Shazbat's Therapy Thread

[Shazbat]

I can understand the basics of the Oscar reports, but I would love to correspond with someone who can read and interpret them better than me. 

I have taken screenshots from Oscar from a typical nights results on CPAP. Can anyone interpret them for me please? How am I doing  

   

   

   

---

   

   

   

---

   

   

[Gideon]

Your numbers (AHI) are as good as they get, which opens the question How do you feel and please be critical.

Your settings are those of one who has never been optimized, this is indicated by the min pressure setting of 4. Generally, this is considered a pediatric setting and most adults feel air starved, breathing thru a straw, or even removing the mask so that they "can breathe".
Your Flow Limits are somewhat elevated. This is not necessarily bad but you can consider them as apneas/hypopneas that didn't make the cut, in other words they could be significant. We use EPR to treat these, we like to see the 95% value at 0.10 or less.

Changes,
Min Pressure = 7, to eliminate the "air starved" feeling you may or may no be feeling but in your case to give the EPR room to work.
EPR = 2, the mid value, to both aid in comfort and to decrease your flow limits.

These pressures are low, you should not need the ramp so if you are using one turn it off for now, if needed it can be turned back on.

[Shazbat]

Thank you

To be honest,  I haven’t really felt any improvement, maybe a little less sleepy in the day. But I have only been using it for about 3 months. The dry mouth keeps waking me up, I have tried a chin strap, mouth plasters, xylimelts and saliva gel and also different levels of humidity, but to no avail.

My private sleep test said 25ah and my NHS one 27ah (although they seem to have ‘lost’ my NHS report). Having had 2 heart attacks in the past, I’m using it more to slow down my health problems.

I’ve never had a problem with the pressure starting at 4 (Resmed N30i cushion mask) and I’ve always fallen to sleep quite quickly, even before CPAP. But I will try starting at 7 and turning the ramp off, to see how it goes. 

When you say the flow levels are elevated, what does that mean please and what is EPR?

[Melman]

EPR is exhale pressure relief. The machine senses when you begin to exhale and lowers the pressure by 1-3cm depending on the setting. It is intended as a comfort feature but also can be used therapeutically to lower flow limitations and obstructive events.

[Shazbat]

Just wanted to say thank you for your help. I changed the settings as suggested (ramp off, min. pressure 7, EPR 2) and it was wonderful. I didn’t realise until I changed them that it had been uncomfortable

I will carry on with these settings and in a few days post some updated Oscar screenshots, to see if it has improved my flow limits etc.

[Shazbat]

Just a quick question. Since changing my settings to the above, I wake up after several hours with my top front teeth really hurting. Is this due to any of the setting changes?

[Gideon]

Is the N30I pushing over your front teeth?

[Shazbat]

Not really, I have it high up on my nose, with the bottom of the cushion on the bottom of my nose. I also keep the straps quite loose, so there is no pressure.

[Shazbat]

OK, here are my new stats. Have they improved with the new settings please?

   
   
   

---

   
   

  O2Ring 090821.pdf (Size: 274.56 KB / Downloads: 0)

---

   
   

[Sleeprider]

In comparing new results with old results, your 95% flow limitation has improved from 0.14 to 0.07 which must be a significant relief. Your tidal volume has improved from 340 mL/sec to 400 and the minute vent has gone from 5.38 L/min to 6.0 L/min. This shows you are considerably better ventilated throughout the night. This has been accomplished while your median pressure has dropped 2-cm from 10 to 8, not to mention the lower exhale pressure which has dropped from 10 to 6 cm-H2O. So you are breathing better at lower pressure. That sounds like a win, and the most important factor of all is your comfort and how you feel the next day has qualitatively improved.

Moving forward, I think you should increase the minimum pressure to 8.0 and EPR to 3. This should continue the good trends we see in these results and perhaps improve on them.