Chin Tucking as cause of apnea

[ejbpesca]

This OSCAR report shows an A/B example.  The left side with with collar and tape the right side is without.  The right side looks better to me than the left,  but I do not know how to read the subtle details of OSCAR.  I woke to find the collar and tape irritating so I removed them, stayed up a bit, and went back to sleep with FF mask in place.  I woke again due to mask irritation then got more sleep without CPAP.  I woke with a typical lack of therapy symptoms, yet light ones.

   

[Gideon]

By the numbers you are doing fine. Th half night looks smoother, much less disturbed.
Go a full night without the collar. I want you to note which gives you the better overall sleep.

Then the question become, and this is important, how much is your sleep disturbed? Why? because I'm beginning to think you mat do better on a biLevel with a higher PS to treat is looking more like UARS with the low AHI and the high 95% FL stat (0.20 on your split night.

I see similar FL on both halves with the without being slightly less. Thus try a night without.

[ejbpesca]

By the numbers you are doing fine.  1. Th half night looks smoother, much less disturbed.  
2. Go a full night without the collar.  I want you to note which gives you the better overall sleep.

Then the question become, and this is important, how much is your sleep disturbed?  Why? because I'm beginning to think you mat do better 3. on a biLevel with a higher PS to treat is looking more like UARS with the low AHI and the high 95% FL stat (0.20 on your split night.

I see similar FL on both halves with the without being slightly less.  Thus try a night without.

1. "Th half night" I guess that Th half means the half night on the right of that report without collar and tape.

2. No collar will be worn tonight as per suggestion.

3. I do not understand: on a biLevel with a higher PS to treat is looking more like UARS with the low AHI and the high 95% FL stat (0.20 on your split night.

What is a bilevel with a higher PS?  (a different therapy machine with higher pressure?)

Thank you for your consideration.

[Gideon]

BiLevel has 2 pressures, inhale and exhale. They can be very far apart, up to 20. EPR can only put them 3 cmw apart.

It is the difference between inhale and exhale pressures that best treats hypopneas, RERAS, and flow limits which are a fundamental part of both UARS and RERAS.

It is exhale pressure which actually splints the airway.

[ejbpesca]

BiLevel has 2 pressures, inhale and exhale.  They can be very far apart, up to 20.  EPR can only put them 3 cmw apart.  

It is the difference between inhale and exhale pressures that best treats hypopneas, RERAS, and flow limits which are a fundamental part of both UARS and RERAS.

1. It is exhale pressure which actually splints the airway.

So a BiLevel is a sleep therapy machine separate from my ResMed AirSense?  I hope they are available without a prescription.  I guess they also will save data to load to OSCAR via an SD card to give AHI scores and other data.  

1. What does "splints the airway," mean?

[UnicornRider]

Bi-Level

Look at my profile I am using a Bi-PAP machine, ResMed AirCurve 10 VAuto, my pressure is PS 4 over 18.0-22.0 (cmH2O). My PAP Mode is VPAPAuto

Instead of EPR(Expiration Relief Pressure) that is limited to 3 (cmH2O) and is what your machine is running. So when you report your pressure it is  PAP Mode:APAP,  Min 13.6 Max 20.0 (cmH2O) EPR-3 (cmH2O), Your expiration pressure is always 3 (cmH2O) below your inspiration pressure, your machine controls Inspiration in response to Flow Limits. As Flow Limits increase your machine drives Inspiration pressure up and Expiration follows 3 (cmH2O) below Inspiration.  With Bi-PAP Pressure Support (PS) is above the lower number, therefore my machine with  it's PS and pressures in effect is acting like CPAP because the press Max is set to Press Min plus PS, no room for APAP to increase                                      inspiratory pressure. It was set up that way so if aI needed additional support, I could increase it up to 25.0 maximum.

That is why I wanted to see several nights of OSCAR reports before any pressure set point changes. If you change something in your sleep routine such as pillow height, SCC soft Cervical Cushion size or style, Mask style or fit, Leak rate, medication timing or dosage, sleep position, room temperature, Other Stuff (OS),  it can affect Flow Limits therefore your machine response and forum members that have not followed your entire thread may inadvertently suggest changes based upon a single nights OSCAR Report when it was a bad night not a normal night, that may not be appropriate at that current time.

Meanwhile I hope to teach you how to read your OSCAR Reports and O2 Insight Pro reports so you can evaluate what affects minor changes in your sleep routine may be making. Or be able to recognize that something major has changed and needs to be address either through a machine set point change or a sleep routine change. While you are doing that You will be building the documentation needed in case you require a change to a different machine, the Resmed AirCurve 10 VAuto is a well respected machine that has multiple Modes available, as well as parameters for tweaking and tuning therapy that your current machine does not have, but that may not be the machine best suited to your needs there are other machines that have specialized functions that potentially could serve you better. Facts yet to be uncovered will determine your final outcome.

  So when I enquire about an "O2 Insight Pro report" I will try to remember to request only the first page and then individualized follow up detail page by time period covered. Be sure to redact any personal information you do not want to share. we do not want that kind of information spread across the internet. See my "O2 Insight Pro report below.


  UnicornRider Nov 8 2023 not a good night.pdf (Size: 293.74 KB / Downloads: 11)

I made a file in my documents folder for "O2 Insight Pro" reports I am going to share, On the O2 insight Pro program, I go into "Options" at the top of the page and modify the "Default User Information" that I care to share. Then I "Save as PDF" at the top of the display. there I direct it to the folder I previously created in my Documents File.

I will sometimes print out an "O2 Insight Pro" report to take to my Primary doctor or specialist I have been referred to.

On the O2 INsight Pro upper left there is a "Configure"  tab, while in Configure you can set alarm set points for Pulse and SpO2, also the strength of the vibratory alarm and how loud the audible alarm is. While in configurations it is a good idea to synchronize the time on the Wellue with  the computer, then you can set the time on your Resmed to match the Welllue. It make synchronizing the Oscar with the imported O2 Data.

       Lanky Lefty has a YT for the O2 Ring, the app and the program, I find the information in the O2 Insight Pro formatt a little more useful than Lanky Lefty does, but when incorporated in to OSCAR it also has additional value.

      https://www.youtube.com/watch?v=Oaqt3GJY83k

   The OSCAR Guide for interfacing the Wellue is worthy of review.
       
       https://www.apneaboard.com/wiki/index.ph...e_vignette

You said " I cannot recall how to get my O2 App report, generated by last night's O2 ring data, into OSCAR.  I will attempt it after this writing.  There is a sort of trick to it."  in an earlier post. In O2 Insight Pro, when you are in "Options" to create your profile the very bottom of the window there is the file directory to where Pulse/Oximeter information is stored. It should be something like:  C:/Users/your name_f/Downloads/Checkme O2 Max/file name.

Let me know if you need additional help importing the Pulse and O2 data to OSCAR.


Soon we will work on the granular view of FLow Rate and O2 data. 








 

[ejbpesca]

 
Thank you for the reply.  I am starting to get the BPAP concept but have questions:

I understand EPR 3 for APAP, but I do not understand what is PS 4 for BPAP.  Is PS for BPAP the same as EPR for APAP?

Reading about BPAP online, again, I don't see why we all are not using BPAP because would we all not want pressure reduced upon exhaling?  What is the purpose of exhaling against pressure with CPAP and APAP?

You wote:  PS and pressures in effect is acting like CPAP because the press Max is set to Press Min plus PS, no room for APAP to increase                                      inspiratory pressure.

I don't understand the above italicized sentence.  Could you please rephrase it?  How is Max set to Min and what is PS?  Are you saying Max and Min are equal and PS is a setting for pressure relief on exhale?  Your BPAP pressure setting is 18 - 22.  Is that not a varying pressure setting? (I have reasearched PS Pressure Support and cannot find a simple direct definition of what it is.)

I can save O2 Insight Pro reports to my Macbook as image files, but I cannot find the reports as binary files to insert to OSCAR.  The guy in the O2 Ring video uses an Iphone to import the data easily to Mac.  I have an Android phone that will not export in binary mode.

Under Options in my Mac version of O2 Insight Pro there is no file directory option in that window to show where data is stored.  

The instructions in Apnea Wiki for finding O2 Insight Pro data files on Mac fail to function as written or I am missing something.  I follow the instructions only to get a "beep" failure notice from the Mac.  I have written Wellue concerning O2 data insertion to OSCAR.  A reply email comes with as automated warranty issue so no support there thusfar.  What is needed to communicate instructions for Mac is a click path, e.g. OSCAR > DATA > Viatom Wellue > etc.  Taking that path leads nowhere on a Mac so another click path must be given by someone who has had success inserting O2 data to OSCAR via Android phone not Iphone.  The guy (Lanky Lefty?) in the video about the O2 Ring is baffled by the Wiki instructions also.  Very frustrating.  I recall finding the O2 report binary files on my PC to insert to OSCAR, but I cannot find them on my Mac.  My PC is outdated and has several issues so I hestitate to fire the old thing up.  Crimson Nape tried to help me by quoting the Wiki article which I think needs rephrasing.  Yes, I still need help trying to get (explitive) data from O2 ring to OSCAR.

I have my O2 ring set to vibrate a 88% threshold.  I take it that means if blood O2 hits 88 then the ring vibrates.   I don't think my ring has an audible alarm.

My inhale/exhale wave forms look a mess to me even if I am awake. I see not much smoothness to them from up to down.

Thank you so much again. 

Here's last night's OSCAR with no collar.  Mouth was taped but tape came apart I suspect early on. (Hard to keep my chin up and mouth shut.)

   








 

[ejbpesca]

A note on opioids: The study on the link you posted concerning opioids and cpap therapy was done for a patient who took a much larger dosage and stronger medication than what I take. She took hydrocodone and oxycodone together. That is unheard of in my area now due to the political backlash of the "opioid crisis." Due to mistakes by some that caused overdosing, all must suffer concerning opioids. I take a minimal dosage compared to that indicated in the study, but I do realize that any dosage amount can have effects on respiratory function.

[UnicornRider]

  Is PS for BPAP the same as EPR for APAP?
 Basically they are the same, except PS is added to the min pressure, so my 18 (cmH2O) plus my PS of 4 (cmH2O) equals 22(cmH2O), My AirCurve 10 VAuto has a pressure range up to 25 (cmH2O) If my press Max was set to 25 (cmH2O) my machine could increase my min press to meet my needs with Inspiration pressure always 4 (cmH2O) above my Expiratory pressure. Once my inspiratory pressure hit 25 (cmH2O) expiration would be limited at 21 (cmH2) In the Mode I have selected VPAPauto. AirCurve 10 VAuto is capable of several modes of operation.

        https://document.resmed.com/en-us/docume...er_eng.pdf

     I don't see why we all are not using BPAP because would we all not want pressure reduced upon exhaling?  What is the purpose of exhaling against pressure with CPAP and APAP?

    The reason we do not all use BiPAP is because the Insurance companies are in the business of making money. BiPap machines cost more money than CPAP.Therefore Insurance companies would spend extra money and not so much profit or mega millions bonus for the corporate officers.

Under Options in my Mac version of O2 Insight Pro there is no file directory option in that window to show where data is stored.  

   From OSCAR instructions.

     macOS

1. Download and install Viatom's free O2 Insight Pro software. [link]
   
   
2. Open the O2 Insight Pro.app
   
   
3. Turn your oximeter on by inserting your finger into the probe momentarily until the time shows on the display.
   
   
4. From the O2 Insight Pro software click the "Connect" button in the top left of the app window.
   
   
5. Another small window will open which should show your oximeter. Click the "Connect" button next to your oximeter. The O2 Insight Pro window should say "Device connected" in the bottom right corner.
   
   
6. Once your oximeter is connected to the app, click "Download". Once the download is complete the file needed to import the oximetry data into will be available.
   
   
7. When finished, click the "Disconnect" button at the top left of the O2 Insight Pro window.
   

The downloaded session files will be stored in one of two possible locations:

Code:

/Users/YourUserNameHere/Library/Containers/com.viatom.O2PCViewer-BLE/Data/Library/Application Support/O2_Insight_Pro/DATA/SerialNumber/

.
or

Code:

/Users/YourUserNameHere/Library/Containers/O2_Insight_Pro/Data/Library/Application Support/O2_Insight_Pro/DATA/SerialNumber/

The "Library" folder is hidden by default, but you can still reach it in Finder by pressing cmd-shift-G and entering 

Code:

~/Library

 in the file selection dialog. 


  I am not a Mac user,  but the above should be the file path to find it, 


I have my O2 ring set to vibrate a 88% threshold.  I take it that means if blood O2 hits 88 then the ring vibrates.   I don't think my ring has an audible alarm.

   In the "Configure" area of O2 Insight Pro, where you set the vibrate alarm setpoint there will be an audible alarm if your ring has that function, In  the same area, you should be able to synchronize time on your Ring with your Mac. Then get into your AirSense 10 menu and set the time to match your Ring. Then you start your ring before you start your CPAP, and start time will be close to each other.

My inhale/exhale wave forms look a mess to me even if I am awake. I see not much smoothness to them from up to down.

From the wiki "Glossary of terms"  Sleep-Wake-Junk - Clusters of apnea and hypopnea events concentrated mainly around periods of sleep-wake transition. In general Sleep-wake-junk (SWJ) is not regarded as "real" since they do not occur during periods of sleep, but may be during semi-awake periods or "dozing".

SWJ, Sleep, Wake, Junk. All of us have ragged looking breathing when awake or waking up, that is why I do not score events during the start and ending of a session.


I shall return.

[UnicornRider]

A note on opioids: They really cracked down here in the late 90's early 2000's. I know myself, family and friends were offered OTC pain killers when an opioid would have been more appropriate, but Doctors do not want to lose their license. Even family that were on their short calendar with weeks to live could not get opioides outside of the hospital, and the doctors could only keep them a limited time in the hospital due to Medicare and insurance restrictions. Fear of addiction, known abuse by the few, the masses must suffer.

    So You know to be aware of your respiratory rate and inspiration vs expiration time (I:E Ratio). Late at night when sleep evades me I watch various lectures from Universities, American Academy of Sleep Medicine (AASM), and there are several on respiratory function under various medical conditions. I will see if I can reference something that may provide enlightenment. My mother caught a nasty flu back in the late/mid 90's, she came out of the hospital on O2 with severe COPD that totally changed her life. They never put her on a CPAP machine, I still try to figure that out. It is possible that the *PAP machines they had available were not appropriate for her condition.

   I could find no source to guide you in getting Pulse/Oximeter info into Mac Oscar. Perhaps Reddit or one of the other CPAP Forums could offer additional insight.

    How is the therapy pressure feeling for you, let us know if you are starved for air or being overwhelmed with the timing or tuning of the cycles. 

    Earlier I posted: "The reason we do not all use BiPAP is because the Insurance companies are in the business of making money. BiPap machines cost more money than CPAP. Therefore Insurance companies would spend extra money and not so much profit or mega millions bonus for the corporate officers."

      I can add to that, If you were to look inside the various models of CPAP, APAP, BiPAP and some speciality machines, they would look the same. The only difference would be the Firmware installed. So why not have everyone start with a machine that can do all the various functions? Greed. Is the only thing I can think of. 

    Post some more OSCAR Reports when you get a chance.