Need help with Oscar data!

[sc2neans]

Hi everyone, I just downloaded Oscar and need some help with the data. I've been on CPAP/BiPap therapy for the last 4 years and I still don't feel good using it. I've had UPPP and tonsillectomy in 2019. I switched from Bipap to CPAP treatment in October last year because I thought Bipap wasn't working for me. 

I remember when I first tried CPAP on a CPAP machine trial I woke up feeling refreshed and thought to my self this is what I should feel like after sleeping. After that trial, my sleep specialist put me on BiPap therapy for whatever reason and I never had that feeling of full rest ever since. I've been trying to get to that point but it seems impossible.

Anyway, if someone could help me read the OSCAR data I would appreciate it. I've been trying to adjust the pressure myself to see what works for me but I haven't quite figured out what's the best yet.

Edit: had to add files as attachments because images weren't showing up in post.

[staceyburke]

Welcome, there are great knowledgeable people on this site. First a question - what Cpap machine were you on?  A ResMed or a Phillips dream station?

I would suggest to raise to 11 and turn on the flex to 2. Don’t use 3 that seems to cause more problems. 

That should help with flows and apnea.

[Sleeprider]

Sc2neans, welcome to Apnea board, and thanks for posting your charts. We can see you are using a Philips Dreamstation Auto BiPAP in essentially fixed-pressure CPAP mode at a pressure of 10. You have tried a number of different pressure settings between 7.0 and 10.0 cm without much difference and your AHI ranges mostly from 5 to 12, with predominately hypopnea events. The appearance of your flow rate graph suggests there is likely a lot of flow limitation, and the very good news is that you have an excellent machine to deal with it. I'm going to suggest some radical changes to your settings that should be much more comfortable and effective.

Mode: BiPAP Auto
EPAP min 7.0
IPAP max pressure 14.0
PS min 3.0
PS max 3.0
BiFlex 1

These settings will change you from CPAP therapy to BiPAP therapy with a very conservative difference between inhale and exhale pressure of 3.0 cm. I anticipate increasing pressure support to 4.0 but want to start here first so you have a chance to adapt to the differences. Your minimum exhale pressure (EPAP min) is selected based on your history of good results for OA events with pressures at 7 to 10. The pressure support will help you overcome inspiratory flow limitations and should significantly reduce hypopnea. The maximum pressure allows your machine to raise and lower pressure to meet your needs and provides room for pressure support to work. In BiPAP auto mode, the machine will only raise pressure based on snores and obstructive events, so it is unlikely you will experience the maximum pressure of 14. Let me know how your like it and post a follow-up chart tomorrow.

[Gideon]

Welcome to the forum. We actually prefer you to use attachments here, you couldn't use links as a new user because of our spam controls. You will be able to soon,

First your numbers are very good, very very good. A BiPAP has you light years ahead of others on a Philips CPAP/APAP.
In your posts here ALWAYS include a detailed critical view of how you feel and why you think you feel that way. What you say will help to guide us along your journey.

[sc2neans]

Hi everyone, thank you so much for replying. In general, when I wake up using my CPAP machine, I get tension headaches in the front of my head, somewhere near my eyes. My eyes and the front part of my head feel heavy as there's always pressure there.

Last night, I adjusted my Philips Responsics dreamstation machine to the settings that Sleeprider suggested and I've attached the data from Oscar.

In regards to how I feel this morning, my headache was slightly better than normal, however, I've maintained a headache throughout the entire day (it's now 4:30pm EST and I've been up since 8am. My energy level felt slightly better this morning, but I also woke up with my stomache feeling bloated.

I think my goal would be to get rid of the pressure in my head so that my eyes and head don't feel so heavy. Any input or changes I need to make to feel better would be appreciated.

[SarcasticDave94]

Any likelihood we're dealing with higher leak rates periodically that the Respironics is having trouble compensating? And is positional Apnea coming into play here a bit, such as 0145-0200 time?

Just wondering, because the bottom line of the leak chart looks fairly high with multiple intermittent leaking, for a Respironics that is. Which mask are you using currently?

[sc2neans]

I'm using the Amara view full mask as seen from this website[Commercial Link Removed] Manufacturer's image inserted

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[Sleeprider]

Looking at your most recent chart, I think you have made some good progress, and we are learning more about the pressure you need. Most of your headaches is probably due to the flow limitation, which is driving the RERA and hypopnea. We should do a close-up view of about 3-minutes of therapy to see what your flow rate wave-form looks like so I can explain more. It's worth noting that with EPAP min 7.0, PS 3, your median EPAP pressure was 7.9 and your 95% IPAP was still close to your previous pressure. To address the RERA and hypopnea, I'd like to have you increase the PS min and PS max to 4.0. We an leave the rest alone for now.

[sc2neans]

Here's the data from the last few days with the previously suggested changes. I think it's improved slightly, but I am still waking up with a headache that persists and pressure behind my eyes. 

Should I continue to slowly increase the PS min and PS max values?

[Sleeprider]

The increase in PS has had the unintended consequence of increasing CA while hypopnea and OA are about the same. I think we need to adjust PS down to 3.5 and increase EPAP min to 7.5. So we are looking to move to EPAP min 7.5, PS min 3.5, PS max 3.5 and Max IPAP at 14.0.