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Help interpreting OSCAR data?
#11
RE: Help interpreting OSCAR data?
(02-24-2023, 09:30 AM)Sleeprider Wrote: The main takeaway from your titration study was the recommendation of pressure at 7.0 with EPR 3.  That is only possible with a Resmed Airsense 10 or 11 Autoset. Your Philips is not able to provide the equivalent pressure support (EPR).  This is however consistent with my suggestion of increasing minimum pressure from 5.0 to 7.0 and using Flex at 1 or 2.  That said,  you would be more comfortable with the Resmed.

Okay, got it. So I’ll need a new machine anyway. Thanks for the help!
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#12
RE: Help interpreting OSCAR data?
Sorry additional information if anyone needs it. Smile

https://imgur.com/a/nKHnWY0

What I don’t quite understand is that during my study I was always wearing a CPAP. Shouldn’t I have not been wearing it first to get an idea of what my sleep apnea was like without being corrected, and then have the mask put on? Or is that not how it works?

And looking back at the original report, it said the diagnosis is obstructive sleep apnea… but all of my events during the study were central apneas. I had no obstructive apneas. How does that make sense?
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#13
RE: Help interpreting OSCAR data?
This new image really helps to put your results in context, and is much more useful than the narrative summary.  Hre we see sleep stage, CPAP pressure, flow limits, leg movement, sleep position, respiratory events, oxygen and CO2, all graphed out.  Perfect.  Your study started with CPAP pressure at 5.0 and progressed to 7.0 with expiratory positive pressure at 4.0 cm.  No events were recorded at 5.0/4.0 and there were 3 apnea at 7.0/4.0 resulting in an AHI of 0.6 events per hour.  Your chart shows either pressure was effective, but all of your REM sleep occurred with pressure at 7.0.  The only reason we know EPR 3 was used is due to the narrative.

Below your graph I have posted a typical CPAP titration protocol. The need for CPAP is determined in a diagnostic sleep test where CPAP is not worn, then the titration test is normally started at 4-cm pressure and increases to reduce events and flow limits.  You achieved efficacy with very low pressure.  So normally a CPAP titration begins with pressure.  

I'm a little unclear. Are you due for a new machine and this test is in support of that? If so, please request the Resmed Airsense 10 Autoset. If you were dispensed a Philips Dreamstation, then it should have been set for your titrated pressure, instead it appears to be set at 4.0 minimum, 20.0 maximum and we can't tell anything else about settings. Your AHI is far worse with this machine than your titration would have predicted, and it could be you need the pressure delivery and EPR of the Resmed. They are both CPAPs but they feel and perform very differently. You should ask your doctor for a revised prescription for a Resmed Airsense 10 Autoset with minimum pressure 5.0, maximum pressure 7.0, EPR 3 and to dispense as written. It's a shame to see how poorly you are doing with the Philips Dreamstation 2. Sometimes the suppliers have exclusive sales agreements with Philips and can only dispense those machines, but most can offer a choice.

[Image: Qp16qho.png]

[Image: attachment.php?aid=4115]
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
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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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#14
RE: Help interpreting OSCAR data?
(02-24-2023, 03:03 PM)Sleeprider Wrote: This new image really helps to put your results in context, and is much more useful than the narrative summary.  Hre we see sleep stage, CPAP pressure, flow limits, leg movement, sleep position, respiratory events, oxygen and CO2, all graphed out.  Perfect.  Your study started with CPAP pressure at 5.0 and progressed to 7.0 with expiratory positive pressure at 4.0 cm.  No events were recorded at 5.0/4.0 and there were 3 apnea at 7.0/4.0 resulting in an AHI of 0.6 events per hour.  Your chart shows either pressure was effective, but all of your REM sleep occurred with pressure at 7.0.  The only reason we know EPR 3 was used is due to the narrative.

Below your graph I have posted a typical CPAP titration protocol. The need for CPAP is determined in a diagnostic sleep test where CPAP is not worn, then the titration test is normally started at 4-cm pressure and increases to reduce events and flow limits.  You achieved efficacy with very low pressure.  So normally a CPAP titration begins with pressure.  

I'm a little unclear. Are you due for a new machine and this test is in support of that? If so, please request the Resmed Airsense 10 Autoset. If you were dispensed a Philips Dreamstation, then it should have been set for your titrated pressure, instead it appears to be set at 4.0 minimum, 20.0 maximum and we can't tell anything else about settings. Your AHI is far worse with this machine than your titration would have predicted, and it could be you need the pressure delivery and EPR of the Resmed. They are both CPAPs but they feel and perform very differently.  You should ask your doctor for a revised prescription for a Resmed Airsense 10 Autoset with minimum pressure 5.0, maximum pressure 7.0, EPR 3 and to dispense as written.  It's a shame to see how poorly you are doing with the Philips Dreamstation 2. Sometimes the suppliers have exclusive sales agreements with Philips and can only dispense those machines, but most can offer a choice.

[Image: Qp16qho.png]

[Image: attachment.php?aid=4115]

I got the DreamStation previously under different insurance after an at home sleep study. I had this one done because I couldn’t understand why I still didn’t feel any improvement after using the CPAP for months. I am curious - so a test without a sleep study is needed first? Would that be the at home test that I did a while ago, and that’s why the one I just did in the hospital had me on a CPAP right away? Also, why is the EPR only posted on the narrative and not in the more in depth report? Is that just because it’s something that’s determined from a full review of the results of the study?
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#15
RE: Help interpreting OSCAR data?
Your home sleep test was your diagnostic test. It qualifies under many insurance policies to demonstrate medical necessity for treatment.  Your current results on the Dreamstation are just awful. It would be interesting to see if they are actually worse than your home test.

Ask your doctor why the EPR is not in the test, but he probably mentioned it for a reason.  EPR is basically bilevel pressure, which means your exhale pressure is lower than inhale pressure.   Resmed only markets it as a comfort feature, but trust me, it's the same as my bilevel.  Here is an example of my wife's charts showing the mask pressure in blue below the respiratory flow rate. Your Dreamstation can't do this.

[Image: attachment.php?aid=27301]
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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#16
RE: Help interpreting OSCAR data?
(02-24-2023, 04:03 PM)Sleeprider Wrote: Your home sleep test was your diagnostic test. It qualifies under many insurance policies to demonstrate medical necessity for treatment.  Your current results on the Dreamstation are just awful. It would be interesting to see if they are actually worse than your home test.

Ask your doctor why the EPR is not in the test, but he probably mentioned it for a reason.  EPR is basically bilevel pressure, which means your exhale pressure is lower than inhale pressure.   Resmed only markets it as a comfort feature, but trust me, it's the same as my bilevel.  Here is an example of my wife's charts showing the mask pressure in blue below the respiratory flow rate. Your Dreamstation can't do this.

[Image: attachment.php?aid=27301]

Oh that’s really interesting. So the report says under interpretations and recommendations “alleviation at the final settings: CPAP pressure 7, EPR = 3” - which doesn’t necessarily mean I need a CPAP/APAP but a BiPAP? 

Sorry for all the questions. Thank you, I really appreciate your help.
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#17
RE: Help interpreting OSCAR data?
The language suggests exactly what I said, Resmed Airsense 10 Auto set with pressure 8 and EPR 3. Pressure support with equivalent or better treatment is also possible with the Resmed Aircurve 10 Vauto which is "BiPAP" in Philips terms or VPAP in Resmed terms. The Resmed bilevel uses PS (pressure support) and while it is probably superior to the CPAP EPR, your doctor was clearly saying you should use a CPAP with EPR. That is ONLY provided by the Resmed Airsense 10 and 11 series CPAPs or Autoset. You can get the treatment specified with the same CPAP machine my wife uses.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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#18
RE: Help interpreting OSCAR data?
(02-24-2023, 06:04 PM)Sleeprider Wrote: The language suggests exactly what I said, Resmed Airsense 10 Auto set with pressure 8 and EPR 3.  Pressure support with equivalent or better treatment is also possible with the Resmed Aircurve 10 Vauto which is "BiPAP" in Philips terms or VPAP in Resmed terms.   The Resmed bilevel uses PS (pressure support) and while it is probably superior to the CPAP EPR, your doctor was clearly saying you should use a CPAP with EPR. That is ONLY  provided by the Resmed Airsense 10 and 11 series CPAPs or Autoset. You can get the treatment specified with the same CPAP machine my wife uses.

Ah okay, I think I get it now. I’ll talk with my doctor and try to discuss it. Maybe that’s what she was saying when she scheduled me to get the CPAP. I was under the impression that it would be exactly the same as my Philips one so I was pretty disappointed when I heard “CPAP.”If she doesn’t suggest the Resmed Airsense 10 then I will ask for it! Thanks again for all your help Smile
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#19
RE: Help interpreting OSCAR data?
Request that your prescription specify the Resmed Airsense 10 Autoset at the prescribed pressure and EPR, with the words Dispense As Written. That will prevent substitutions by the supplier. You should feel free to tell your doctor of your experience on the Philips Dreamstation as uncomfortable and less effective and you believe the Resmed should work much better with EPR based on your test.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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#20
RE: Help interpreting OSCAR data?
(02-25-2023, 09:45 AM)Sleeprider Wrote: Request that your prescription specify the Resmed Airsense 10 Autoset at the prescribed pressure and EPR, with the words Dispense As Written.  That will prevent substitutions by the supplier.  You should feel free to tell your doctor of your experience on the Philips Dreamstation as uncomfortable and less effective and you believe the Resmed should work much better with EPR based on your test.

Hi again! So I will be picking up my Airsense today! I wanted to ask for your thoughts though - they were saying that my dream station 2 already has something like the EPR just named something else. Is that right? is  there any difference?
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