[CPAP] Oscar Data Review

[reverseswing]

Here's a summary of what I'm dealing with and the Oscar data. I'd appreciate it if someone could take a look. I do have a meeting with my doctor this week but I want to see what you guys have to say.

• Diagnosed with severe apnea, AHI was 36+ during sleep study
  
• Started using CPAP on Nov 13th.
  
• Using Philips Dreamstation
  
• Started with Nasal Pillows
  
• Switched to Face Mask on December 9th.
  
• From the beginning, my AHI came down immediately. Largely in the lower teens. Then lowered even further with the mask into single digits.
  
• According to the Dreammapper app, the nasal pillow fit was almost 100% each night and with the mask it falls down some.
  
• Reason I talked to the tech and switched to the mask on his suggestion was that despite the lower AHI I actually felt even more tired than I used to without CPAP. If there was no change I wouldn't mind too much but being worse was actually really frustrating.
  
• I'm hoping the mask will help but not sure.
  
• I can only change ramp up time so I increased that after the first couple of nights, it helped some. 
  
• Pressure is pre-set to 10 per doctor's findings from sleep study, I can't change it right now.
  

Basically my biggest issue is I don't know what I'm supposed to be feeling like. Trial and error I guess. I'm wondering if you guys can point to something in the data that might help.

[Sleeprider]

Reverssewing, Will you please post a typical Oscar daily details chart with Events, Flow Rate, Pressure, Snore and Leaks. It appears you are using a fixed pressure of 10. The daily chart will give us details about which model Dreamstation you are using, and allow us to visualize more accurately how therapy is working with your respiratory flow rate. My impression from the overview is that therapy is improving, however it looks like sleep may be somewhat disrupted at times.

[reverseswing]

Hopefully I understood what you're asking for; I'm attaching two screenshots. One from about a week ago with the nasal pillow and one from last night where I'm now using the mask. Thanks!

[Sleeprider]

Those are excellent charts. Now we know we are dealing with a Dreamstation Auto CPAP set to fixed pressure mode at 10.0 with CFlex + at a setting of 2, and a ramp for about 30 minutes starting at 4.0 cm. Both charts show some respiratory instability with periodic breathing showing at times. Obstructive apnea and hypopnea is clustered enough that positional issues might be worth considering. You clearly had higher leak rates with the nasal pillows, and current leak rates are satisfactory. I think there is some evidence of therapy onset central apnea. This can account for the CA, H and periodic breathing in these results. This is something you probably want to focus on when you talk to the doctor. All of these types of events can be treated with ASV which provides adaptive pressure support to stabilize your respiratory rate and volume. It is doubtful that anyone is considering ASV therapy at this stage of your therapy. You might want to experiment with a lower Flex setting of 1 or off, which can often help stabilize respiration in individuals with mild central events. Access to your mode, pressure settings, CFlex and everything else is pretty easy. https://www.apneaboard.com/dreamstation-...structions Things like ramp and Flex are considered comfort settings, and your doctor is not going to be concerned if you access those settings. Given the types of events we see here, I think fixed pressure is actually a good thing, but might be set a bit lower if CA and H continue to be prevalent.

[reverseswing]

Thank you for the detailed response, I wanted to wait to reply until after my doctor's appointment which I had today. Just to summarize what he said, he confirmed what you said about CA and that it might just go away on it's own. Due to other positive numbers, he wants me to continue without changes for 4-6 weeks until I meet him again (unless things get worse). 

He does also want me to get tested for other things such as Thyroid, etc., to eliminate other causes of fatigue.

Now back to my cpap. I noticed something new last night. I woke up I think 3 times because of noisy air coming out of the mask. At first I thought it was a leak but it wasn't. It was basically coming out of the vents in the mask and the pressure was high so it made noise. Soon after I woke up it went back down to normal. Almost like the machine is setup to increase the pressure when it notices that I wasn't breathing, aka CA. Could that be? The doctor thinks the CA is happening because the body is so used to periods of not breathing that it just goes into that mode even though there's no OA due to air pressure being good.