Help Analyzing Oscar Data

[sillyzippy]

Hey Sleep Apnea and Oscar experts-

Diagnosed with severe obstructive sleep apnea in 2015. Was compliant on CPAP machine for 4 years and then lost some weight and went off it for a few years. Recently back onto machine, but have very inconsistent results. Asleep all night, but some mornings just wake up with that zombie feeling. Trying to understand if this is sleep apnea related, or if there is something else contributing to me not get into deep sleep during the night. Frequent exerciser, but also frequent drinker.

Posting 2 nights of Oscar data for review by the experts to see if there is anything that sticks out.

Night 1 - Feb. 13 - woke up feeling fine
Night 2 - Feb 14 - woke up feeling like a zombie

Thanks in advance for any insight.
   
   

[Sleeprider]

Welcome to Apnea Board. Your two charts show that with fixed pressure at 8.2 and EPR 3 your obstructive apnea is well controlled. The main difference between the two nights is that you had a lot of large leaks on 2/13 and felt fine, and the leaks were much lower on 2/14 and you felt like a zombie. I'm concerned that your flow limits are under-reported in CPAP mode because your respiratory statistics show a longer inspiration time than expiration time. We need to get a couple of zoomed images of your flow rate chart in 3-4 minute segments so we can see what the flow wave looks like. I'd like to see you in Autoset mode instead of CPAP mode, even if we don't change pressure. That would be Autoset mode with minimum and maximum pressure at 8.2 and EPR 3, or we can put in a range of pressure. This will more accurately record flow limits. With regard to leaks, let us know what mask you're using. The leaks look like mostly leaking from your mouth rather than mask leaks from a poor seal. I'm sure we can find some solutions to improve that.

[sillyzippy]

Thank you so much for your time and effort trying to help people here.

I currently use an AirFit Nasal 20 and I tape my mouth shut. Main reason being is that one of the reasons I had a pause in therapy a few years ago was because air started blowing out my mouth and I couldn't resolve it - it was waking me up abruptly. I did try a full face mask but that didn't seem to solve it. I also have a soft palate that seems to have lost a lot of it's muscle tone as I can often feel it in the back of my throat when I swallow - it is usually worse when I have a worse night of sleep...

I will adjust my machine to Autoset (per your recommendations), and I've attached 4 zoomed-in screenshots of flow rate (2 per night)

Thank you!
   
   
   

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follow-up post with last screenshot

   

[Sleeprider]

For future zooms, we're going to need a shorter segment of 2-minutes or so. The respiration timing looks more balanced than what we see in the statistics, however the inspiratory peaks show an initial peak of inspiration, reduced flow followed by another peak, so flow limitation is in play, but your flow looks good. The wave form is just too compressed to read accurately.

[sillyzippy]

Is this better? Also- is there a particular time in the graph that would be most useful to look at - I kind of just hovered on a random area...

   
   

[Sleeprider]

That is some strange stuff. The first graph shows both Class 2 and 3 inspiratory flow limitation.  The second chart shows a cut-off of expiratory flow which is a more rare expiratory flow limit or palatal prolapse (PP). Normally the PP type shunts through the mouth, but you continue to show nasal expiratory flow pending the next inspiration.  I can deal with inspiratory flow limits pretty easily, but the expiratory stuff, we're going to have to think about. 

Classification of inspiratory flow limits come from this https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4688581/




Expiratory flow limit / palatal prolapse https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5915321/

[sillyzippy]

Thanks for sharing this.

[sillyzippy]

I switched to autoset last night (with a range of 8.4 and 7.8, EPR 3) and have attached a screenshot of all graphs, and a zoomed-in one of flow rate chart in case there are any new insights from that.

   
   

[Sleeprider]

Your range was 8.0 to 8.4 and is indistinguishable from your previously posted results from 2/13. The use of Autoset mode didn't change the statistic on flow limits, so the 95% remains a modest 0.02, yet we still see Class 2-3 anomalies in the inspiration. I don't see palatal prolapse here, but might be present at 03:40.

[sillyzippy]

zoomed in at 3:40

I think in your prior post you said you may have some thoughts on how to deal with the Class 2 and class 3 inspiration flow anomalies? Also - do you think it makes sense for me to increase the max/min range from say 7.8 to 9.0 on autoset?

   

Thanks again for all of your assistance.