[Treatment] Interpreting OSCAR data

[Tired Young Man]

           

Hello

I bought and started using  a CPAP (Resmed 10 airsense) a little over 2 weeks ago. While I managed to get used to the mask and sleep the whole night with it on fairly quickly, I have yet to feel any improvements in the daytime. I looked at my statistics with OSCAR but I don't know how to interpret them.

I use an Airfit F20 Resmed Full Face Mask. For most of the nights I had my CPAP on the default settings. For the last 2 nights I had changed the settings by switching it from APAP to CPAP and from Pillow to Full Face, as well as turning off ramp up. The images show my most recent night, the last night before I changed the settings, and the total overview.

My diagnosis was done over 2 days from an at home study, and measured an AHI of 9.54 (12.70 on the first night and 6.38 on the second). Although this is classified as mild apnea, my symptoms are not mild, as I am very dysfunctional in my day to day life, struggling to do even the bare minimum of chores, out of education + work, constant brainfog that not only affects important activities, but even enjoyable ones. However I don't have an issue with falling asleep in the day. I am 21, male, and am otherwise physically healthy (healthy weight).

If anyone can help me out I would be grateful.

[DaveSkvn]

Hi Tired Young Man,

You probably want to watch this video. Particularly the bit at 2:05.

https://www.youtube.com/watch?v=sa9zNYpTWlM

As you say your OSA appears to be relatively mild and well treated by the CPAP (in future screen shots could you click on the down arrow next to the date to hide the calendar - it allows more info to be seen - including the AHI). You probably want to focus on the flow limitations (the term used hereabouts for UARS like problems) which are restrictions in the airway that don't cause complete closure - but may well cause some warning light to flash somewhere in the brain leading to poor sleep. You can see from the flow limitation graph quite a bit of activity - you want that to be blank. (I personally believe the flow limitations recorded by the machine are only a subset used to manage OSA - the true flow limitations can be far more significant.)

I see you have a high respiratory rate on some days. This was the greatest red flag for me. Respiratory rate should be between 12 and 20 breaths per minute. If it goes much above 20 this can be gasping / panting due to a restricted airway. Can you upload a screenshot of your respiratory rate - especially if it is patchy - and zoom in to one minute's data of the detailed flow rate graph when its high?

What can you do about flow limitations? (A) Set EPR to 3 and for full time - not just "ramp only". This means you get a different pressure (difference 3) when inhaling and exhaling. This gives the obstruction a little kick with each breath. In time you may benefit from a bi level PAP machine which allows a difference greater than 3. You may need a slightly higher base pressure than 8 for this to work but raw pressure doesn't seem to work so well on flow limitations.  (B) soft cervical collar - keeps the chin away from the chest and the neck a bit straighter - I found it to make it a big difference and its petty cheap and easy to get hold of.

Give that a shot and good luck!

[Tired Young Man]

       

Thanks for the detailed reply, I'll give your suggestions a try tonight. I've attached the respiratory rate of last night, both overall and over 1 minute.

[staceyburke]

The main problem you have are Flow Limits.  Flow Limits cause your machine to raise pressure to help with FL.  FL cause you not to get into deep sleep and cause other problems.  We use EPR to help with them.  I would suggest the following settings.

autoset
min 7
max 12
EPR Full time
EPR 3
Turn off Ramp

[Tired Young Man]

   
       

So I followed Dave's advice last night by changing the EPR to 3 and full time, and increasing the pressure. I've attached the results. Physically I still feel the same. I'll attempt Stacey's suggestion tonight and set the min to 7 and max to 12 to see how that goes. 

Also I'll note it here that I suspect that a nasal blockage may be causing my problems, as my nose never feels completely clear (it's not completely blocked, I still typically breath through my nose both during the day and night).

Also thanks to both of you for taking the time to help me. I appreciate it.

[DaveSkvn]

If you look at your 8 Feb data, in the box on the left against "Flow Limit" the 95% figure is 0.12 (you spent 5% of the night with a flow limitation over 0.12) and the 99.5% figure is 0.28.

Last night you had a 95% figure of 0.04 (you spent 5% of the night with a flow limitation over 0.04) and 99.5% figure of 0.20.

That's a good improvement.

The respiratory rate is similarly down noticeably but still goes over 20 so there is definitely still some way to go.

Here is my respiratory rate data from Oscar. Can you tell when I started using the surgical collar? (In January I did some testing by gradually dropping the EPR - hence the bump towards the end of the month when it hit zero)

   

I see you're in the UK. If you use ebay, the surgical collar I got was titled "Soft Foam Sponge Neck Collar Brace Support Cervical Traction Collar Pain Relief" from "credw-62-NEW" and cost £4.66.

Have a go with the auto settings but I fear the algorithm only looks at the flow limitations it uses to manage apneas which may not be the ones causing you trouble. The results tomorrow will tell.  

On the nasal blockage issue, in your pre-CPAP days, why would you not start breathing through your mouth if you had difficulty breathing in your sleep?

[Tired Young Man]

           
Here's the results. As for the question about nasal breathing, it wasn't severe enough for me to switch. It's something I only notice if I focus on it.

[DaveSkvn]

A shade better last night. 95% flow limitation 0.03 vs 0.04 the night before (Fixed pressure) vs 0.12 without EPR.

The respiratory rate is still patchy so there is still work to be done.

From my experience changing the pressure won't make much of a difference but you're free to have a go.

   

Its EPR & the surgical collar that improved things for me. You've maxed out on the EPR on a standard CPAP and would need a bi level machine to increase it any more.

Its up to you if you give the surgical collar a go.

None of this is in the standard medical repertoire. Your diagnosis was against an AHI so you will be treated as an OSA person and with an AHI of under 1 you will be considered treated. If you head back to a sleep specialist you're probably going to have to point at the respiratory rate being sky high - the graph should be pretty much flat. Reset the machine to what it was on 8 Feb or so to make it look dramatic, generate some more data and ask them to explain why the respiratory rate is so high & patchy.  Suggest there might be something wrong with the machine if you are high-frequency panting for some of the night. That way they MAY engage with the notion that your trouble goes beyond OSA.

Good luck