Lorrubdb Therapy Thread: Fine-tuning therapy with Oscar

[Lorrubdb]

Hello,

I am new to this board and cpap. Have been using resmed airsense 10 for around a month with AHI ranges from approx 4-15.  I was sleeping on my back but started using a soft collar and sleeping on my right side which resolved obstructives and the past two days it was under 2!  Big difference, felt great and actually had energy!  

But now its going up again and last night was a bunch of UA but I had large air leaks and wonder if they're real events or something to do with the leaks. Very disappointed with increasing events and return of low energy. Don't understand why and can't interpret Oscar despite watching a ton of you tube videos. Seems just a small increase in AHI makes a big difference in how I feel.

Could someone please take a look and let me know what you think?

I attached 3 charts, hope I did it right

Thanks so much! :thanks:











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[Sleeprider]

You are using 8.0 to 14.0 pressure with no EPR on a Resmed Airsense 10 Autoset, in Auto For Her mode. You seem to have significant leaks from time to time and notable flow limitations. Pressure is mostly at 10.0 cm through the night. I'd like to see you try some EPR (exhale pressure relief) which will make this more comfortable and will reduce flow limitation. There is a possibility it will increase CA events, but we need to give it a try. Turn EPR on Full Time and set it to 2. This will make your starting pressure 8.0/6.0 and maximum pressure 14.0/12.0. I'd like to see the results from this change before advising further.

Your mask leaks are normally very low, but occasionally spike as you remove the mask or experience a large leak, presumably from movement. Have you tried other masks or sizes. Have you tried nasal therapy like nasal pillows? The leaks appear to be more related to sleep disturbance than fit. What is your awareness of these therapy breaks and mask leaks?

[Lorrubdb]

Thanks so much, I will make the changes tonight and report back tomorrow. By flow do you mean length of apneas? I thought they looked long and am very worried about that bc of possible heart damage etc. I do have the worst time finding the right mask. I tried around 4 of them and they all leak at times., sometimes a lot . Theyre all resmed-the straps are so flimsy and the Velcro gets tangled in my hair and at times just pops off. They’re sending me anther one- Phillips I think/ I looked on their website and it looked sturdier . I used to take it off to go to bathroom but now just remove the air tube. I was up half the night trying to get it back on right so that works better, should I turn off the machine? Thanks again, I’ve been struggling with it for a month and getting scared with my results . I am so relieved to have your feedback and help. Much appreciated. Hoping for an easier night and good numbers tomorrow.

[Lorrubdb]

I just reread your post and don’t think I fully answered your question Re sleep disturbance. My awareness is I’m up a lot adjusting the mask. Probably I do move and dislodge it. But I don’t sleep well and always seem to be waking up.  I tried the nasal mask and it was terrible -blew out my mouth and I got no air. I tried to close my mouth but felt like I was suffocating. Anyway, am adjusting machine now and will check in with you tomorrow.

[Lorrubdb]

Made changes to EPR per adviser suggestion but unfortunately didn't realize I had to click on it again for options full time or ramp and it defaulted to ramp although ramp is off on my menu. Looks like some of it recorded.

There are still no obstructives so assume the rest are CA? I did get the AHI under 2 so not sure why it shot up again. I can tell the difference if therapy is effective or not the next day and today low energy and tired. Frustrating!

I attached 2 charts because one is before midnight 11/9 and looks blank and on the other uchecked that session so there are full results.

Please take a look and let me know what you think, if any improvement in flow or if any other suggestions.

Thank you!














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[Gideon]

Your Flow limits are very high, let's see what happens when you enable EPR, fulltime.

[Lorrubdb]

Ok thank you. What does it mean in terms of my health that my flow times are really high?   Not getting enough oxygen? Please explain. Ty

[Gideon]

Your breathing is restricted, flow-limited and you expend more effort to breathe plus the associated arousals are bad for your sleep.
Flow limits are the least severe form of apnea. Some individuals find them extremely disturbing of their sleep. I believe your O2 sats are fine if you have a recording oximeter we could prove that though. High flow limits will cause some pressure excursions and the pressure excursions can cause central apnea and some individuals find the excursion itself disturbing and they sometimes lead to arousal. We like to see the 95%Flow Limit stat at or below 0.10.

[Lorrubdb]

Gideon, Thanks so much for the  enlightening explanation-I understand now what high flow means and problems it causes. . If my breathing is restricted at night would it  account for my difficulties breathing during the day? I usually feel short of breath like I can't breathe .  That's why my doc ordered the sleep study-my ahi was 8 but had desats as low as   73. My apple watch monitors O2 while sleeping and if it's accurate the sats are ok between 93 and 98.  I do wake up a lot and if it's a bad night feel exhausted with no energy the next day. Also-what would cause the restriction? It just started a few moths ago, my breathing was fine until then.

I corrected the  EPR settings but  very unfortunately  I forgot to reinsert the SD card into the machine last night. So Oscar is only showing limited info and no graphs. Ugh, So mad at myself! Is there anyway to extract data  it or do I  just have to wait and try again tonight? I attached the chart but not much on it that I can see. Maybe you can but  it did show  higher AHI with increased CA and OA

 I will make sure the card inserted tonight aand send it to you tomorrow.

Thanks for all your help



[attachment=37060]

[Gideon]

Detailed data is written in "real" time so the SD card has to be inplace overnight.