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Newbie question - No OSCAR data yet.
#21
RE: Newbie question - No OSCAR data yet.
Let's do some chart interpretation using what you posted earlier. It might help you understand. You are using a Resmed Airsense 10 Autoset at a pressure range of 10 to 20 cm with EPR at 3 cm.  These settings mean you're leveraging most of the power of your machine when it comes to flow limitation and hypopnea, and the machine has enough room to increase pressure for obstructive apnea.  As you fall asleep at 21:30 you pretty quickly develop flow limitation which increases the pressure. Flow limitation can come from congestion, a partially obstructed airway or chin tucking.  This looks like as you relax,  your airway narrows quickly.  As the flow limitations grow, you react by taking larger recovery breaths because you are not getting enough air even though your pressure has risen to 15/12 cm. We see the first hypopnea which is at least a 50% reduction in breathing volume, and a series of respiratory event related arousals (RERA) which are recovery breathing indicating an arousal.  Arousal may not be awakening, but it is disruptive to sleep. At 21:45 you have a cluster of hypopnea followed by a cluster of obstructive apnea, which is a complete cessation of breathing.  The fact the machine is unable to keep your airway patent at 15 cm means this is likely a positional (chin-tuck) issue.  Suddenly, we see the air-flow significantly increase at 22:55 which means you physically moved into a position that is more protective of your airway.  After this, there are infrequent OA or CA events and you appear to enter into your first REM sleep at about 00:00.

We could go on, but I think this gives you a start to understand what we are looking at. There are clusters at 03:30 and 04:30 that also look positional.  I think this can be overcome, and I would suggest a pillow with a bit more "give". Some members have done well with the shredded foam My Pillow brand.  We can hold off on using a collar until you try some other approaches. Your minimum pressure probably needs to go up to 12.0 which is closer to your median.

[Image: attachment.php?aid=18338]
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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#22
RE: Newbie question - No OSCAR data yet.
Wow! Thank you SleepRider! Much appreciated! As I stated, I am still learning and trying. Smile

I raised my pressure to 11 on 12/24 and honestly had a terrible night sleep Christmas eve with and AHI of 7 and a LOT of aerophagia. I woke up in the middle of the night and felt like a balloon that was about to burst. LOL Not sure what that happened and since my median pressure is higher than that, I tend to discount the pressure change as the cause of the aerophagia. Last night I slept good and I feel great today. According to Myair, my AHI was at 3. I will post the OSCAR data from last night when I get home later. I don't want to make too many changes too quickly, so will leave the pressure at 11 for a few days to see what happens. I will also look into the MyPillow. Thanks again!
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#23
RE: Newbie question - No OSCAR data yet.
Here is my data from last night.    I would have said it was one of my better nights.  I'm obviously new at this, but from what I have read, the clusters of events point to chin slippage?  Its odd, they also seem to occur when my leak rate is higher too.   As usual, thanks for your input.


Attached Files Thumbnail(s)
   
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#24
RE: Newbie question - No OSCAR data yet.
It looks like you are still getting flow limitations which are causing RERA events.

I'd be interested to see how your flow rate looks zoomed up close on one of those yellow RERAs where the pressure is high at 19
Not the ones where the pressure is lower ... aim for the ones where it is at 19.
EDIT: Try the one just after 23:00

I'm looking to see if the inhalation looks nice and rounded or flattened or chair-shaped.
I think I know what we'll see but can you do that zoom please?

EDIT: See my "What I learned to day about RERA" post http://www.apneaboard.com/forums/Thread-...#pid323859

HINT: Up and down arrows to zoom, left and right arrows to slide the timeslot
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#25
RE: Newbie question - No OSCAR data yet.
I'll upload the zoomed data this evening.   Thanks again!
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#26
RE: Newbie question - No OSCAR data yet.
Since you experience aerophagia with higher pressure, and beyond a certain point higher pressure does not appear helpful, I think your minimum pressure of 11.0 looks good, and a maximum pressure 14 may help in achieving less disrupted sleep. A pressure range of 3-cm is usually effective and we should give 11 to 14 a shot to see if that is true for you. We can see that events of hypopnea, RERA and flow limitation are strongly clustered, and a soft cervical collar could probably tame those. The choice is yours, and whether the positional therapy is better or worse for your sleep should drive your decision. The key objectives with CPAP therapy are reducing the events and maintaining comfort. This needs to be a balanced goal with comfort and "how you feel" being more important than great numbers / AHI.
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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#27
RE: Newbie question - No OSCAR data yet.
Sorry for the delay.   Hopefully I zoomed this in correctly.     Thank you!


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#28
RE: Newbie question - No OSCAR data yet.
(12-27-2019, 10:40 AM)Sleeprider Wrote: Since you experience aerophagia with higher pressure, and beyond a certain point higher pressure does not appear helpful, I think your minimum pressure of 11.0 looks good, and a maximum pressure 14 may help in achieving less disrupted sleep.  A pressure range of 3-cm is usually effective and we should give 11 to 14 a shot to see if that is true for you.  We can see that events of hypopnea, RERA and flow limitation are strongly clustered, and a soft cervical collar could probably tame those.  The choice is yours, and whether the positional therapy is better or worse for your sleep should drive your decision.  The key objectives with CPAP therapy are reducing the events and maintaining comfort.  This needs to be a balanced goal with comfort and "how you feel" being more important than great numbers / AHI.

Thanks Sleeprider.   I haven't bought a collar yet, but have changed to a thinner pillow to try to change things up.   I will give it a few nights to see how that goes.  In the meantime, I guess I will go ahead and order the collar to give that a shot  too.   It's a small investment and may pay dividends so what the heck.

Thanks again!   Have a Safe and Happy New Year!
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#29
RE: Newbie question - No OSCAR data yet.
All of the examples in your charts show classic inspiratory flow limitation leading to an arousal (RERA). In this example we can see flow limited inspiration, and an abrupt arousal with larger volume breaths as you change sleep stage or awaken to promote better airflow. Interesting feature here is expiratory snoring during the arousal. I rarely see this good of an example of expiratory snoring.  The machine responds to the flow limitation by moving from 15/12 to 16/13 pressure but fails to stop the RERA in time.  I'm a bit surprised that the machine is not moving quicker on flow limitation ahead of the event.

The ideal solution for the hypopnea and flow limitation is either greater pressure support (bilevel), or protecting the airway physically from restriction (collar).  In a perfect world, you would be more comfortable with a bilevel machine like the Aircurve 10 Vauto set at EPAP min 9.0, PS 4.0 and IPAP max 18.  With bilevel the pressure support can be titrated to eliminate these kinds of events at generally lower pressures than will resolve them with CPAP.  

Just a quick question, do you have COPD? Expiratory snoring is often predictive https://www.ncbi.nlm.nih.gov/pubmed/26630563


[Image: attachment.php?aid=18502]
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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#30
RE: Newbie question - No OSCAR data yet.
As usual, Thanks SleepRider.   I have ordered a soft collar from Amazon and will give that a shot too.

I have an appointment with my doctor so will ask him about these results and possibly a bilevel machine although I am not clear what the difference is between a bilevel and the APAP I have  (So much still to learn LOL).    



No, I have never been diagnosed with COPD and don't have shortness of breath etc when awake.   I do have some sinus issues that make breathing through my nose problematic.  Not sure if that could have anything to do with the results on the graph.

Anyway,  I'll give the collar a shot and report back.  Smile

Thanks again!
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