CPAP, Surgery and OSCAR

[snoozemaster]

Hello,

New in this forum. I'll give my background story but for those who don't want to read I need some help analyzing my OSCAR data.

I'm a 29 years old male, been diagnosed with OSA for the past 2 years, but probably had it for a lot longer. First sleep study showed an AHI of 26 (and higher on my back). Tried using CPAP with a suggested pressure of 4 - 8.5 cmH2O and AHI improved to around 16, which wasn't that good since I still felt tired all the time. I thought to be CPAP intolerant and stopped using it.

After some time I started looking into surgeries and after consulting with an ENT and having a DISE done I was diagnosed with enlarged lingual tonsils, enlarged turbinates and a deviated septum (I've had my tonsils and adenoids removed as a kid). Two months ago I had lingual tonsillectomy using coblation. I genuinely hoped it will solve my OSA. Second sleep study showed only a mild improvement, with an AHI of 22.

Desparate, I tried going back to using my CPAP, hoping that the surgery might have helped with that. And it actually did. My AHI went down to around 8. I still feel horrible though, maybe not used to sleeping with the mask, but the data looks a lot better. I actually feel that I'm close enough to get my OSA under control.

I just found out about OSCAR a few days ago and I'm trying to make sense of my data. I'm was hoping if someone here could take a look to give me some insights.
I've been using the Lowenstein Prisma Smart machine with a full face mask.

Here are some screenshots of my OSCAR data:

   
   
   

Thanks!

[Expat31]

Hello, 

We can't deduce much from your graphs as youe statistics and settings are obscured. 

Please remove the calendar (by going into  view, or using the small triangle to the left of the day's date)
Or alternatively:-, (View > Reset Graphs > Standard)

For full details of  graph organising, please see here. 
                                         
However, even without full details, there are observations from your graphs that still can still be made:-

 - Your minimum pressure of 4 in quite insufficient for an efficient therapy. Try setting minimum to 7. This may help.
 
- You have a fair number of large leaks,  either mask or mouth leaks. These often cause considerable arousals and generally disrupt the therapy also. Check on the Mask primer that may assist in reducing mask leaking. 
 
 - There are considerable flow limitations. Does your machine provide pressure support to help reduce these like EPR?
  
 - It looks possible that you have clustering or events that my indicate positional apnea, but too early to be sure at this early stage. 

 Please repost your graphs in the coming days. (Zoomed graphs are not needed at thie moment).

Thanks.

[Phaleronic]

Welcome to the forum Fckapnea (nice name too) . Expat is on the money with the observations and suggestions, you do have many Hypopneas and FLs from what we can see in these charts. The Lowenstein machines have their own brand of EPR (softPAP) which you should enable as well. Raise min to at least 7cm (I would set it to 8cm) and raise max pressure to 14cm-turn on softPAP and set to 2)-these together should help your FL events and provide you with enough air pressure to help the Hypopneas as well.

Since you're having such high ahi I think you should try changes sooner than later. Give it a night or two then post the charts again please.

[snoozemaster]

Thank you both for the replies. I’ll post edit and updated screenshots soon. This night I couldn’t fall asleep with the mask so I’ll wait for tomorrow.

Phale, what mode would you suggest I set my APAP to? Standard or Dynamic? Is soft start necessary in your opinion?

[snoozemaster]

Adding some updated OSCAR screenshots:

Full night, APAP mode (dynamic) 4 - 8.5, with EPR, AHI 9.6:

   

Half night, CPAP mode fixed 5, then fixed 6, AHI 8.7:

   

Afternoon nap, APAP mode (standard) 6 - 16, AHI 3.5 (lowest yet):

   

Next I plan on trying APAP mode 7 - 14, with 30 minute soft start, not sure if standard or dynamic mode, not sure about EPR.

[Phaleronic]

Thanks for the charts snoozemaster. Your last graph during the nap looks pretty good (some leakage). I agree with the change to 7min 14max. Dynamic mode will try to fix flow limits as they occur during the night, standard mode will try to keep the machine at the lowest pressure settings to maximize comfort. I think for now keep it in standard mode for a few nights and see if flow limits crop up. Your first graph had many many FL events, because the pressure was too low and at that range even with dynamic mode set it couldn't overcome them..

After a few nights with this setting maybe we can try softpap (epr) if the flow limits are there or you're not feeling comfortable during expiration?

[snoozemaster]

Last night I wasn’t comfortable with the full face mask so I tried the nasal mask. It was more comfortable but the data is actually worse. APAP mode was standard and SoftPAP was set to 1. Pressure was set to 8 - 12 cm (and not 7 - 14 as written) because I thought the nasal would require less than you suggested for the full face mask.

[Phaleronic]

Thanks for the chart Snoozemaster. You still are having lots of flow limits, hypopneas, and clear airway events. The CA and H events are somewhat clustered so you're likely having positionally charged events here.

I think you should raise your min pressure up 2cm to 9cm min-try this for a night or two, check the charts and see if it's helping-along with making sure you're not chin tucking (flat pillow)-and you may need a soft cervical collar.

[snoozemaster]

Thanks Phaleronic. I’ve been experimenting for a week now and quite frankly discouraged. I tried different masks and different settings but my AHI stay relatively unchanged at 10. What am I doing wrong? I can’t seem to find anything that works.

[snoozemaster]

15.5: (Nasal mask)

   

16.5: (Nasal pillows)

   

17.5: (Full face)

   

Nothing seems to improve my AHI enough to feel a difference. Still exhausted. Any suggestions?