Help analyzing OSCAR data - CA's?

[alemon]

Thank you Dave, I appreciate your attention and kind words. This whole thing has me feeling anxious. When you mean static, are you thinking straight CPAP +EPR, or without? Sorry, just not quite sure here.

[SarcasticDave94]

You're still using EPR 3 now I think. Several directions to get there, either CPAP mode and 8 or 9 as the pressure. I'd consider just setting both numbers on AutoSet 8 or 9.

Alternate is lower EPR unless you did before and it wasn't good.

[alemon]

Thank you very much for your thoughts, as ever, I'll set a static pressure and see how it goes!

[alemon]

Hi Dave (and everyone else)!!

I worked my way up to trying a stable pressure (I admit I was intimidated) and omg, I've woken up early(??) two days in a row (?!!). Holy crap, you were right! I'm SO hopeful and excited. I feel better - I was tired at about 8PM yesterday, but that's SO much better than most days where I am just inoperable. We're at day 2, so we'll see if day 3 I wind up tripping and falling again lol. But it feels like the most 'normal' my sleep has felt since starting therapy also - like I've been also able to just move naturally and get comfortable without my mask leaking.

I saw some folks say the F40 was a game changer and they were SO right haha.

My wave forms still seem a little flat at times, I'm sure partly because the machine can't compensate when it needs to. I'm afraid to touch anything for the moment, but thought maybe I'll need to raise min again to try to help with those(?), eventually? Let me know what y'all think. I'm gonna try to not touch this for a hot minute though, unless something major changes. Thanks so much for your help so far!


SleepHQ links because they allow that nice zoom-in

https://sleephq.com/public/f5c7317a-251a...027514c116
https://sleephq.com/public/41aa9f9b-493a...1868c28566

[SarcasticDave94]

Looks great, and if you're feeling better, that's a win. Congrats.

Unless you need to, probably keep it set here for a bit longer.

[alemon]

Hi all!

Back again, bit of the same old story but also a bit less dire. I've had a couple bad days after a pretty good stretch - I have a theory that as I get acclimated to new settings, they start to slowly work less well (and will until I find the right ones!)

My numbers look half-decent in comparison to my previous, but I wish they were better. I noticed last night especially I had periods of cyclical breathing: https://sleephq.com/public/4722b3aa-c98a...e605f3d2af

Here's a full account-share link to supplement screenshots for the ability to zoom on flow rate (though I also attached a screenshot): https://sleephq.com/public/teams/share_l...d74a2806f5

User Flags are set to 8 seconds of 50% flow restriction, of which I had a very large amount last night as well. Ugh.

It looks like I had a period of really nasty CA's and cyclical breathing starting at about 2:15 until about 3:30. Is there a way to resolve this? Many of my CA's seem to be post-arousal breathing, but a couple times it looks like they were post-hypopnea. I'm thinking maybe I just need to keep slowly raising min pressure to try to eliminate those near-hypopneas? As ever, bummed to have a good stretch and a couple bad days (but not as bad!) again. Any other insights/suggestions? Should I be thinking about bi-level? I really don't want to try messing with EPR again, even though it helps CA's it makes me feel so much worse.

Much appreciation for any insight anyone can offer!
   
[attachment=69227]
   

[alemon]

A few more days. Yesterday I was really congested, thought a bit more pressure would help with it, today started out well but I'm tired at 2. Running out of space for attachments so hosting some on imgur. My numbers are trending steady/slowly lowering, but I'm still just all over the place in how I'll feel next-morning with little consistency - more now, but less than I'd hoped.

User flags are set to 20% Flow Restriction for 8s, UF2 is 50% FR for 8s. I'm just not sure what to do. I felt all right yesterday, but worse and tired today. The 4th is kind of a scratch as I was oncall and had a work emergency, but included anyway, as I actually felt pretty good for the short night. I was looking into the diagnostics for UARS - I don't know how to begin treating if that's the case.

What's funny is my BODY is very rested. I feel it in all my limbs, my arms, etc, they're SO relaxed every morning since hitting that straight CPAP pressure - so I know it's working, a little, but mentally I'm still foggy and exhausted and often inoperatble.

https://imgur.com/a/Fu1gCGt








My BEST breaths are still flatcapped, thus why I'm wondering about UARS:

[alemon]

All right y'all, I continue to feel poor even with ever-lower AHI, I'm going to see if I can get a bi-level, I'm making an appointment with the sleep doctor now. Any experiences in how to get a doctor to prescribe/insurance to cover it? I really just need the prescription, but insurance would be nice.

I've seen some success on this forum with the following:

1. Having a hard time breathing against pressure even with EPR 3
2. Aerophagia
3. Still feeling poor even with low AHI, still having respiratory-related arousals, you can see by spikes of pulse-rate.
4. My sleep stages are clearly a mess by any measure, even with my lowest-AHI numbers ever.

I'm really not sure they'll go for 3 and 4. Any experiences to share? Frankly I just have felt awful again for the past week no matter the settings.

[SarcasticDave94]

Hope this helps, consider making a case that bilevel will be more comfortable than your AutoSet. Add in therapy would be better. A maybe is mention your CA, which I'm thinking are treatment emergent based, can be helped with the VAuto and the Trigger setting. Some or all these can probably help build the case for VAuto.

I'm not sure what edits to try at this time.

The CA component is following the typical consistently inconsistent attitude. It'll be hard to pin down due to this.

[alemon]

Thanks Dave. I've had some success in treating the CA's by elevating the head of the bed, actually - this was the other night, and of course I'd prefer none but it has been a huge numbers improvement. Issue is I still just feel awful most days again, I can see a ton of HR spikes and awakenings outside of the recorded events. I can't seem to get the 'good' nights back. Nothing else in my usual routine has changed, etc.

I'd show last night but for some reason the flow rate data just hasn't recorded, though everything else did.