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Oscar Data ?/ switch from APAP to Resmed Bipap or ASV?
#1
Oscar Data ?/ switch from APAP to Resmed Bipap or ASV?
After three year compliant use of APAP, my AHI are still over 5 and my Daytime sleepiness is  getting worse. Seems like many use Resmed Air Sense 10 ( better algorythm?). Recent in home  LOFTA/ Itamer PSG showed worse OSA ( from 17 in 2018 to 30 in 2020). They provided a RX for the Resmed but i need help looking at the Oscar Data if it shed light on  more issues...REM/Centrals/ etc. that I need to ask about at a new Pulmonologist Appointment.
I should try to sleep on my side, otherwise my sleep hygeine is good.


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#2
RE: Oscar Data ?/ switch from APAP to Resmed Bipap or ASV?
The bulk of your numbers is the CAI. After years of use it is not treatment emergent central apneas.
Post a redacted copy of your original and subsequent sleep studies. Full copies, not just the summaries. They should have charts and tables. Looking for evidence of centrals without CPAP.

Also post 10 minute views of your centrals. This is to see if we can see what is driving your centrals.
.
While I prefer ResMed devices, they will not manage the centrals any better than your PR machine.

For sure an ASV will do the trick, we prefer the ResMed there as well. Different algorithim.

Another thing that may work. Get a 1 week at home trial of the ResMed AirCurve 10 VAuto, ResMed's auto BiLevel. It has a trigger setting that can be set at a higher/more sensitive setting than normal which triggers the PS to come on a smaller starting signal. Several VAuto users here use this and it manages low levels of centrals even though it is an off book use of that setting.

IMHO if the VAuto works it would be the better choice.

Otherwise the goal is to get a ASV, typically by proving it's rffacy in a titration study.
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#3
RE: Oscar Data ?/ switch from APAP to Resmed Bipap or ASV?
I think what the doc could do is titration with ASV if you end up going that path. This way, the test can show successfully treated with mode x and pressure y.

Agreed on trying VAuto first to see how that goes.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#4
RE: Oscar Data ?/ switch from APAP to Resmed Bipap or ASV?
Shulamet, it would be good to zoom in on a region with both CA and OA. I suspect that many of the OA are misclassified CAs (which is what I see in my data when I was using PR - now on Resmed I only see CA). The period around 2:50am on April 10 might be appropriate.

I think the key here is to try and treat the PLM which is likely the underlying trigger of the SDB. As discussed in other threads PLM can be a result of PAP therapy but it is more likely present without PAP and confounds PAP treatment. Do you have a baseline PSG which measured PLM?

[ Oh, and please keep your stuff together! ]
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#5
RE: Oscar Data ?/ switch from APAP to Resmed Bipap or ASV?
Thank you for the responses. I will try to follow up on the suggestions.
Trying to absorb more information and saw responses on another thread.
I may try these now until I can get a ASV Titration ( which is what I had asked for from my last Doctor):
I will turn off ramp. I will either turn off EPR or try to set it at 3. I will change my setiings back to 7-12 as I am concerned that the high pressure caused emergent Centrals.....
I have no idea what EPR is I think it relates to exhale resistance.
I will try to redact my name and scan my prior studies. which were pretty inadequate.. Even scanning is not so straightforward. I have no idea how to zoom in on Oscar.
Asking for patience as my cognitive capacity is reduced by EDS etc. I have spent significant time reading on this Forum to get the courage to post....not everone's brain is hardwired the same nor even when reading WIKI implementing it is not intuitive....I have analytical skills but not engineering/computer science. I am exhausted.
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#6
RE: Oscar Data ?/ switch from APAP to Resmed Bipap or ASV?
EPR, Expiratory Pressure Relief, is officially a comfort feature. In this role it lowers your exhale pressure to make it easier and more comfortable to exhale.

Beyond that there is therapeutic magic in there. In the CPAP/APAP class of machines EPR is the best tool to treat hypopneas, flow limits, , RERAS, UARS, and even snores. You have to go to the next class up, a BiLevel/BiPAP, to get similar, better capability.

Increase EPR to treat/reduce obstructive events.

IF your Central Apnea is treatment emergent, and I don't believe it is because of your length of use of CPAP, your Central Apnea will increase. IMHO any increase that YOU see will be minimal.

Don't be afraid of higher PS or EPR.. on an ASV the default PS setting is 3-15. ASV starts with the max value your machine can set.

Setting EPR off will give you the minimum that your machine can do.

Setting EPR=3 will do the best job possible for resolving obstructive events.
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#7
RE: Oscar Data ?/ switch from APAP to Resmed Bipap or ASV?
Shulamet, perfectly understand that all of this is pretty overwhelming. There's a mass of information and opinions out there and sifting through it and identifying what is right for you is challenging even without reduced cognitive capacity.

To zoom in on a particular time period in OSCAR you can just drag your mouse over that part of the graph while holding the left mouse button. You can use the right mouse button to drag left and right. There's an example video on youtube here that might be useful.
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#8
RE: Oscar Data ?/ switch from APAP to Resmed Bipap or ASV?
The easy part is using the PAP and mask. The hard part is jumping through all the flaming hoops to get doc to create a script and insurance to pay for it, and oh yep, the DME to not substitute the wrong brand.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#9
RE: Oscar Data ?/ switch from APAP to Resmed Bipap or ASV?
I read the wiki and I think because I have a Dreamstation EPR settings is for Resmed and Phillips is "CPAP exhalation pressure relief". I probably missed something...
I not find a setting for that. I will try the CPAP Manual route in case I missed something in settings....
Your explanation of the devices in another thread was great. Thanks
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#10
RE: Oscar Data ?/ switch from APAP to Resmed Bipap or ASV?
Philips CPAP machines do not have a therapeutic equivalent to EPR or PS. This is a very large part of why we so strongly support ResMed.
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