Bizarre OSCAR Charts!

[Narcil]

ahi is a rolling average so it goes up slowly after an event. it's hard to tell because you've zoomed in but it does seem to go up after events. instead of zooming in which makes it very hard to correlate event flags with data, disable the irrelevant sessions at the bottom left. you'll have to enable permissive mode (file > preferences > clinical) first.

i don't think much useful info can be gathered while large leaks are going on, the numbers are usually inaccurate since the machine can't differentiate between the air you're breathing and the liters of air leaking.

doubt a ffm would help they're even bigger so it's probably even easier to knock off. maybe you need one with the hose on top like the p30i ?

[GeorgeGus]

Thanks for the help.

I have tried nasal masks that connect at the top and the front and neither one helped my situation. I’m surprised that with a 35 minute large leak it would not wake me up.

My first post has complete charts. There is not much difference between those and the ones recently posted, so you could get a good idea what the overall picture is if you take a look.

it would seem as you suggested very important to get the large leak under control before trying to assess the rest of the metrics. Just running out of ideas.

[staceyburke]

Obviously the leaks need work but I would try 2 changes and see if it helps.  Raise the min by 1 and decrease the max by 2.  We will tighten the numbers that could help both the flow limits and I hope some of the leaks.

[GeorgeGus]

When you say to adjust the pressures are you referring to the pressures shown on my latest charts or the pressure shown in the information to the left of my posting, 5/11 or 7/14? it seems if you change the pressure on your machine. It is not reflected at the column at the left.

[staceyburke]

I guess I don't understand your question.  Your machine pressure is set to min 7 max 14.  Increase min by1 Min 8 and decrease the max by 2 max 12.

Min 8
max 12
EPR 3 set to full time.

[Sleeprider]

We have had several members in the past with very high respiration rates like this. This is caused by extremely high flow limitation from a restricted airway. I can safely say you will need a bilevel machine to address this in addition to positional apnea therapy. Without significant inspiratory pressure support this pattern can't be defeated, so you're looking to move up to an Aircurve 10 Vauto. We can coach you on discussing this need with your doctor, or obtaining a device on the used marketplaces. If you have not already done so, read the Positional Apnea Wiki https://www.apneaboard.com/wiki/index.ph...onal_Apnea

Please post a zoomed image including your flow rate. The zoom should capture 3-4 minutes of sleep time and we will see both the underlying respiratory pattern and rate, as well as the irregularities caused by the flow limitation that causes every breath to be double and triple counted as individual breaths.

[GeorgeGus]

   

Attached zoomed section of May 31. Not sure what portion I should have used so I picked one in the middle of the LL.

Look forward to your findings.

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I guess I don't understand your question.  Your machine pressure is set to min 7 max 14.  Increase min by1 Min 8 and decrease the max by 2 max 12.

Min 8
max 12
EPR 3 set to full time.

Got it. Will give it a try tonight. Many thanks!

[Sleeprider]

Classic! As you can see, the inspiration is so flow-limited that it never rises above maybe 20 mL/sec. You can change the Y-axis to a range of -80 to +80 mL and it will really show up. So what bilevel does is to replace spontaneous muscular (diaphram) effort with a mechanical assist to normalize inspiration. In this segment, your actual respiration rate is 15 breaths per minute, but I'm sure it was counted as nearly 50. You just don't have the muscle power to overcome the upper airway resistance. This respiratory effort is very hard on you and will leave you fatigued until we fix it. Right now, you're using EPR 3, but I'm thinking of bilevel pressure with inspiratory pressure perhaps as much as 5 or 6 cm higher than exhale. This kind of pressure support will assist your spontaneous effort to normalize inspiratory flow. The machine does a lot of the inspiration effort on your behalf and you get to relax. rather than experience countless respiratory effort arousals. I think it's certainly worth investigating the medical reasons that you're working so hard to get a breath, but you are never going to resolve this issue with CPAP.

[GeorgeGus]

Thanks for the reply. Quite a lot of food for thought.

Should inspiration time and expiration time also reflect the problem?

I will check some older charts to see if they will share any light on the situation.

It seems to me that I need to get LL under control to make sure it is not a contributing factor.

[GeorgeGus]

Last night, I set pressure to eight minimum and 12. This resulted in an AHI of 2.2 but LL still at 40 L. I forgot to put the SD card in, but I’m sure my breathing was just as ragged as previous. I have felt fine all day clearheaded and not fatigued

I got my Resmed 10 last September and my AHI has always been under five and mostly under two, so I never investigated Oscar and when I did, I was daunted by its complexity. During this time, and even now, my ODI has been always under five and frequently under two. SP02 has been 99% of the time 94% or greater. Heart rate always under 55 with no unusual features.

I went back and checked Oscar for a few charts each month and found my ragged breathing to be the same as it is now. This is all quite shocking to me as generally I feel just fine each day, sleep soundly and occasionally take 15 minute naps during the day. Perhaps this is due to being in fairly good shape, walking 5 miles through the hills each day and various other exercises. 

Anyway it seems I should give the BiPAP a try as you recommended. I found an Aircurve 10 VAuto BiPAP for $899 on Sleeplay web site, brand new.  DME LINK REMOVED.  
I have never dealt with them before, but this seems like an unbeatable deal. I would order it tomorrow with overnight delivery.

Seem the way to go?

Many thanks for your help and analysis.

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