Newbie kindly asking for OSCAR analysis
Hi everyone,
I'm a bit lost trying to understand my OSCAR data and adjust accordingly. I'm attaching 3 screenshots from 2 nights (2 zoomed out, 1 zoomed in). Would very much appreciate if anyone can give me any insight!
My initial sleep report (WatchPAT) was AHI 10.2 and pRDI 34.7. With my APAP, I find I wake up like 3 hours into the night every night and take off the mask (that's why my sessions are so short). I seem to be having mostly CA events.
RE: Newbie kindly asking for OSCAR analysis
You have some CA events that may be simply a therapy onset issue. Your EPR is set to ramp-only, so you're not getting anything out of that and we can see the flow limitations in the zoomed shot on March 12 that cause the hypopnea, and continue afterwards. I think you will do fine with some minor setting changes.
Mode: Autoset
Minimum pressure: 6.0
Maximum pressure: 8.0
EPR: on full-time
EPR setting: 2
Ramp: off
Smart Start: Off
Try to avoid removing the mask, or if you become aware of it, replace it. This becomes a habit or behavior, and if you don't modify it, the problem remains or gets worse. I have recommended you turn off Smart Start because it turns your machine off when you remove the mask. I want it to wake you up and bother you enough to put the mask back on. The ramp is off because your pressure is very low starting at 6/4 (inhale/exhale), and so ramp is pointless. We will monitor the CA events, but there is not much concern with early treatment.
RE: Newbie kindly asking for OSCAR analysis
Thank you for the analysis and suggestion. I adjusted to the suggested settings (tweaked a tiny bit) and got these results (attached).
Any advice on how to adjust from here? Seems like I'm still having a lot of CA events. How long before I should consider switching to an ASV machine?
RE: Newbie kindly asking for OSCAR analysis
You have a lot of therapy onset central apnea that is much worse with higher pressure and more EPR. There really is not a good solution to treating this with CPAP. What were the results of your sleep test? Was central or mixed apnea present prior to use of CPAP? If you have a test report, post a copy with your personal information redacted. Some of the WatchPAT tests do not include the RIP belt, so don't give good results, however if your AHI in the test was 10.2, it's clearly unacceptable that you continue to have 10 to 20 events per hour with CPAP.
I think we need to reset, and do a simple CPAP titration, one step at a time. Since EPR was clearly a problem, and your results show no evidence of obstructive apnea, even at low pressures, I think we will go to CPAP mode (fixed pressure) with a setting of 5.0. EPR Off, no ramp.
RE: Newbie kindly asking for OSCAR analysis
Thanks for the quick reply. Posting my sleep report here- though I don't think it differentiates between central or mixed apneas. Will try the CPAP mode with 5 pressure and report back.
RE: Newbie kindly asking for OSCAR analysis
As I suspected your sleep study was unable to itemize central and obstructive events, so not much help there. If the problem with centrals continues, you may need a better diagnostic study or titration at some point. You have relatively mild apnea, that is mostly hypopnea and 4.5 apnea per hour, and a relatively high respiratory disturbance index, which is consistent with the flow limits or upper airway resistance.
I think we should continue with a simplified titration starting at fixed pressure and use that information to advise us on how to proceed. I have a lot of uncertainty what pressure you will do best with, and after a second look at your charts, I think a pressure of 6.0 and EPR at 1 may be better than the pressure of 5 without EPR. At least on your screenshot of March 12, that looked like you have good breathing before the EPR kicked off and you started having the centrals.
