Thoughts on my OSCAR chart?

[mikesd]

Hi. I was prescribed my CPAP a couple of years ago. However, I'm one of those people who tried it, didn't get used to it, and I didn't think it made a big difference. My sleep got worse, so here I am again. Well, my CPAP makes a huge difference in my energy and even ability to think clearly. I've been using it regularly for a couple of months. 

My pressure is pretty low because I was swallowing air. I think that was mainly happening when I slept on my back, but I mainly sleep on my side now. I can probably raise pressure if needed. 

I've included a typical night, and a zoom in. I would sure appreciate any insights from the charts. Thank you!

   

   

[kellybig]

I know very little about this as I’m new. Your having basically no events. How do you feel?

[Expat31]

Hello, 

A few observations on your graphs:- 

Your 95% flow limitations are too high at 1.4. They should be around 0.05 to achieve best sleep comfort.
Reduction in flow limitations is obtained with a combination of a sufficent minimum pressure, together with a suitable corresponding EPR level. 

You have 2 possibilities to try:-

 (1) You have currently an EPR level of 2. To be effective, you need a minimum pressure of 6. Your current minimum pressure of 4.4 won't work as too low.
 Or
 (2) You can increase the EPR level to 3, with a required minimum pressure of 7.

You can chose which of these options is best for you.

[2SleepBetta]

A bit different take, but much the same thought about raising EPAP to no less than 5, maybe 5.5, and EPR to 3. I don't recall AB advisor consensus on dealing with aerophagia, but having experienced it (only) early myself, I suggest you try each slightly higher pressure adjustment for a few days in succession. Watch your CA's though, we don't want a significant, persistent increase in them.

There are only three flow limitations as high as 0.18 after 0110. You have wiggle room to get to a FL-aerophagia sweet spot at higher EPAP. The lengthy, high, early flow limitation before 0110 skews the 95% figure.

Your opening flow limitation and snore bursts are most interesting and do beg explanation. Possibly, after initial sleep-wake junk and falling asleep, it seems you rolled to your personal-worst supine positioning, with holdings of breath. The need for sudden PAP pressure rise came, but it came far too late and low for whatever your peculiar initial snore/flow-limitation conditions were or are.

I think you may resort to your most troubling supine sleep position more than you realize and that it shows in your flow rate.

There are effective commercial and DIY devices for preventing supine sleep. Some far less draconian than I have used and posted as DIY's. With my severe apnea long controlled well,  flow limitations continue as a trouble of mine as I look for my EPAP and pressure support (PS) sweet spot to enable more REM and restful sleep.

Like you, I blew off my first (sleepless?) sleep test. 'Got serious addressing my severe apnea years later.

[Expat31]

Hello, 

I did not bring this up my last post, but your flow limit graph is deceivingly optimistic, due to the scaling. 

We need a much higher level of detail.

To do this, over the flow limitations scale, right click, select y axis, override, set min to zero, max to 0. 20.

Likely will show a very different picture...

[mikesd]

Wow, I really appreciate all the help. I have to do some reading to understand the guidance here, plus watching the video in Expat31's signature. I'm going to try the adjustments recommended. 

@Expat31 - Maximizing sleep comfort would be good since it's tough for me to keep the mask on for a full night.

@2SleepBetta - I think I may be rolling onto my back, so I'll look into some of the less draconian methods of preventing it. 

As requested, I've included the above charts with Flow Limitations scaled to 0.2 max. Hopefully this provides more insight. 

Thanks again!

   

   

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