Oscar chart. how to interpret? where are RERA?

[Remmy]

       


Hello all  

I am still new to Oscar and trying to educate myself so I can look at these graphs and understand what im looking for. I know my. AHI is much lower w treatment so something is working (I started at AHI 32-37, RDi 19)....but still feel really crappy most day so lots of work yet to do here. I am super clear I must be my own advocate and keep trying. I have all the usual issues many folks here have. 

Why if the ahi is 'controlled' by pap use do I still feel all the same symptoms as before treatment (albeit a little less but thats not saying much). I especially hate the intense adrenaline rushes and heart palpitations. what is not being addressed? pressure not right? inhale v exhale etc.

my questions to those smart ones here if you can spare a moment, I sure appreciate it:

1. What am I looking for on these graphs most days that would allow me to assess and/or tweak my treatment (I see the ahi and follow the curser to details which is cool-so well designed!)

2. What are flow 'limits',how do I find/monitor/change them and how they effect my treatment?

3. What specifically is causing the crazy adrenaline dumps? low )2 or failure to expel C02 properly due to poor pressure structure on pap

4. Iv been playing with the ERA (I have a air sense 10) somewhat but I dont know what it does...ie why would I have it at 3 v 1? 

5. Do we want to have our pressure set with a wide window or narrow it to where we see we need it....ie stay just where you see your events are controlled? 

6. I understand tidal volume in theory...volume in/volume out. how is it significant wrt apnea? In v OUT should be relative and/or equal? Is this where the RERA come into play....this may be an issue for me? are they connected to the apnea events or in addition to?

7. what is the clear airway component here refer to? 

OK thats enough alto I could go on lol!!! I know this is a work in progress and I am much better than I could/would be without treatment BUT not good enough. still major impact to my well being so thanks for your help!!!!!! I am so glad I found you all. xoxo

PS. background: diagnosed 10 months or so ago-suffered and complained for about three years to dr before sleep study (take home). been really compliant since day one. been interacting with techs (kaiser), have a sleep dr referral for 6 weeks away and I want to be well informed with understanding so I can get the most out of my visit (and help myself!!)

[SarcasticDave94]

Hello all  

...

my questions to those smart ones here if you can spare a moment, I sure appreciate it:

1. What am I looking for on these graphs most days that would allow me to assess and/or tweak my treatment (I see the ahi and follow the curser to details which is cool-so well designed!)
The areas of Flow Rate shows airflow in and out, and the patterns it creates can help decipher what's going on after it is zoomed in to say a 2 min window. Leaks; track that if it is elevated. Flow Limit, more below, but FL is an untimed airflow restriction that is not strong enough to be hypopnea or apnea. About 50% restricted. Events is a collection of flags per the session. Pressure chart shows where the pressures went and may correspond with elevated pressure to react to events.

2. What are flow 'limits',how do I find/monitor/change them and how they effect my treatment? Flow Limit again, as above, include that the higher the FL typically 0.25 or more will probably disrupt sleep or cause an arousal. Change the low pressure setting to a higher number or add EPR/Exhale Pressure Relief.

3. What specifically is causing the crazy adrenaline dumps? low )2 or failure to expel C02 properly due to poor pressure structure on pap This is just a guess, but it could be the odd feeling of adding to your sleep routine disrupted by having a foreign machine at your bedside with an odd looking alien with a long tail strapped to your face while you try to fall asleep. Not necessarily scientific, but it is a guess.

4. Iv been playing with the ERA (I have a air sense 10) somewhat but I dont know what it does...ie why would I have it at 3 v 1? No offense intended, but I'll interpret this to be EPR/Exhale Pressure Relief. EPR is a reverse acting Pressure Support that is on a bilevel/BPAP. This EPR sees your Min. pressure and reduces it by the setting of 1, 2, 3 cmH20. This is measured the same as your positive pressure on the therapy side, and in fact even though EPR is a "comfort setting", we coach many here on the forum to use EPR to enhance therapy. And it does indeed work wonders.

5. Do we want to have our pressure set with a wide window or narrow it to where we see we need it....ie stay just where you see your events are controlled? It is always best to go with optimized personal pressure settings. The CPAP therapy needs tailored to your personal needs. No cookie cutter default setting will do better than settings specific for you.

6. I understand tidal volume in theory...volume in/volume out. how is it significant wrt apnea? In v OUT should be relative and/or equal? Is this where the RERA come into play....this may be an issue for me? are they connected to the apnea events or in addition to? Tidal volume is a measurement of the incoming air and it's and indicator of the amount of air contained in a normal breath. Higher or lower than the norm can indicate various medical conditions.

7. what is the clear airway component here refer to? Clear airway is really another CA called Central Apnea. Most apnea patients have the more common OA or obstructive apnea. Obstructive Apnea literally means a physical restriction reducing airflow 80-100% along your airway for 10 seconds or more. CA or central apnea is a 10 seconds or longer breath stoppage that is not accompanied by a restriction. It can be due to treatment emergent cause, which is due to an imbalance in the carbon dioxide level, where it is too low from a too efficient exchange of air due to CPAP. This type likely clears up within the first 3 months of PAP use. There is also pre-existing or pre-dominant CA that shows on your sleep study charts. This type needs a different PAP called ASV or Adaptive Servo Ventilator, a much more expensive PAP. There is also idiopathic CA, which means medical cause not known.

OK thats enough alto I could go on lol!!! I know this is a work in progress and I am much better than I could/would be without treatment BUT not good enough. still major impact to my well being so thanks for your help!!!!!! I am so glad I found you all. xoxo

PS. background: diagnosed 10 months or so ago-suffered and complained for about three years to dr before sleep study (take home). been really compliant since day one. been interacting with techs (kaiser), have a sleep dr referral for 6 weeks away and I want to be well informed with understanding so I can get the most out of my visit (and help myself!!)

My answers are within the quote in bold blue. Hope it helps clear up some therapy mysteries.

PS you may edit your PAP settings by yourself with no penalty here in the US. You do not need a new script, but doc and DMEs do need a new script to edit settings. On the EPR, you may add 1 if you so choose to get a bit of exhale pressure relief. But note your bit of CA purple flags. It's probably treatment emergent, so it should be on the downward path as you approach the 3 months mark.

[Dormeo]

One more thing about CAs to add to Dave's list. When we're awake, we often pause between breaths for 10 seconds or more. Our breathing while we sleep is generally much more regular. So if you're awake, or semi-awake during the night, any pause of 10 seconds or more is going to get a CA flag, because the machine doesn't know whether you're awake or asleep. If you're awake, the basic problem is you're awake, not that you're having a CA.

Could you zoom down to two minutes on one of those CAs and post a screenshot? We might be able to learn a little more about what is going on. Ideally position the CA a little right of center so we can see the lead-in.

Do you normally sleep for 6 hours per night? If so, do try sleeping longer. That could help you feel better during the day.

I'm assuming those adrenalin dumps are waking you up. Next time you have one, reach over and turn your machine off for a little bit, then turn it back on. That way you can see where to look as you seek clues to what caused the problem. An even simpler way to flag the episode is to take a really deep breath and exhale really fully. You'll probably be able to see the big inhale/exhale on the flow rate graph. You could also deliberately cause a short large leak, though if that messes up your mask fit, don't.