Help interpreting OSCAR results on first successful night w/ CPAP!

[freddieku]

Soooo I'm not 100% sure if I'm presenting the OSCAR data as you guys prefer to see it but please let me know if I'm not. I followed the instructions on the Wiki but my app doesn't seem to do anything when I change the graph settings. 

The first night went really bad as apparently EPR made me think I was dying. Someone suggested turning it off and it was a MUCH better feeling immediately. Here is the info:

   

   

I must have woken up 7 or 8 times and adjusted things. I think I got up to go to the bathroom once. I don't know how that affects data in terms of events happening? Additionally, I woke up and was up for 45 minutes reading the news on my phone and decided to go back to bed where I laid there for 30 minutes or longer just breathing in before I fell asleep for 30-45 minutes I think. I don't know how all these things effect the data. I suppose I'll learn. The ResMed app said I took my mask off 8 times but I scored 95/100 otherwise. Don't know if that helps.

The other question I had was wondering if I discovered that I have central sleep apnea. The EPR thing almost killed me the first night it felt like but last night, I constantly would be close to falling asleep and then I'd have this sensation like I had forgotten to breathe. The CPAP somehow would make it 'tolerable' and I'd quickly breathe in so somehow it wasn't unpleasant but it was still "weird". 

My other question being, my ears popped every time I had to swallow my saliva or something which I guess happens here and there and so my ears would pop. I'd have to reach over and turn off the machine to unpop my ears and turn them back on instead of taking off the mask which is what I was doing at first until I figured it out. That's kind of annoying.

Oh and I have GERD and was definitely "swallowing" air apparently because my stomach felt distended and I was expelling the air numerous ways in the morning. I don't know if this is just a minor side effect or something that I need to look into as a problem.

Anyway, I don't know if it's placebo but even though I feel tired now, I can't explain it but I felt great upon getting out of bed for the day again, even though I was tired. My head was clear and I felt alert and fresh. Additionally, it felt like I could breathe easier. I know the feeling better thing can be overblown or people expect too much but I'm very happy with how last night went even after waking up several times and having a few issues. I look forward to optimizing stuff and trying again tonight.

Thanks in advance, I really appreciate all the help.

[Sleeprider]

Freddie, let's limit that pressure swing and see if things settle down, including your GERD or aerophasia. Your machine is running to pressure much higher than you need in response to flow limitation. What we're going to do is to limit the maximum pressure of your machine to 9.0, and try to make this more comfortable so you can sleep. We will later come back and address the flow limitation. The central apnea may be real or not. We just don't know this early in your therapy, and before we get the machine settings under control. Central apnea at sleep onset is not unusual, nor does it indicate a serious health problem. It normally goes away on its own as you adapt to the therapy, so for now we are going to call it "sleep-wake-junk" because it is mostly where you are in a transitional sleep.

For tonight, minimum pressure 7.0, Maximum pressure 9.0. If you want to try EPR, use a setting of 1, but feel free to leave it off for now since you didn't have a good experience with it the night before last.

[freddieku]

Thank you so much!

I understand what you’re saying and sounds like a plan to me.

I’m walking my dog but will make a donation when I get home and grab my wallet because I’m not sure how else I can help out here. Because I really, really appreciate it!

[freddieku]

So my 2nd night when I tried 9 - 7 except it was actually 10 - 7 because I thought I might have overstated the air swallowing and stuff. I got neurotic that that was too narrow a range.. I don't even particularly understand what happens if the MAX level is too low and you're trying to breathe.. if that makes sense. 

Well, anyway.. problem was.. I woke up 5-6 hours after I fell asleep and my mask was laying next to me in bed. No recollection of taking it off. I bought a new CPAP pillow as I'm a side sleeper and I think adjusting to that might have caused it. Regardless, can you tell if my mask was leaking or anything. I'm looking at the data and I still don't understand it. Any help about what may have happened would be appreciated.  Thanks as always.

   

   

[Sleeprider]

Between 1:50 and 2:25 you had a sustained large leak that ended abruptly when you awoke and fixed it. Your therapy time was only 1:41 so notne much of a test, but no events in that time. Fix the leak, and get a grip on your anxiety and things will be fine.

Let's talk about pressure, the pressure range, and whether it's enough to breathe. When you sleep without CPAP, you breathe room air at atmospheric pressure. When you sleep at night, your muscles around your airway relax and when you breathe in, the pressure in your airway becomes negative compared to atmospheric pressure. Air naturally flows from higher to lower pressure, so as your lungs expand and create low (negative) pressure, air flows in through your nose (and mouth if open), and when your chest muscles react, the rebound create a higher pressure in your chest and air flow out (expiration). The problem is, the negative pressure of inspiration makes your airway collapse, and the result is like trying to suck a milkshake through a narrow straw, or kinking a water hose; not as much air flows freely through your airway resulting in apnea or hyperplane. Stick with me here.

We use a CPAP machine to add a little bit of positive air pressure to the airway, and that keeps it from collapsing. At 7-cm pressure you only get 0.1 PSI, and 10 cm raises that to 0.14 psi. That's enough to do the job. The machine produces enough airflow to maintain that pressure. Note pressure and flow are different. How much flow do you need to breathe? Your Oscar chart shows you inhale and exhale 7.25 Liters per minute. It makes no difference if the pressure is 7.0 or 20.0, that requirement does not change. Your CPAP mask is designed to leak some air intentionally to keep you from rebreathing expired CO2. So your full face mask will vent about 30 Liters of air per minute. That is 4-times your respiration requirement. With the unintentional leaks in your chart (10 to 30 L/min) the actual flow rate was closer to 40 to 60 L/min. That leak is really disruptive, and makes it harder to breathe. Have you ever tried sticking your face out in a high wind?

It doesn't matter how low, or how high I ask you to set your pressure, that flow will be there as long as we don't make pressure ridiculously low. Don't worry about settings or breathing. You appear to be anxious about having enough air to breathe. I am explaining to you, that anxiety is unnecessary. If you have claustrophobia or anxiety those are treatable conditions, you must overcome to succeed at CPAP therapy. Be calm, wear the mask, and put it back on if you are aware it has been removed.

[freddieku]

You are a gentleman and a scholar.

Yes, I did get diagnosed with generalized anxiety disorder. What actually kick started me trying to get back on the CPAP was that I read a lot of people helped their anxiety and depression by fixing their sleep with CPAP. Being tired makes both of those things worse.

Anyway, I will try 7 to 9 tonight and trust you. There is some kind of brain disorder where in the middle of the night when you see the mask laying next to you you don’t have the power to put it back on but I will do a better job if that happens again.

Thank you so so so much again.

[freddieku]

So here is my 3rd night info:

   

   

I can see I had a large leak at some point in the night. I don't recall waking up and fixing it or feeling it. I have my mask pretty secure so I'll have to look into that.

Overall, I currently feel rather tired. Compared to the first night when I had "more problems", I feel worse but I don't know if you can actually draw anything from that. Unless more pressure/less pressure could be the cause but I would guess not.

Anyway, thank you so much for any advice and letting me know where to go from here. I really appreciate it.

[Sleeprider]

Let's start slowly adding some EPR. It's going to tame the flow limits which is why your pressure bounces all over the place. EPR full-time setting 1.

[freddieku]

I’m willing to take a leap of faith but when it was on EPR 3, I did that thing where I thought I was dying and ripped my mask off.

I’m scared but… I trust you.

Thank you for the quick reply.

[Sleeprider]

If you're nervous, schedule a short practice session and decide. You'll be fine, and you have a lot more experience now.