Help analyzing OSCAR - Sent by beerdujour

[spaceodyssey]

I was directed to make this thread by beerdujour on reddit. Essentially, I have OSA that's been managed by Auto Resmed 10 but have suspicion that I am experiencing arousals that are causing me to still feel very tired throughout the day, with very tired eyes. Last night I turned my EPR on to 3. My pressure is 7cm-20cm. I did not up the pressure with the EPR. Well, I posted my OSCAR reports on reddit and user beerdujour made this comment

"First you are apparently very good at identifying arousals. I don't see any RERAS, see the small spikes in your exhale, they are not on every breath. I'm not talking about the ones in your arousals but the ones in your breathing prior and after the Arrousal has settled. These imply a restriction is suddenly applying to your exhale. This is not very common. My guess is your pallet is partially collapsing on exhale. It is not the cause of your arousals, at least not the ones you have here. Don't be surprised if someone says palatal prolaspe. It may be a partial one.

I'm going to ask you to continue this on apneaboard.com say I sent you and ask Sleeprider for his opinion. This is different enough that I'd like some additional experienced eyes on it." I have messaged sleeprider privately as I do not know how to direct or tag someone in a thread.

Others have told me my arousals are due to other non-respiratory reasons.. but what could they be? What do yall think about all this? Here is an imgur link with my reports from last night with an EPR of 3 after being advised to by multiple people. What could be my next step (I cannot afford a BiPap) and what do yall think is going on here? 

Photos of my sleep report on imgur due to limited attachment space: https://imgur.com/a/q0LkdSU

If anyone needs more zoom in photos, let me know. 

[gainerfull]

Welcome to apneaboard - before we dive into the weeds of your flow architecture it looks like you're therapy is not well titrated. Your current range including EPR does not sufficiently keep your airway open as evidenced by the prevalent obstructive events.

Two paths:
1. Increase minimum by 3cmH20 to 10cmH20
2. Turn off EPR so we can find your minimal viable pressure to control obstructive events

Once you're at the right pressure then we can revisit the rest.

[Sleeprider]

I don't see an issue with palatal prolapse, but there is an abrupt reduction in expiratory flow right at the peak. Hard to say if some flow is shunted to the mouth or there is a leak or some form of expiratory flow limit. It is not something we can specifically treat with settings. Looking at the individual charts, at 01:20:40 we see increasing inspiratory flow limitation with lower peak flow an longer inspiration indicating effort, followed by an arousal that appears to qualify as RERA. Flow afterward shows normal peak inspiration and expiration, but becomes more flow-limited by the end of the chart. At 01:36:45 there is another arousal. No obvious flow impairment, so this may be spontaneous. The very abrupt expiration leading into the recovery could be a cough or nothing. 03:57:40 is similar with arousal starting with a breath-hold. This looks like a normal shift in position. 00:19:30 is increasing flow limitations leading to nearly apnea, followed by arousal and recovery breathing. This is an obstructive event just barely avoiding a 10-second flag, and may be positional. This one actually shows an under-estimated flow limitation.

General impression is that your therapy is good but not excellent, and your minimum pressure is too low. I would keep EPR 3 and use a range of 9.0 to 14.0

[spaceodyssey]

Thanks, Sleeprider. So basically, the arousals I am having are probably more like coughs, turning over, etc. Do you see many RERAs? That's another of my concerns.

BTW, tonight I'll set my pressure min to 9 and max to 14. Also keeping in mind that I'm not  even a week into this. I just get worried as I feel no relief. Will keep you posted.

[spaceodyssey]

I'm going to take the path of keeping the EPR at 3cmh2o while upping my minimum to 9 or 10.

[Sleeprider]

The RERA are hard to spot because your machine is not really charting RERA properly. Once your pressure is a bit higher, I think they might show up a bit better. The issue is that Resmed actually charts peak inspiratory flow and "flow limitation" is a measure of the changes in peak flow from a baseline. The problem is your baseline mL/sec is often low and a bit slow which means real flow limitation is not standing out. With a higher minimum pressure, I suspect we may see an improvement in overall tidal volume and peak inspiratory flow rate. Trust me, those huge snoring sessions you're having are not free of significant flow limitation, and they correspond to the obstructive events. I suspect a positional issue due to the way those snores are in clusters, or distinct time periods, then disappear.

[spaceodyssey]

I honestly think the snoring is due to the EPR being on at 3 while not changing the min. pressure. Before I turned EPR on and my min was 7, I was hardly snoring. This was from the day before that. (Attachment included)

Meaning once I up the pressure, the snoring should be gone again.

[staceyburke]

According to the left panel you have your EPR turned off.  It needs to be set to FULL TIME  and set to 3

[spaceodyssey]

My EPR was on at 3 full time last night (first post of this thread). The latest screenshot I posted was a previous night, before turning EPR on. I was showing Sleeprider that I used to not snore before EPR (at 7 cm pressure) and hoping my snore goes away by upping my min. pressure tonight.

[Sleeprider]

SpaceOdessey, I agree. I think my suggestion for higher minimum pressure restores the lost EPAP pressure, and with EPR you may finally address both snoring and obstruction as well as flow limitation. Good call!