Help Interpreting OSCAR Data and Next Steps

[cpapish]

Hi Apneaboard,
This is my first post and I'm a new member. I am a 42 yo male and have used CPAP for about 15 years. For most of that time I was on an old Resmed machine with a constant pressure of 9, but I would adjust it myself based on how I feel and seasons, etc.. I can't find a copy of my original sleep study from back then, but it was an OSA diagnosis, and honestly most of the doctors didn't know much about it during that time. I did "pretty good" on the old machine, and felt a little better than baseline but never really felt like the treatment was optimal. In 2020 my machine broke and I slept with no CPAP from early 2020 until October 2022 and it honestly wasn't much different based on how I felt in the morning.

I recently just got a new Resmed Airsense 11 and have actual data in OSCAR for the first time in my life and I really want to optimize my treatment. My new doc is great but I would also appreciate any feedback on ideas to improve.

Airsense 11 was originally set to auto titrate between 6-10cm but my doctor said that it was overcompensating and causing some central events so he set it to a fixed pressure of 7.6. To be honest, it actually felt good for a few days but now it feels worse for some reason. I've been waking up feeling very non refreshed.

I've attached 2 oscar screenshots from this week and I believe they both show a large number of central events. My thought is to try putting it back into auto titration mode but with a tighter window, say something like 6-7.8?  

I know it's a lot of work to read these posts so Thank You in advance.

[Sleepster]

You are leaking a lot. This may be your problem as the leaking is constantly waking you up, disturbing your sleep. It's also rendering your therapy ineffective. You need to maintain the pressure splint in your upper airway and you can't do this if the leak rate is too high.

You can try a chin strap or soft cervical collar, but the best remedy is a full face mask.

[cpapish]

Thanks Sleepster,
I'm curious, wouldn't a mask lead cause ineffective treatment against obstructive events more than central events? Or perhaps I'm treating them as too distinct when they are more related to each other. I'll try a chin strap as a first pass to see if it helps with the leak rate, then maybe go to a full mask. Thanks for the input.

[Sleepster]

I'm curious, wouldn't a mask lead cause ineffective treatment against obstructive events more than central events?

I would think so, yes. But keep in mind that when you have a high leak rate your machine is not able to report data like obstructive apneas and central apneas accurately.

[Gideon]

Your leak is mostly mouth breathing.  See how your flow rate 'shrinks' during your large leaks? That is showing that your machine is having trouble recognizing events.  Number 1 priority is managing that leak.

On Centrals, can you post a daily charts with EPR.  We need to see the difference that makes.  Also a few 5 minute views showing a CA events centered in the view.  Your CA events are spread out which is different than the CO2 induced CA you usually see if EPR is too high.

Not ignoring your CA events but this level is fairly insignificant.  With a VAuto we have a trigger setting we can use.  But first let's see what is going on if we can.

[cpapish]

I would think so, yes. But keep in mind that when you have a high leak rate your machine is not able to report data like obstructive apneas and central apneas accurately.

Thanks Sleepster, that makes sense. I'll try to correct the leak rate before I do any more digging.

---

Your leak is mostly mouth breathing.  See how your flow rate 'shrinks' during your large leaks? That is showing that your machine is having trouble recognizing events.  Number 1 priority is managing that leak.

On Centrals, can you post a daily charts with EPR.  We need to see the difference that makes.  Also a few 5 minute views showing a CA events centered in the view.  Your CA events are spread out which is different than the CO2 induced CA you usually see if EPR is too high.

Not ignoring your CA events but this level is fairly insignificant.  With a VAuto we have a trigger setting we can use.  But first let's see what is going on if we can.

Thanks, that makes sense and tracks with with Sleepster was saying. I appreciate you both interpreting the data, I wouldn't have realized this is what's actually going on. I'll try to correct the leak a bit and then post more detailed charts showing CA events.