No sleep doctor where I live, need help evaluating OSCAR data

[jak75]

I'm living on a small island in the Mediterranean where getting a proper sleep study is near impossible. Five years ago I was offered a cheap home sleep study which resulted in a diagnosis of OSA and a CPAP prescription. I never received the actual report, I should have asked for it but didn't. The doctor had no clue how to setup the CPAP in terms of pressure etc. so I bought a Resmed S9 online and tried to do it myself but after a few weeks I didn't feel any better (mostly due to large leaks), gave up and sold it. In the following years I lost quite a bit of weight, 310lbs -> 250lbs and assumed my OSA would be resolved. 

However after giving up alcohol about 6 months ago I noticed that I was waking up several times in the night and unable to quickly go back to sleep which resulted in an average sleep duration of 5-6 hours per night (as confirmed by my Oura sleep tracking ring). This left me extremely tired throughout the days. I thought perhaps the issue was my untreated OSA so I purchased a dreamstation auto and F20 facemask a few weeks ago and things have improved a bit but I'm concerned that I don't have things setup correctly and that the data may be telling me something which I can't see. Again, I have no sleep doctor to consult with so I'm left having to try to interpret everything on my own. 

I have spent quite some time reading the Wiki and trying to understand all the terminology in OSCAR but I don't feel qualified to evaluate it properly and take action. Clearly I'm suffering mostly from hypopneas and I'm guessing that I should probably increase my minimum pressure to around 6 since my 90% is around 8. But there is so much other data its overwhelming. I also purchased a Viatom O2Ring to measure SPO2 and almost everynight I score a perfect 10 with no drops below 94%, on a few nights I saw one or two drops to around 90.

Would any members be so kind to provide any feedback on the attached data, I would be so greatly appreciated! 

I have attached last 3 nights from OSCAR.

Grazie Mille

[OpalRose]

Hi jak75,
Welcome to Apnea Board!

I believe if you raise your minimum pressure to 7.5cm and limit the maximum to 15cm, you may see some improvement.  You may need a higher minimum, but start at 7.5 or 8cm if you can tolerate it. If you were using a ResMed machine, then a minimum of 6cm might work, but with a Respironics, because it is slower to react, you'll need a higher minimum.

Also, if you are able, turn the ramp feature off and keep the Flex set to 2.

Your leak rate is pretty good, but the Flow Limitation is high.  I also notice that it looks like you may be tucking or letting your chin fall to your chest.  This can cut off your air supply.  Have you tried a soft cervical collar?
Many here have found this to make a huge difference.

See the links in my signature line for guidance.

[Sleeprider]

Completely agree with Rose. Your Philips Dreamstation Auto CPAP is set to the default 4-20 pressure and the most common reslt of that strategy is that the user will experience excessive obstructive events (OA, H) as this machine is slow to respond to head off events, and too quick to resume the minimum pressure. A minimum pressure of 7.5-8.0 is actually quite low for CPAP, and by moving closer to your 90% pressure, you will effectively block a significant portion of the events, and probably be more comfortable as pressure will not fluctuate as widely. Ramp is not needed when pressure settings are this low and Flex setting of 2 works for most people. I notice you are using "Smart Ramp" and it tries to start your pressure at 5.0 cm. This is a pretty solid sign your minimum pressure is way too low.

On April 19 at 02:30 and 06:15 you have clusters of obstructive hypopnea that is likely related to positional apnea as discussed in the Soft Cervical Collar wiki linked in my signature. Other nights show similar brief clusters. I thnk the increased minimum pressure will help with these events, but you should read the wiki to be aware of the mechanism that can cause these clusters of events.

[jak75]

 Rose and Sleeprider!

I'm very encouraged there is consensus on next steps to take. I've upped min to 7.5 and reduced max to 15. Flex is at 2 as before. 

I've also ordered a cervical collar from amazon but thats likely to take a week to be delivered. I'll update this thread with new results.

[jak75]

Hey everyone, so I adjusted pressure to 7.5-15 on Monday and 8-15 on Tuesday and got AHI of 1.9 and 1.8 respectively. This is a huge improvement over previous nights! 

I see I'm still having lots of hypopneas - I have the cervical collar arriving tomorrow. I forgot to mention that I'm a strict side sleeper, I have filmed myself overnight and never saw myself on my back.

Do you think I should adjust the pressure again? Last 2 nights attached.

[OpalRose]

Hi jak75,

It's good to see an improvement, and what's important is how you are feeling. Does the higher pressure bother you at all? If not, move the minimum up by .5cm to 8.5. Monitor the results for a couple days to see if that helps with the Hypopneas.

Your results are very good, but would be nice to be able to clean up some of those Hypopneas.

As far as being a side sleeper, that's probably a good thing. But chin tucking has been seen with side sleeping too.

[Sleeprider]

Looks much better. I don't see any significant clusters that would require a soft collar. These results are pretty typical for using a Philips CPAP, and you can see with the higher minimum pressure that there is less variation. Increasing pressure slowly as suggested by Rose will let you find the balance between comfort and efficacy.