Little Olive - Therapy Adventure

[Little Olive]

Ive spent some time revisiting all the advice and info I have received from you guys over the weeks. Now that I have a slightly better understanding I can probably make better use of it.  I also reread the mask advice from jeffy58, as i had a tantrum yesterday about masks and posted elsewhere on the board, having forgotten about that link. The airfit was more satisfactory last night thankfully.  

Re the centrals, I remember jcp519 saying that CSA is consitently inconsistent, and have not forgotten that, so i know I need to accept that there will be variations in that area. I have also reread jcp519, stevew and unicorn rider's posts re ramp, response settings, EPR, flow limits and pressure settings, and I reaslise that some of this got lost on me on the way, . There are also just one or two contradictions, and some stuff Im still confused about.   But hey I'm just confused anyhow.   

So does it sound reasonable to continue as advised with increase in min pressure (I was comfortable last night on 6.6), max pressure 12, EPR on 3,   Ramp either 6.4 or off, response on standard. ?  There were comments that EPR is not doing me any favours.....

It was also suggested to lower min pressure  to 5 or 6, but this was in relation to lowering EPR to 1 .  Am I right in thinking that in order to lower the EPR and at the same time preserve my comfort in exhale, it makes sense to lower the min pressure?

Or am I better off sticking with the EPR on 3 ?  Maybe I could try 2, as a middle way.

Stevew and JCP also commented on Ramp.  I am wondering if there is much point in ramp for me, when some of my apneas actually occur when I am not even asleep, so if, as they say, apneas are not recorded till the machine says I'm asleep, and ramp stops, then its not really useful for me?

Sorry about all the questions, and thanks for reading.  

[UnicornRider]

By now you should be able to wean off of Ramp. Turn it off.

The next step I think you would benefit from raising your Pressure minimum to ~8 cmH2O, Looking back at your previous OSCAR Reports at your Median pressure in the Statistics area of the Left hand panel, I would expect to see that possibly going up to mid 9.? cmH2O, but did not want to jump you up too fast on your starting pressure. If 8 is too much to start with try 7 cmH2O, then every couple of days bump it up 0.4 cmH2O.

I still think after your Hospital sleep study they will order a new machine for you., I hope they titrate you for a possible new machine. If your CSR is real then I would expect the ResMed AirCurve 10 ASV machine. Otherwise it is possible they may get an AirCurve 10 VAuto. It has a lot of tuning, timing and trigger settings that could possibly eliminate or greatly reduce the CA events. The Sleep Therapist that hooks you up to the recording machine has a lot of input into what machine you end up with, It would not hurt to casually mention that several friends have had good experience with the AirCurve 10 VAuto. Would that be good for me?.  Lowenstein primus 20 A, has gotten some very good reviews from some of our Australian and European members. I have looked at the manuals on line and it appears to have numerous tuning parameter to work with. That would be acceptable, I guess.

   I do not know if you have followed the Philips Respironics equipment problems. They are no longer allowed to sell any of their PAP equipment in the USA. They have recalled all of their machines prior to ~2022 are reconditioning them and sending them out as replacements for the recalled units. My Mother got a reconditioned Philips DreamStation CPAP, The algorithm Philips uses is sluggish in comparison to the Resmed PAP equipment. But Philips is selling their machines everywhere but the USA. Try not to get a Philips machine, 

There are some Chinese machines that are NOT recommended, BMC and Luna come to mind, that is what I started out on.

Make sure the machine is "Card to Cloud", has a SD card so you can load to OSCAR.

Here is a link of OSCAR compatible machines.:   https://www.apneaboard.com/wiki/index.ph...d_machines

There is a lot to learn so I would recommend you review the information and links in this post:   https://www.apneaboard.com/forums/Thread...#pid510531

The information will have a lot more meaning now that you have some experience.

You would do us a favor by re-arranging the order of your OSCAR graphs according to the link at the bottom of the post I linked to. Having a standardized report helps us scan for information more quickly and accurately.

Please post back when you get a chance.

[Little Olive]

Good advice about the machines, I will definitely have all that noted to rehearse in the waiting room before I see tem.  I did call the hosital today to see of they have a date for me yet, but not heard back from them. Hopefully they call me tomorrow and will give me a timeline.

I followed everything in the link about rearranging my oscar, but it still looks the same.  I tried to lower the graph height and clicked onto all the right things but they still look the same.

I got rid of ramp, I should have done it a while ago because I already knew that I wasnt getting enough air in those starting out for sleep periods.  Some of these things are all very well for a person who goes to sleep at night, stays asleep and wakes up in the morning, but a feature like ramp is pretty much useless for someone like me who is awake and then trying to go to sleep again numerous times through the night. I did notice the difference, being easier to breathe from the moment the tube is attached, instead of that long period of not enough breath.

[UnicornRider]

All good news.

To adjust graph height, grab the border between the Pressure Graph and the Leak Rate graph, as you move the cursor across the border you should see the cursor change into the symbol for moving the border. When you see that symbol hold your left mouse button down and drag the border up a little. Then repeat for the border between the Leak Rate Graph and the Flow Limits Graph. That should get your Flow Limit Graph into view for screenshots.

  I think that CPAPFriend may have demonstrated adjusting Graph Height in one of his videos that I referenced in that link I left for you.  

 If 6.6 cmH2O felt good, try to raise it to 7.0 cmH2O, that is only a 0.4 cmH2O pressure differential. Most people do not start to feel less starved for air until they get to 7 cmH2O pressure. In the Left hand panel under Statistics, for the pressure row under the Med column, Pressure is 9.36, the closer you get to that median pressure the less pressure change you will experience, hopefully fewer wake ups.

       You are doing well, as soon as you get a PAP machine more adapted to your needs, I think you will see much improvement in sleep quality.

 Do keep posting.

[Little Olive]

Thanks for the easy explanation, I managed to do it!  I did move up to 7 min last night.  I have had 7 before but it was in combination with 15 max and that did not work.  But it was comfortable last night.  I will slowly move up towards 8.

The worst time for me with not breathing properly is in the early morning,.  Since doing oscars I have noticed frequent big clumps of apneas right at the end of the recording ie the last hour or so of (so-called) sleep.  These happen even if I'm not actually asleep, just resting relaxed, or half asleep.  I just stop breathing.  I breathe out but then realise that I never breathed in again. My breaths feel incredibly small and shallow , but the weird thing is I dont feel breathless, I dont feel anything.  Untill I suddenly think oh wow, Im not breathing, then take a breath in and so it goes over and over.  Even if I dont fall asleep,  this produces the big blocks of back to back apneas and sometimes the cheyne stokes as well,.  And this is WITH the machine on.  These contribute to the AHI, and are avoidable if I just get up early !   This is when I feel the most need for more air.  I'd love a remote button I could easily access to boost up the airfow to get extra when this happens.  So maybe raising the min will help with these episodes, because it doesnt look like the apap knows to raise pressure to max for me at these specific times.  

I wonder if that's because it responds best to more 'acute' or sudden apnea events like OA, and not so much with slow build up events like centrals that start out with increasingly shallow breaths then just stop.  So the apap only kicks in when the breathing actually stops.Today I i stopped the machine early before this all started, and just got up.

[UnicornRider]

The worst time for me with not breathing properly is in the early morning,.  Since doing oscars I have noticed frequent big clumps of apneas right at the end of the recording ie the last hour or so of (so-called) sleep.  These happen even if I'm not actually asleep, just resting relaxed, or half asleep.  I just stop breathing.  I breathe out but then realise that I never breathed in again. My breaths feel incredibly small and shallow , but the weird thing is I dont feel breathless, I dont feel anything.  Untill I suddenly think oh wow, Im not breathing, then take a breath in and so it goes over and over.  Even if I dont fall asleep,  this produces the big blocks of back to back apneas and sometimes the cheyne stokes as well,.  And this is WITH the machine on.  These contribute to the AHI, and are avoidable if I just get up early !   This is when I feel the most need for more air.  I'd love a remote button I could easily access to boost up the airfow to get extra when this happens.  So maybe raising the min will help with these episodes, because it doesnt look like the apap knows to raise pressure to max for me at these specific times.  

I wonder if that's because it responds best to more 'acute' or sudden apnea events like OA, and not so much with slow build up events like centrals that start out with increasingly shallow breaths then just stop.  So the apap only kicks in when the breathing actually stops.Today I i stopped the machine early before this all started, and just got up.

Sleep Wake Junk (SWJ) is the awful mess we see going into & coming out of sleep. I usually ignore most of the events recorded during this period.

Yes your machine's response is graduated to the severity of events. OA have the greatest weight, Flow Limits, which you have plenty of, also start the increase in pressure, you can see the response in your graphs is predominately controlled by Flow Limits. Pressure Support in your new machine will suppress those Flow Limits.

Some of your events are clustered, indicative of "chin tuck" type positional apnea. There will be good days and some not so good days for this type of positional apnea.

  The reason I suggested you wear the Sleepu during the day is because the same "forgetting to breath" will happen during the daytime. Bend over to pick something up, we hold our breath, then walk away and not realize until my Checkme O2 Max starts buzzing my finger. Oh I forgot to inhale.


Our whole household is that way now. Ever since we caught that nasty respiratory infection last September. Except my Mom does not like the vibration so we put it on audible alarm, she doesn't hear so well either, so we are constantly reminding her to breath.

Take care.

[Little Olive]

Ah OK so SWJ is a thing. Glad its not just me .

I just got a call from the Respiratory department to say they are scheduling an appointment for me in the first week of July. They require me to have blood tests done the week before and at the appointment want to do chest Xray and ECG . I don't know if they will be handing our new machines on the day but it's the first step anyhow. I will attend armed with a file of my oscar bad and uglies.

Any ideas on how to make nice copies of them? When l print them they don't look good.

[Little Olive]

First is what happens when you forget your collar, not just for your afternoon nap,   but then forget to put it on at night as well 

And next is what happens when you wear your collar! 

I feel like I should be celebrating my lowest AHI ever, but tbh I feel just as tired and exhausted as ever. maybe it takes time to start really feeling the full benefits of the therapy, and I spose I do have other conditions that contribute to fatigue.

[UnicornRider]

That type of OSCAR Reports, will make a believer out of you. It is amazing how little things can make a big difference. I can still see a couple, possibly three clustered incidents with the collar on, where you still went into "Chin Tuck".

 Did you happen to capture a SleepU record of those sleep sessions? Post the O2 Insight Pro Reports if you did. It will be interesting to see the SpO2 desaturation differences compared to nights with the collar on.  If you happened to import that SleepU information into OSCAR, then Pin the Events, Flow Rate, Mask Pressure, Motion, Pulse and SpO2 Graphs. with graphs height adjusted to get all six graphs on one screenshot, can you spot REM sleep? A lot of people experience SpO2 Drops during REM sleep, especially on nights they forget their SCC.

For taking better quality OSCAR Report print. Under VIEW, in the upper left corner, Take Screenshot, is the normal route I utilize to get screenshots for printing. The f12 key is an alternative ( fn+f12 on my keyboard).

shift key + windows key + S key, will bring up the snipping tool for partial or full screen clips.

If you have not imported from your SleepU reports into OSCAR, now is the time to practice. After you get your first session imported, get brave then try to import a couple of sessions at a time. Don't be afraid to ask questions if you have any doubts or fears.

For the reports you take with you to the hospital...

Remember, on days with multiple OSCAR views you want to print, to pull the slider of the Left Hand Panel to expose additional Device Settings and Sessions Information for the additional views.

 If you have been taking "Notes" You will want to include those with one of the later screen shots. 

If you happen to see a Pulmonologist trained as a sleep medicine specialists, they like to see every graph OSCAR includes in it's report. 

If you have an IPhone you can get additional sleep position/movement graphs into OSCAR by down loading the app. "SomnoPose". It will give angular movement for partial rollover events.

 Include the associated O2 Insight Pro report with the Daily OSCAR Report of the same date, even if you include the Pulse/Oximetery imported into OSCAR. For O2 Insight Pro reports I usually only print the first page, the follow up detailed graphs I only print if there is a lot of time below 90% SpO2 for a given desaturation episode.

It can take a long time for years of sleep deprivation to clear from the body. I would expect to see significant improvement in the "how do I feel" category, with a new machine of the right persuasion. Your new machine should be able to knock down the remaining Flow Limits with a little Pressure Support. Then Timing and Tuning with special features will eliminate the CA events, so only the really persistent Chin Tuck events come through.

[Little Olive]

So frustrating  being so thick, l just can't do it.  I reread ratchicks post and other posts , and l also  searched Linux on the forum, but couldnt make itcwork. and put device into computer on Oscar wizard but doesn't  recognize my device. So lve done all the steps , but can't do it.  Probably l could do it just on my phpne  which is where the o2 reports are in the vihealth app.  I don't know how to download it off the app into a more detailed format.