Interpreting OSCAR data (relatively new CPAP user)

[bolivar98]

Hi all,

Request 

Please could someone interpret my most recent OSCAR data. I have recently installed OSCAR and I do not know where to start re: analysing my data. Please do not hesitate to request more data if it's required.

Context

I was diagnosed with mild sleep apnea earlier this year (AHI 5) after regularly waking up feeling unrefreshed/experiencing consistent day time fatigue, and recently received a Resmed Airsense 10 Autoset machine. Having used the machine for the last two weeks with a Phillips Dreamwear nasal mask, I am still not able to last a full night without waking up (typically around the 6 hour mark) and often take off the mask before returning to sleep (for approximately another 2-3 hours). My inability to return to sleep with my mask on seems be a psychological issue. I will normally give myself 30-45 minutes to return to sleep and, if I can't, I take the mask off. Interestingly, as soon as I take the mask off I tend to immediately return to sleep.

My AHI is consistently around 0.8 - 1 and my pressure range is 4-6.6. However, despite my improved AHI (5 to ≤1), I do not notice much/any improvement in my daytime energy levels relative to when I was not on CPAP therapy. I would be grateful if a member of the board could help me to interpret my data to better figure out what is causing my night time awakening and why I still do not feel recovered upon waking after 6-9 hours' sleep. 

Please see my most recent OSCAR data below, which is typical of a normal night of using the machine (asleep by 11.40pm and awake by approximately 5.30am).

[G. Szabo]

Your minimum pressure is too low. 
I suggest the following settings: 
Pressure min/max = 7/9
EPR = 2, full time.

[bolivar98]

Thank you very much for replying and suggesting new settings. I really appreciate it and will definitely try them out tonight.

[quiescence at last]

well, I respectfully disagree. you don't say you feel air starved at current settings. most people feel air starved when pressures are below 6.0.

what you need is quiet and effective sleep. there are NO APNEAS in your current chart, so the settings are effective as is.

this night may not be characteristic, so look at a few other nights before slapping your settings around.

QAL

[Narcil]

he still has flow limits ... that's a good reason alone to raise min pressure. they are "apneas" only they don't last 10s.

smoothing out the peaks on the pressure graph can't hurt either.

[bolivar98]

Hi,

I took your suggestion and put my EPR to 2 (full time) whilst slightly increasing my pressure settings from 4-6.6 to 6-8.6.

Interestingly, my AHI reduced from 0.8 to 0.1 (it has never been below 0.7 before); however, I still seem to be having a relatively significant amount of flow limitation throughout the night (a similar rate to when my AHI was at 0.8). Do you know if it's possible to rectify this? I was thinking about making my pressure fixed to a rate that's closer to my average with the EPR setting turned on. Or, instead, should I keep my new settings as they are and see if my flow limitation stabilises with increased use?

Any input / advice would be greatly appreciated.

Thanks again.

[G. Szabo]

You are making progress. But it still can be improved.
I suggest the following settings:
Pressure min/max = 7/9
EPR = 3, full time.


Would you mind adding the pressure curve to your next posting?

[quiescence at last]

I can't wait to hear, "wow, I feel so rested." Hope you are making quality assessments independent of a point score. Try assessing your rested-ness before you look at your curve/graphs of the night.

[bolivar98]

Hi again,

I had trouble adjusting to the suggested settings. I could not tolerate EPR at 3, full-time, as I was experiencing a strange sensation in my throat between each inhale and exhale, as if the pressure was rapidly dropping. This made it difficult to breathe, so I tried 7/9 at EPR 2 (see the first attachment); however, these settings seemed to raise my AHI quite a lot (in relative terms) and I often woke up in the night with increased aerophagia. 

Subsequently, I returned to my lower settings 6-6.6/7.6-8 (attachments 2 and 3). While this has made it easier to sleep for 6+ hours undisturbed, I still do not wake up feeling particularly refreshed and find myself falling back asleep within a few hours of waking. I appreciate I am still at the beginning of my CPAP/APAP therapy and that increased sleepiness is often a common symptom at this stage. 

Any advice or input would be seriously appreciated. I can add further attachments if required, as I have selectively included my OSCAR data from the last six nights. 

Thanks again.

[G. Szabo]

On your second and third charts, you are hitting the pressure ceiling. Therefore, your maximum pressure should be increased; I suggest setting it to 8.6. You also had frequent pressure adjustments, which did not let you rest. This begs for a higher minimum pressure than 6. I suggest 7.
Higer EPR combats aerophagia. It would be best to try using EPR=3, mainly because of the increased maximum pressure of 8.6.

If you are not comfortable with the EPR 3 and the increased pressure causing aerophagia, then an alternative approach is the following:
Minimum pressure 7.6. Maximum pressure 7.6. And EPR=2 full-time.