MildOSAHighRera's therapy tuning thread

[MildOSAHighRera]

Hi All,

I was recently diagnosed with Mild OSA (5.6 AHI, 15.5 RDI. 11.7 AHI during REM 31.3 RDI during REM)

Full sleep study diagnosis:
INTERPRETATION:
The patient had a sleep efficiency of 74.5% and a normal sleep onset time of 21.0 minutes. REM sleep latency, 205.5
minutes, was prolonged.
The overall apnea/hypopnea index (AHI) was 5.6 per hour; 1 apnea, 29 hypopneas, 54 RERAs were present. The AHI
during REM sleep was 11.7 per hour. The overall respiratory disturbance index (RDI) was 15.5 per hour. RDI during
REM sleep was 31.3 per hour. The longest duration of the respiratory event was 54.0 seconds, and the average
duration was 19.3 seconds. The baseline oxygen saturation was 94%; the minimum during the study was 91%.
Tracheal microphone monitoring revealed frequent mild snoring.
The Central Apnea index was 0.2/hour. The patient’s oxygen levels were below 88% for 0.0 minutes. Frequent
periodic leg movements during sleep were absent. Prolonged cardiac rhythm monitoring was unremarkable.


I've been able to sleep roughly halfway through the night with my mask, and then start waking up every hour or 2 until morning. Not sure if it's just me adjusting to the CPAP or there's something I need to tune in my therapy

I was looking for help interpreting this OSCAR data and how to action it. I.e, is my mask too lose, too tight? Should I raise/lower EPR? Thanks!


Attached is my last 2 nights in OSCAR

[Gideon]

Welcome to the forum.

I and others would like to see your entire Sleep Study including the charts and tables.  
I'd like to see the details of especially the oxygen Sat portion.  
They said 

The baseline oxygen saturation was 94%; the minimum during the study was 91%.

which is ok but they also mentioned 

The patient’s oxygen levels were below 88% for 0.0 minutes.

which, is also 'good' but why mention it at all?  I just want to make sure nothing unexpected is going on.

 Mild OSA (5.6 AHI, 15.5 RDI. ...)

AHI of 5.6 is mild but an RDI of 15.5 is low Moderate.  The fairly large difference points to more of a UARS type of condition.  Your 54 RERAS do back this up.

Overall your "Numbers"  are AWESOME!  Your doctor will be very pleased.

Looking at the RERAS case your main tool to treat that is a differential pressure between inhale and exhale.  On your CPAP we use EPR to achieve that.  So I suggest that you make the following changes to allow your EPR to fully function,

Set 
Min Pressure=7.  Why? EPR subtracts from this but will never go below 4. EPR max is 3 and 3+4=7 thus a min pressure of 7.
EPR =3, Fulltime.  At your current settings EPR varies between 1 and 2.  These changes will leave it at 3 all the time.


WE want the 95% FL STAT to be as low as possible to best manage your flow limitations of which you had plenty and managed many and, 
this is important, make you as comfortable as we can.  

So try these and evaluate which feels better, current settings or these, and why what is your perceived difference.

[MildOSAHighRera]

Thank you for the help! I'll try upping the EPR to 3; are the leak rate spikes anything to be concerned about also? Also will anonymize my full report and upload it here

[Gideon]

The spikes, not at all.
See the leak chart at the end of the night. If you were sleeping then, not likely, maybe. We want leak rate below the red line as above that it is harder for the CPAP (and us) to accurately see what is going on and event that should be responded to are missed. You are good.

[MildOSAHighRera]

Sorry another dumb follow-up question this part:

"WE want the 95% FL STAT to be as low as possible to best manage your flow limitations of which you had plenty and managed many and, 

this is important, make you as comfortable as we can.  "

Does this refer to the "Flow Limit" graph? What does the 95% part signify? What does this look like more ideally? Totally flat? And this is the part the higher EPR/min pressure is meant to rectify?

[Crimson Nape]

That statistic is a percentile. Its meaning is all recorded data is at or below the displayed value.

- Red

[MaskedOne]

I read that FL 95th of about 0.10 (and median at zero) is a reasonable target for FL to be of low or no concern.  Is that true?   Gideon mentioned keeping the FL 95th as low as possible; is there a scale or table for FL percentiles at low, moderate and high concern?

[MildOSAHighRera]

Hi,



I left this thread dormant for a while and decided to just follow the doctor's recommendations and see how it goes. After a while on APAP mode 5-15, he adjusted me to CPAP mode Pressure 9 EPR 1-2 (he left it up to me). I eventually adjusted myself down to EPR 3 based on the guidance on this forum re: UARS. This has been a slight improvement for me in terms of how I feel from APAP, however I still am counciously awake 2-3 times per night and don't feel 100%. I've had an increase in flow limitations since changing to CPAP mode, it seems mainly earlier in the night.

As to the root of my apnea, I believe my poor nasal breathing is likely related, though can't say for sure. I'm considering seeing an ENT to see if there's anything to be done about my nasal breathing specifically. 

Recently, I've been trying an MAD as I want a solution for camping that I can carry with me. It hasn't been going great though, I actually find the MAD less comfortable than the CPAP. I know there are travel-sized CPAPs, but I figured the MAD would be a much lower hassle solution in the backcountry without access to power (have to carry in all the batteries I need)

I've attached my full anonimized sleep study, as well as a few rew recent example days.

My current questions/thoughts
My doctor believes 2-3 arousals per night is normal, and given that my numbers from the machine look great I shouldn't be concerned. However, I've read on the forum that the machine data can struggle to acurately score RERAs as the only true way to do that is polysomnography. Do you all believe my 2-3 concious arousals per night may indicate ongoing RERAs beyond what's in my OSCAR data? If so, should I increase pressure to reduce flow limitations? Or do you think it's that I would need more pressure support to eliminate flow limitations?

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Sleep report, continued:

[MildOSAHighRera]

Sleep report, further continued and a recent night's data

[MildOSAHighRera]

Hi All,

I’ve been on a CPAP for about 10 months now for mild apnea/UARS, and have done a little tuning of my own therapy since then, and am looking for guidance for where to go from here. For some background, here’s my initial sleep study results:

Full sleep study diagnosis:
INTERPRETATION:
The patient had a sleep efficiency of 74.5% and a normal sleep onset time of 21.0 minutes. REM sleep latency, 205.5
minutes, was prolonged.
The overall apnea/hypopnea index (AHI) was 5.6 per hour; 1 apnea, 29 hypopneas, 54 RERAs were present. The AHI
during REM sleep was 11.7 per hour. The overall respiratory disturbance index (RDI) was 15.5 per hour. RDI during
REM sleep was 31.3 per hour. The longest duration of the respiratory event was 54.0 seconds, and the average
duration was 19.3 seconds. The baseline oxygen saturation was 94%; the minimum during the study was 91%.
Tracheal microphone monitoring revealed frequent mild snoring.
The Central Apnea index was 0.2/hour. The patient’s oxygen levels were below 88% for 0.0 minutes. Frequent
periodic leg movements during sleep were absent. Prolonged cardiac rhythm monitoring was unremarkable.

I’ve linked an old forum post of mine with with the entire sleep: https://www.apneaboard.com/forums/Thread...OSCAR-Data 

At the time, I was initially prescribed to run my Resmed Airsense 10 in APAP mode with range 5-15. After a month or two of that, my docto prescribed me a fixed pressure of 9 on EPR 1-2. Based on what I read here for UARS, I immediately upped the EPR to 3, and ran on pressure 9 EPR 3 for a while. This entire time, I was still waking up 1-3 times a night and overall wasn’t feeling greatly improved. I started dialing the pressure up further, first to 10 and then to 11, and at each jump I felt that I personally felt slightly better. Overall, I feel like I’m doing OK now, however I still wake up 1-3 times a night (though usually closer to 1). However, I can’t really see why in the data that might be the case, especially going from 10 - 11. My AHI in OSCAR was always pretty low (0.5 - 2) and going from 10 to 11 didn’t even have a significant difference in FL95 or FL99.5. I’m wondering if you all see anything in this data that would indicate why the higher pressure is helping me?

Finally, I’m wondering where to go from here? Should I continue increasing the pressure (as long as I’m not getting centrals) and go on feel alone? Should I just call it good despite waking up a few times a night still and still not feeling 100% a few days a week? Is there something in my data that can say why a pressure of 11 is working better for me than a pressure of 10? I’m hesitant to keep dialing pressure based entirely on the feel without data to back it up as I keep deviating further and further away from my initial prescription.

I've attached a night from a pressure of 10 and a pressure of 11 to see if you all can identify any differences in the data:

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Sorry, forgot to include the new pressure. New screenshot attached