Need help interpreting OSCAR data

[Sleeprider]

I have picked these IPAP and EPAP figures out of last night's data. I am curious to know what the significance is. 

To my untrained eye it seems I need to raise the pressures (17-9 last night).
   
            Min    Med   95%   Max 
EPAP   4.70    8.90   8.90   9.00
IPAP    4.70 16.80   17.00  17.10

What does "Med" stand for? If it is some kind of average this would seem to me to imply that my pressures are whacked up against the max all the time.

What does 95% refer to exactly?

Chalke, if you don't have a clinical manual for your machine, be sure to request on here https://www.apneaboard.com/adjust-cpap-p...tup-manual  You need to be able to access the clinical settings in orer to change pressure.  I have suggested increasing EPAP pressure from 9.0 to 10.0 in several places.  To do that, you need to know how to access the clinical settings. Here is a simplified tutorial, https://www.apneaboard.com/pr-system-one...structions 

Your machine is an older model System One BiPAP ST. Why were your prescribed this kind of machine?  The BiPAP ST is often provided to a person with COPD or hypoventlation syndrome.  For us to properly help you we need at least a little bit of medical history on you.

[SarcasticDave94]

In answer from post 4 on the question if the large leaks are still high. At nearly 32%, yes you will need to work on leaks.

[Chalkie]

Hi Sleeprider,

Thanks for your further input. I do in fact have a manual and raised EPAP for last night to 10, as you suggested

Concerning why I was put on BiPAP...I started on CPAP when I was first diagnosed with severe OSA back in 2003. (AHI 33). I had first started getting chronic fatigue way back in 1988 and I reckon I had apnea even then.

Around 10 years ago I was not feeling a whole lot better and AHIs were still around 10-15 IIRC. I was doing some research and someone on another forum suggested I had complex apnea and needed a bi-level machine. I asked my doctor and that is how I got to be on this machine. I think the NHS clinic I attend is basically for COPD and treats everyone as if they had it. I started off with PS 11 (17-6), and in fact, those settings allegedly controlled my apnea well (AHIs <5). I say allegedly as I am sceptical as to whether the sleep doc fully took into account the leaks.  

A complicating factor is that I am tapering off a benzo (Clonazepam). Long story short, I started on 2mg and am now down to about 0.4mg, tapering slowly after getting badly burned with big cuts early on. I noticed a sudden increase in AHI when I resumed tapering after a long hold. At current rates, I am on course to be off the med
within the year.

However, I still feel I can improve the AHI while on these meds. Like you say, I need to cut down on leaks. The chin strap seems to help, but next step is finding a mask that works. The Respironics Comfort Gel may not be perfect but has been thr least bad solution. I know I will not be able to source it much longer and need to change. The Wisp will be my first port of call.

It's been suggested that I need an ASV. I think it's worth asking whether I am on the right machine and would be interested in your opinion, and that of others.

But for now I agree, cutting leaks is a priority.

Meanwhile I have inserted below last night's OSCAR data plus some from Encore Basic for the last few nights. I have used the EB data as I have upgraded to the latest version of OSCAR, as suggested above, and wanted to verify OSCAR's accuracy, given the warning that popped up about sending zipped data to the developer to help improve accuracy.    

AHI on this evidence almost identical but it is just one night.

       

[Sleeprider]

The background information helps a great deal to put into perspective why your have high number of hypopnea with central apnea and some OA. The ST is not a very intelligent machine with its fixed pressure, and with your persistent pressure support, you have an abnormally high tidal volume, and low medan respiration rate of 9 bpm. I think the question is whether you would be better off on ASV or tehe ST-A in iVAPS mode. I think you would find less pressure support much more comfortable and normal, and both ASV and iVAPS are capable of increasing pressure support when needed as needed to maintain your respiration rate and volume, but back-off to lower levels when you are breathing on your own. If COPD is a factor, and higher pressure are needed, then the ST-A is the better choice, however if all these hypopnea are incomplete central apnea, then the ASV would be the machine of choice, and I suspect that is the case.

The ideal solution would be if you can get a trial on one of these machines to see if your efficacy and comfort improves. Given how slowly NHS moves on these matters, many of our members in UK have simply self-financed machines. Meanwhile, your EPAP pressure is still unchanged in this last chart. What is your backup rate in ST mode (BPM)?

[Chalkie]

Hi again Sleeprider, 

Interesting. I definitely do not have COPD. I was given the Respironics A30 (IIRC that was the model) AVAPS (not sure if that us the same as iVAPS) last year but simply could not get used to it and the NHS took it back. I went back on the ST. I had asked for ASV but got AVAPS. 

I wasn't aware of the option to use my machine in iVAPS mode. I think if I changed that myself the staff at the clinic would freak out (they got upset enough when I tweaked the pressures myself). So I will set an appointment for further down the track (not keen to set foot in a hospital right now for obvious reasons). I am not convinced ASV is unavailable on the NHS. Sleep doc and sleep nurse gave me different information -  so will try again but buying my own may be necessary.

Meanwhile please see below the correct data. My bad. This is for last night and shows EPAP at 10:

   

In the short term (and I mean before switching to iVAPS or ASV) apart from sorting out leaks is there anything else you would recommend?