[Pressure] I have uploaded my data to OSCAR, now what?

[XeniaBoy]

I am a new member of the forum and have several questions regarding understanding the data from OSCAR.  I have been using my CPAP successfully since 2007, I am on my fourth machine, a Phillips Dream Station 2 which I am using as a CPAP but it appears to have auto capability.  As I have aged, I am going on 73, my annual visits to my doctor have resulted in a study increase in pressure,  I am now at 19, to keep my 30 day average AHI below 5.  I am now 20 pounds lighter than when I started using the CPAP in 2007 and since my pressure was increased in February from 18 to 19 my AHI has gone up, some nights as high as 11.5 and my wife says that she is hearing a high level of air escaping from my mask.  I wear a Phillips Dreamware silicone nasal pillows mask and my Dreamstation gives me a Good Mask Fit message every morning.  I lowered my pressure from 19 to 12 and increased my ramp pressure from 4 to 7 thinking that the reason my AHI was going up was because of the high pressure level causing my mask to leak.  Below are my charts from this past Monday:

1. Does the data indicate that my mask is leaking or that I am opening my mouth?
   
2. Is the Leak Rate data indicating that I was 35% higher than Leak Rate threshold an indicator that my nasal pillow mask may not be suitable for this pressure level?
   
3. Any other data points that I should discuss with my doctor?
   
4. I am happy that this forum exists and look forward to your feedback!  
   

           

[Sleeprider]

You are using a Philips Dreamstation 2 at a pressure of 12. We don't see many Dreamstations since they were discontinued in the U.S. under the consent decree, and you would do much better with a Resmed Autoset if you can make the switch. We prefer to see the full graph and statistics as shown in the tutorial Organize Your Oscar Charts linked in my signature below. You have a median leak rate of 14 L/min, so you have a fit or size problem. Nasal pillows are a very reliable mask that can handle any pressure, but if leaks occur around the mask fit or if you open your mouth and leak, then you may need a different style. You have relatively high flow limits and would benefit from the Resmed EPR. As far as your appointment with your doctor, ask why you ended up with this machine that has been withdrawn from the U.S. market.

[XeniaBoy]

Thanks so much for your feedback!  I received the Dream Station 2 when my last machine was recalled by Phillips.  Not sure why it was prescribed by my doctor as my first CPAP was a ResMed.  I am now on Medicare and not sure what the rules are around machine replacement.  Attached is my file from last night.  I don't believe that my mask leaks when I put it on at the ramp pressue of 7 but I will try it tonight at 12.  My wife says that she hears me snore occaisionally and I am wondering if that is an indication that I am opening my mouth?  I have never taken my mask off during the night and have never been aware that my mouth is opening.  I beginning to wonder if that has been happening for a while which has cused my doctor to just increase my pressure over time?  Attached is the data from last night.

[Sleeprider]

I recommend you discuss your difficulty with efficacy using the Philips Dreamstation 2 and note that this device is not supported by the manufacturer. Request a prescription for the Resmed Airsense Autoset CPAP and see if it flies with your DME for a claim. The Dreamstation is complete garbage, and I'm certain the Resmed can greatly improve your results. The Resmed CPAP is actually a bilevel with up to 3-cm pressure difference between inhale and exhale and is particularly effective at reducing flow limitation and arousals related to upper airway resistance. The Vauto bilevel is better, but anything to dump the DS2 CPAP.

Your last chart suggests pressure is too low to be effective. We know the Dreamstation auto algorithm is slow to increase pressure. Let's try turning off ramp, and using the Auto CPAP mode with minimum pressure 12, Maximum pressure 15, and A-Flex at 2. this will give a somewhat more comfortable pressure as the device will relieve pressure on exhale. Note, I have assumed you have ramp on because your device is reducing pressure to 7.0, and you have a lot of events when the pressure is low. If I'm wrong, then there is a defect in the machine which should be maintaining a steady 12 cm pressure in CPAP mode.

[ejbpesca]

I too have a DreamStation 2 sent to me as a replacement from Phillips.  I have never used it because I had already switched to ResMed AirSense 10 by the time it arrived.  At the end of the AS10's service, I tried AirSense 11 but had trouble with it so back to an AirSense 10.  

According to my DME, they have customers who use the DreamStation 2 replacement without complaint although its sale was banned in the U.S.  A search for why it was banned in the U.S. produces evidence of why so many have switched to ResMed.

At the end of the 5 year service time of the DS2, a ResMed will be the likely replacement.

[jdougc]

I also have a DreamStation 2 sent to me as a replacement from Phillips. 
Tests by independent laboratories retained by Philips had found that a different foam used by the company — material fitted inside the millions of replacement machines — was also emitting dangerous chemicals, including formaldehyde, a known carcinogen.
https://www.propublica.org/article/philips-recall-machines-chemicals-of-concern

I replacement the airchamber in the original Dreamstation with one without foam and had a technician friend just removed the foam from the Dreamstation 2, providing my with backup machines.

My newer local DME supplied me with an AirSense 11 last July, but that proved to be ineffective for my apnea treatment.
I purchased a lightly used AirCurve10 out of pocket and am slowly getting used to it, struggling post neck surgery.
Good luck!

[XeniaBoy]

Thanks again for all of your help with this.  I made the changes that you suggested have have achieved better results.  Since I am now starting at 12, I am noticing that I have to be intentional about keeping my mouth closed when I first lie down before I go to sleep and since I usually wake up several times in the night, either to go to the bathroom or because I wake up, going back to sleep can sometimes be an issue.  I have experienced insomnia all of my life so that impacts how rested I feel.  Since my leak rate is still high and I do have several instances of snoring, do I need to consider changing from the nasal pillow mask to the hybrid type in addition to getting a better machine?  Regarding, the bi-level type machine, what factors and values are considered to justify the expense for insurance?

[jdougc]

A new machine would not be able to delivery adequate therapy with such leaks.
You appear to be mouth breathing, consider using 2x5 strips of Kinesiology tape, regular original cotton elastic athletic tape or a SomNoSeal  a soft, flexible mouthpiece that prevents mouth breathing and dry mouth during sleep. 

[ejbpesca]

Being a mouth breather during sleep and having failed to keep it shut with tapes/chin straps/collars/mouth appliances I use an F40 hybrid mask.  It is nasal until I roll to my back during sleep and mouth breathe.  For me, the F40 has been a big improvement over the F10 and F20 full-face masks.

Getting a BiLevel machine and having it covered by insurance means I must get it prescribed by my pulmonologist.  I will request one when the 5 year service period is up for my APAP.   If another sleep study is needed to establish the need for one I will probably pass on it.