Newbie OSCAR Data

[rspienciak]

I'm on week two of using a CPAP. Any advice or recommendations based on the attached charts? Thanks!

       

[Dormeo]

Welcome! You're doing really well here at the outset of your PAP therapy. I will probably have a few suggestions about your settings, but first I'd appreciate a little more information.

Are you feeling rested during the day?

Are you doing any sleeping without the machine?

Did your sleep study show any central apnea events?

[rspienciak]

I am feeling pretty simliar to pre-CPAP in terms of restfulness. I think I'm still getting used to sleeping with the mask on, because my "awake" time on my apple watch is drastically higher than it was pre-CPAP. My AHI was 22 in sleep study, so I've drastically reduced those already, but I think I'm REALLY waking up more now. Hoping that will decrease in future!

I have been in the habit of getting 5 hours or so with the machine on, and then going back to sleep for a few hours without it after a bathroom break. So I am doing some sleeping without it, mostly at the end of my sleep time. Trying to be better about this though!

As for Central Apnea on the sleep study, I'm not sure as that phrase is not anywhere on the report. Is there something else I could be looking for on the sleep study? (I'll attach it in case that is helpful!). I'm concerned about the high amount of CA events on OSCAR data, but unclear if it's a "real" Central Apnea or not! 

Thank you so much!

---

Also, the sleep study recommended a pressure range of 6-18, which is different than the 4-20 that the technician set me up at!

[crashdavis]

I am absolutely the same.  I tend to remove mine late morning, 4,5,6 am.

[Expat31]

Hello, 

Thank you for taking the time to carefully present your graphs in such a clear way, with all the key information easily visible for us. It helps a lot.

From what I can discern from your sleep study, there was no clearly indicated breakdown of AHI between obstructive, central and  hypopneas.

On the face of it, your OSCAR graphs indicate only central apneas. These could be machine induced that should dissipate over time.

But I am suspicious that they may be really false positives, being actually obstructives.

I would be inclined to do this test -  try increasing your minimum pressure to say 7*, and see what happens.

If no impact, then likely they are centrals and further review would be required. Its at least a start at the moment. 

Curious the sleep tech did not follow the sleep study recommendations...

.* To change settings, you need to go into the  clinician's menu, press center radio button together with the home button at the same time for about 10 seconds.

[rspienciak]

What does it mean if increasing the minimum to 7 gave me a lot MORE central events? It's only one night but this was by far the worst AHI i've had since starting the machine... I'm also (even before increasing the pressure) experiencing an issue where my mouth fills with air and then I wake up and need to open my mouth to "vent." Thoughts?

   

Thanks.

[Expat31]

Sorry you are having worse sleep with an increase in minimum pressure of 7, increased from 4.

An increase in central apneas can be caused by the flushing out of C02, by the differential between inhale and exhale pressures, tricking the brain to stop breathing, to clear out C02. 

Often EPR can cause this.

However, in the graphs you have submitted so far, EPR has been set to off. So it appears EPR is not the cause. 
On your first graph dated the 28th, all the events were centrals, but the exception of just one hypopnea. 

So there could be already an underlying issue with centrals, but as far as I can tell, no such evidence of central apneas have shown up in your sleep study. 

Was the sleep test designed to detect these? Do you have a doctor's written medical review of the results? 
At the moment there is just a note at the bottom of the last page "Reference values given by a physician”. 

Was it carried out under AASM criteria? 

To try to answer your question ”why the increase in pressure caused an increase in central apneas”, I could only think that the increased air rush you experienced, caused more C02 to vent in the same way as the EPR effect.

 Perhaps the p30i  pillows mask is not for you. Have you tried a full face mask? 

Your quality of sleep would have likely improved if I had suggested EPR set at 3 with the pressure at 7, but avoided this suggestion as centrals already present. 

Are you taking any sleep aids, or other medicines that could likely provoke central apneas. Best to check with your doctor. 

I would think the next step would be to try a full face mask. This should stop the venting issue, and improve sleep quality. If you can tolerate a minimum pressure of 7, with EPR of 3, it would be a good start.

[Dormeo]

You had a few CAs during your sleep study -- nothing interesting. (It's the pAHIc number.)

Higher pressures can induce more CAs. The machine is good at distinguishing between CAs and OAs, but what it can't tell is whether you're awake when you have a CA. I'm willing to bet that if you zoom in on your CAs, you'll see some arousal breathing right before the CA flag. Arousal breathing is deeper and messier-looking than regular asleep breathing. Arousals can be brief; you may not remember them.

As you get used to the machine, you'll probably have fewer arousals and thus fewer CAs.

You're doing really well at heading off OAs at low-ish pressures. Your pressures are going up in response to your flow limitations. You might try min = max = 6 and see how that goes.

For air in your mouth, start training your tongue to work as your gatekeeper. Try putting the tip of your tongue behind your upper front teeth. Then position the main part of your tongue up against your upper palate. Finally, give a little suck or swallow to create a bit of suction. You should now be able to open your mouth while breathing entirely through your nose. Practice this during the day, and see if you can get it grooved in deeply enough to help while you are asleep at night.

Finally, do put your mask back on after you get up to go to the bathroom. It's important not to get into the habit of sleeping without the machine.

[Deborah K.]

Your sleep study showed a very low ratio of CAs, so yours are treatment-emergent and will lessen as time passes.  Don't worry about them.

I agree that turning EPR on full-time and setting it at 3 should make you more comfortable. Your AHI may rise, but don't worry about that. They are just numbers, and as I said, they will decrease in time. Your comfort is more important.

Best wishes for achieving great therapy and comfort!

[rspienciak]

Just want to say that this board is really great. I feel like there are 50 other areas of my life that could benefit from a similar group of support/knowledge! Thank you!