Please help with Oscar data

[ejbpesca]

I had thought I was a side sleeper until realizing I made stops in the middle...on my back and that's where the clusters happen.

[nailzscott]

The cluster of Apneas at 3:20 and 5:40 AM in the Event Flag and Flow Rate charts are Positional Apneas. 

As to 3 EPR, I know you are already using 3 EPR, but to utilize 3 EPR fully you need to have your minimum pressure set to at least 7cm.  When you are set at 5cm minimum pressure with 3 EPR you are actually only getting 1 EPR, rather than 3 EPR as the CPAP will not go lower than 4cm minimum pressure.  



A 4cm or 5cm minimum pressure is normally too low for an adult and the 7cm minimum should also help to eliminate some of the other apneas you are having.

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I changed the pressure to 7 - as you suggested.  Attached is the resulting data from last night.  As you can see there is a whole lot less activity in the charts.  Not that I understand all of the activity but I did notice that the event flags is as unpopulated as any I've had.

Does it seem odd that the initial setup from my provider (based upon the doctor's orders) had the lower setting at 6 - even though you have stated that it needs to be 7 to utilize EPR.


[/quote]

[SarcasticDave94]

Most of these sleep specialists don't care to understand all the CPAP settings, nor make use of the auto aspect. EPR from ResMed is marketed as a comfort item, but users have found in practice the EPR is a therapy item in disguise.

Also doctors would rather hook you into settings that sometimes don't make sense, only to require you to visit the office to plead your case for new settings, which includes the bonus of a new copay, new script with the new settings. Rinse repeat 10X before the CPAP is set reasonably well.

Welcome to CPAP circus.

[ejbpesca]

I first found it odd, then frustrating, and now completely befuddling that not one of 5 DMEs and 2 doctors has taken any action to adjust my machines, ask me if therapy is working, or review OSCAR reports over my 18 years of therapy.  I have undergone 4 sleep studies and 1 nap study in-lab. Nothing was ever explained to me from the data gathered except for a diagnosis of severe apnea and that I must use a full face mask.

It has been bizarre to deal with doctors, technicians, and DMEs who are incommunicado.  Attempting to get answers/help from them I am met with robotic like statements that demonstrate little to no knowledge of PAP therapy.  None know of OSCAR. When I speak of OSCAR to them I am met with a blank stare.

I see a doctor once a year to get my prescription renewed.  Nothing is discussed.  I am asked one question. "Do you use CPAP at least 4 hours per night?  I reply yes, taps are made on a computer keyboard and I leave.

[nailzscott]

About a week ago, as recommended by Old Steve, I adjusted the EPR to 3 and my overall events dropped dramatically. Here I am about a week later and my CA events have risen quite a lot. Which brings me to a new area of review. I now have a lot of moisture in my mask - so much so that the flaps in the hose elbow (nearest my face) can get stuck open.  After reading a bit, I increased my hose temp a bit and lowered my humidity; but what is a normal setting for these?

I was concerned about setting the Humidity too low since I have also experienced "dry mouth" at some point.

I have also read about placement of the hose. My machine resides lower than the bed but due to the fact that I use an adjustable elevated head bed, the hose goes up above the elevation of the head of the mattress and then downward toward the side of my head.  I need it that way because I do role back and forth from side to side at night. But that does mean that is about 1 1/2 feet of hose headed down toward my head from the top of the mattress - which allows the moisture to the tip of the elbow and collect. That's when the little flaps in that elbow begin sticking and clicking as I am breathing.

I hope I haven't made that sound more confusing than it is.

I have attempted to clean, blow, and dry the hose out each day but it's odd that I did not have this issue until recently. But after following suggestions on hose position as much as I can - I would like to understand what Temp & Humidity settings are normal to reduce the problem of rain-out.

Thanks

[ejbpesca]

 After reading a bit, I increased my hose temp a bit and lowered my humidity; but what is a normal setting for these?

There is not a normal humidity and hose temperature.  What is the best setting will depend on the room temperature, humidity of the bedroom, and your personal preference.  I do not think the position of your machine will affect the air within the tube.  I would keep adjusting the humidity to less until the moisture problem stops.

Normal for me is no heat and no humidity.  The environment here is so humid there is little/no need for humidification.  Consider how much is the least humidity setting that will suit your needs.

The heat for the tube is to prevent what is called rain out.  It prevents the moisture in the humidified air from condensating in the tube.  Perhaps increasing that would help but it is your mask exhaust that is the problem so reducing humidity more may be the answer.

[nailzscott]

Clear Airway CA - Oscar data.

I have been reading up on the CA value and find to volume of details a bit much to handle and understand, but I'm trying.

A couple of weeks or so ago a user guided me to set my minimum pressure to 7 to properly utilize EPR.  One major thing I noticed the day after that was that my Event Flags for CA switched to an extreme few.  I had previously manually lowered my pressure from it's original set pressures 6 to 14 to 6 to 10 - since the high pressure setting at 14 was blowing hard enough to create a constant fighting of the leaks.  After the advice given on the other post I set the pressure range at 7 to 10;  and that's when the CA's dropped dramatically (see chart pic).

Since I will be going to my DME next week I understand that she will want to slap me for making manual adjustments; so a few days ago  I begin to adjust my top pressure from the 10 I've been using back to the 14 they prescribed.  On my way to increase to 14 I only got to 12 for the last few days and am concerned.  I now have more leaks to deal with, getting worse sleep quality, and noticed the CA's are on the upswing again.  Can these be related to me increasing the top end of the pressure?

I'm including the Oscar chart where my CA's went way down and another chart from last night showing the CA's back on the rise.

NOTE: There are many areas on forums where I am able to help others - this forum is not one of those and I am so appreciative of those of you who are helping to lesson my ignorance on this apnea topic.

[ejbpesca]

Since I will be going to my DME next week I understand that she will want to slap me for making manual adjustments; so a few days ago  I begin to adjust my top pressure from the 10 I've been using back to the 14 they prescribed.  On my way to increase to 14 I only got to 12 for the last few days and am concerned.  I now have more leaks to deal with, getting worse sleep quality, and noticed the CA's are on the upswing again.  Can these be related to me increasing the top end of the pressure?

I'm including the Oscar chart where my CA's went way down and another chart from last night showing the CA's back on the rise.

NOTE: There are many areas on forums where I am able to help others - this forum is not one of those and I am so appreciative of those of you who are helping to lesson my ignorance on this apnea topic.

Look at your red pressure line after you set the max to 12.  The pressure did not rise much more than having the max set at 10 on the previous OSCAR report.  Yes, higher pressure can cause leaks but what I see between the two OSCAR reports is so slight I would not come to any conclusion until after several nights with the 7-12 settings.  Your clinician should be impressed by the 0.75 report.  More leaks can be caused by movement (my situation).  Your Flow Limitations improved by the higher Max setting.  Why the CAs is a mystery to me but, as so often suggested give it time and they may reduce.

I know it is disappointing to see your AHI go up after such a great low one.  From what I've read it is not uncommon to have AHI fluctuations as such.  It is often suggested to give a few days to establish a trend other than using one OSCAR report as evidence.

[jdougc]

How did you feel when you woke up?
Keep a journal and tell your DME provider
We need to see the device settings
Is your ramp set to 5 minutes and 7 cm of pressure?
Hide the AHI and Snore charts when posting
Use F12 for screen captures
The CAs might be caused by your pressure swings. It takes time for our bodies to get used to changes in pressure, and some like me are very sensitive to pressure changes.
Consider lowering your maximum pressure to 9.8 cm since that is way over your median pressure just under your 95% pressure.
Hopefully your CAs will fall and your Apnea events stay ok.
Good luck and

[nailzscott]

Look at your red pressure line after you set the max to 12.  The pressure did not rise much more than having the max set at 10 on the previous OSCAR report.  Yes, higher pressure can cause leaks but what I see between the two OSCAR reports is so slight I would not come to any conclusion until after several nights with the 7-12 settings.  Your clinician should be impressed by the 0.75 report.  More leaks can be caused by movement (my situation).  Your Flow Limitations improved by the higher Max setting.  Why the CAs is a mystery to me but, as so often suggested give it time and they may reduce.

I know it is disappointing to see your AHI go up after such a great low one.  From what I've read it is not uncommon to have AHI fluctuations as such.  It is often suggested to give a few days to establish a trend other than using one OSCAR report as evidence.

Regarding the pressure - looks like the graph shows about 11.3 just before 1:30 but I don't really know what to expect.

Yes the clinician should be impressed by the .75 - after she chastises me for making changes. A couple of days later I had a .49, but ever since then numbers are going up some. 

The 7 - 12 settings have only be for 2 days so far but I'm not sleeping well with the additional leaks.