your maximum to 16cmH20
3. You might consider testing with EPR 3 full time.

In summary, I think your pressure is a little too low as evidenced by your flow limit data and remaining obstructive events. Keep in mind, the most important thing is how you feel so if you're comfortable with your settings as they are, then leave them be for a while because they're pretty good as is.

[Deborah K.]

I suggest that you raise your upper-pressure limit and your EPR setting. I think your lower-pressure limit is fine.

[Frankiboy]

How did you feel after sleeping this night?

1. You're still recording obstructive events (light blue) this is due to insufficient minimum pressure, consider raising your minimum to 11cmH20
2. The CPAP is maxing out pressure towards the end of the night so you may want to raise your maximum to 16cmH20
3. You might consider testing with EPR 3 full time.

I suggest that you raise your upper-pressure limit and your EPR setting.  I think your lower-pressure limit is fine.

I felt quite good, but I don't know how to assess it, because I slept very badly for too long, so maybe I can do better. But I know that the feeling is the most important. 
I thank you both for your answer and will test it.

Hopefully when I increase the pressure I won't have a problem with the tightness of the mask, because as it is now, it was a long journey to get it tight. I'll see.

[Frankiboy]

Can someone please explain to me how such results occur and how I can prevent this?

As far as I can remember, I must have been lying on my side. My understanding is that I first have occlusion and after 20 seconds I stop breathing again because there is enough O2.
   

[Expat31]

Instead of answering your question directly on central apneas, I would like to go firstly back to your first graph.

Maximum pressure.

If you compare your pressure graph to the flow limitations graph, you will see that there are three groupings of pressure increases corresponding exactly to the flow limitations increases. 

You need to increase your EPR to 3  to reduce these flow limitations as this is a significant problem. 

Your 95% value should be below 0.1. 

The rest of the time your pressure is at around 10-11cms. I would drop your maximum down to 12 cms.
Leave it there for the moment until your other issues are resolved.

Minimum pressure.

I agree this should be increased to "clean up" the hypopneas. Increase  to 11cms.

I note that comparing your first graph, and the last one younhave  your setting have not changed, still at minimum 10, maximum at 15, with EPR still at 2.

Central epneas 

These should eventually decrease as you get your settings right. First things first.

If you are concerned about you oxygen levels, get a pulse oxyimeter, and import the readings into Oscar, which will produce an Spo2 graph as well as a pulse graph.

This all takes time, with much trial and error.

[Frankiboy]

Thank you, I will set the EPR to 3, which was already recommended above, and the minimum pressure to 11, but the maximum pressure to 12 is too low for me, as 95% of 11.6 goes up to 99.5% to 12.2.
I have concerns about that.
So I will set 11 to 15 at EPR 3 and see how it looks.

[Expat31]

OK, but you have to look at why your pressure is going this high. 
In your first graph, it is clear that flow limitations pushed up the pressure increases, nothing else. 

The only tool available with the A10 machine is EPR, and EPR 3 is as far as it will go. 
After that is is probably another type of machine, but that's on another level and so much to do without consideration at the moment.

These pressure increases caused by flow limitations are also doing nothing for your therapy and comfort. 

Each time these unnecessary increases take place, it will cause an arousal, perhaps not waking you up, but still disturbing your underlying sleep patterns. The many hypopneas you have at the moment also disturb sleep patterns, but should be hopefully besolved with increased minimum pressure.

Looking back once again at your first graph, your obstructive apneas as pretty well controlled, which is important. 

This just leaves centrals and flow limitations. As said previously, once you get your basic settings OK, these centrals should greatly reduce. It is however not really possible to eliminate at 100%. 

Give it some more time to settle down.

One thing I noticed is the y axis scaling for flow limitations which does not enough give enough detail. Instead of the current range of 0.00 to 1.00, make it say 0.00 to 0.40. 

Remember, the magic FL number is less than 0.1, not 1.0

It is just a presentation thing, but helps visually to focus on this important graph.

[Frankiboy]

It is difficult. Yesterday on 3.11 I saw that I need the maximum pressure, and today 4.11 during a short nap in supine position it seems to be too much again.
       

[Expat31]

Hi,

I have some observations:-

Firstly the EPR at 3 has reduced your 95% FL's to 0.08 which is a good start.

If you look carefully at the pressure graph together with the FL graph, you will see there is a pretty clear relationship between the two. (See the 4 pressure increases and 4 flow limitations increases at almost the same time @ 1.15h, 2.00h, 2.20h and 4.40 h)

As there were only 4 peak events during the 7 hours on the machine, perhaps this did not cause significant arousals. 

If you are convinced that increasing the maximum pressure limit will help, you can try it to see where it goes and if your quality of sleep improves. You could set it at even 20cms to  see what level it stops at, and if you get any benefit. You could do it in steps, 16, 17 18 etc, but that's up you.

My opinion is that unlikely help you. It is important to understand what flow limitations actually are. 

You may want to look at this:-

https://www.apneaboard.com/wiki/index.ph...limitation

and this:-

https://www.apneaboard.com/wiki/index.ph...imitations

I would summarise flow limitation as a physical norrowing of the airways, thus reducing airflow.  The machines we use cannot produce sufficient pressure to forcefully push open this narrowing, as the maximum the machine can produce is 20cms of water.

Concerning sleeping on your back, very often the best results are not achieved, as during deep sleep stages the body partially shuts down to a state of almost paralysis. Muscle "tone" is lost and the upper airways can collapse due to gravity, blocking airflow, causing apnea events and arousals.

I personally can no longer sleep on my back, although before sleep apnea, it was a really comfortable position and great for sleep!

But the most important thing is how do you feel?  It seems from your comments below it not too bad:-

"I also feel more rested."

"It is difficult. Yesterday on 3.11 I saw that I need the maximum pressure, and today 4.11 during a short nap in supine position it seems to be too much again."

Did your lab report indicate central apneas? Do you take sleep aid medicines?