[CPAP] OSCAR Interpretation - UARS?

[ilikecars]

Hello,

Im grateful we have a forum to seek help when my office wrote me off with "residual hyperparasomnia" because my ResMed said my AHI was 1

Rant aside, I need some help. I am not waking up refreshed or ready to attack the day and im starting to feel like a zombie. If anyone can interpret this data I would appreciate it. I'd love to learn more so video resources/images are also appreciated! I am curious to see if my tidal volume and actual air flow is appropriate/adequate. Are my "peaks" diminshed? Im not sure im still new to this.

Was on 5-15 initially, gained weight + muscle, and now I feel very, very mentally and physically unwell

   

   

   

Additional images: https://ibb.co/FDrhJn8

[ilikecars]

Am I hypoventilating? https://ibb. co/R73NZWr

[Expat31]

Can you send the 6 following graphs only :-

Events
Flow rate
Pressure
Leak rate
Flow limitations
Respiration rate

Full night's view please - no zoom. 

Also unfortunately the daily graphs were not formatted properly, as we cannot see either any of your settings or statistics. 

For detailed graph organising, please see here. 

or briefly:-, (View > Reset Graphs > Standard)

Further tip, taking a screenshot of your Daily screen.
   * For Windows or Linux: Use the F12 key
   * For a Mac: Use Fn+F12

Thanks

[ilikecars]

Hi, here is a better view of 4 nights of varying data

https://ibb. co/album/Lh7HF6

[Expat31]

Can you post as an attachement in the normal way?  Can't read your link.

Attaching images, files and posting charts.

[ilikecars]

You can delete the space between the . and the co but ill individually reupload everything. The link gets auto filtered.  

   

   

   

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Fourth attachment

   

[Expat31]

Thanks for your graphs. 

You have tried some good settings  possibilities, and what so far do you feel resulted in the best sleep quality so far? 

Concerning your graphs, the observations I have are as follows:-

24th 
Ramp on, try to avoid this a no meaningful therapy is obtained during ramp periods.

Peaks in flow limitations seems to have caused some unnecessary rises in pressure. This means micro awakenings and as a result, likely disturbed sleep. You were on EPR of 2. 

EPR 3 likely would have improved flow limitations, and a greater level of comfort. 

You had one events cluster around 3am, looks like positional apnea

25th

Just large leaks, distorting therapy and recorded results. Scratch this one.

27th 

One large positional apnea cluster again. Flow limitations again pushing up pressure, with some likely mask leakage around 3.40am to nearly 4.30am.

28th

Some big variances in pressure again, some caused by flow limitations like on the 24th, some not. You were on EPR of 1, 3 might have been better for sleep comfort. 

In summary, I would  either:-

• Limit your maximum to 14 cms of water, set the minimum pressure to that which you felt the most comfortable, (perhaps  it is 11, only you can tell), and set EPR  on 3
  

• Or a fixed pressure of say 11, with EPR on 3 also. This would of course stop the pressure swings and potentially better quality of sleep.
  

It depends on what happens to flow limitations, control of events and of course sleep quality. 

We don't really know until you try. Finding the best optimum results using the least overall  pressure needed to achieve this. 

Is there anything in your sleep report that may help, such as events breakdown between hypopnea obstructive, centrals, and positional, with Spo2 results?

Thks

[Expat31]

I forgot to insert answers about two of your questions. 

- Your respiration rate looks fine. Peaks are probably due periods of REM, quite normal.

- Tidal volume. I am curious why you have flagged this. It is something that I have not been confronted with as an issue. The information I have is just this:-
                             
Normal tidal volume is about 500 mL for men, 400 mL for women. Phillips ASVs manage tidal volume to treat CAs.
Normal tidal volume is 6-8mL/kg and then 80-120% of this prediction. Anything higher than 10 mL/kg is associated with increased barotrauma of the lungs.

Tidal volume = ideal body weight (IBW) x (5-8 mL/kg)

IBW(female, inches) = 45.5 + (2.3(height in inches - 60))
IBW(male, inches) = 50 + (2.3(height in inches - 60))

IBW(female, metric) = 45.5 + (0.9(height in centimeters - 152 cm))
IBW(male, metric) = 50 + (0.9(height in centimeters - 152cm))

IBW(you) = 50 + (2.3(76 inches - 60 inches))
IBW(you) = 86.8 kg

Tidal volume(you) = 86.8kg(5-8mL/kg)
Tidal volume(you) = 434mL - 694 mL (80 to 120% of this estimate is considered within range)


You could also search on line for a more detailed explanation than I have. 

[Jay51]

I have been diagnosed with hypoventilation.  Great information provided above by Expat31 on hypoventilation!  

Your tidal volume ranged, I think, from the low 400's to high to even mid 300's.  This is kind of borderline.  More importantly, though, is your minute ventilation.  If you respiratory rate is high enough, it can compensate for a lower than normal tidal volume.  

Try the changes that Expat31 suggests.  Hopefully that will improve your tidal volume (and subsequently your minute ventilation also).

[ilikecars]

Hi, here are some updates! 
Im still exhausted despire normal rest + 200mg morning caffeine