OSCAR Analysis

[boo2433]

Hello everybody I was diagnosed with sleep apnea this year and first tried a mandibular advancement device which my dentist made but it didn't work at all.

Last month I started using a resmed airsense 11. I don't notice any changes and still feel tired, day time sleepiness, it's difficult to focus.

I would like to have your opinions on the OSCAR data I have here. I am noticing I have a lot of clear airway event and was wondering what it is because I filmed myself sleeping and I'm never opening my mouth. 
The setting of the CPAP was pre configured by my doctor and since then I changed the pressure from the inital [4-8] to [5-9] but that's all. I have read a lot of post and I'm noticing that you guys talk a lot about the EPR setting. I don't get how this could improve the therapy in any way for me since I wake up only one time a night on average.  Also what do you guys think of the AHI plot and flow limit ? 
Precision : I don't snore and I'm a very fit person so apnea is not caused by overweight.
Any advice would be really nice. Thank you.


   
   
   

[PeaceLoveAndPizza]

Things are not too shabby in the first segment. Some arousals, but not too bad. In the second segment, things go off the tracks as you hit REM sleep. 

Try the following:

Min pressure 7
Max pressure 12
EPR 2 full-time
No ramp
Response standard

You have enough flow limitations to warrant using pressure support. A bit more pressure should help with the arousals. You get no therapy during ramp, so do not use it unless it is absolutely necessary.

Give that a go for a few nights and let us know how it works out. I expect we will have to tweak things a bit further, but this is a good starting point.

[boo2433]

Thank you very much for your quick answer. If anybody has anything else to say or want to comment on the previous answer I would be thankful.
I'll try that tonight.

[boo2433]

I deactivated the ramp and activated the EPR but I'm seeing that I can choose the type of EPR : ramp only or full time. It's on ramp only by default but since I deactivated the ramp I am guessing I should select the EPR on full time right ?

[PeaceLoveAndPizza]

Correct, select full-time.

[boo2433]

Hey here are the results of the first night with the new settings.

We can notice than the AHI index didn't get lower and for the first time ever I had Cheyne Stroke Respiration what does this says about the setting ? Also no reduction in Clear airway which I still don't really understand what it means. I'm also wondering why there is 2 plot on the time at pressure, didn't look like this before.
 
I think I will film myself in the coming days to make sure I don't breathe trough my mouth with the new settings but I'm still wondering if there is another way to know if you breathe trough your mouth during the night via the data ? My lips are a little bit dry when I wake up but it's so small and on the video I know there are some moments during the night where my mouth is slightly open but this is very little.  

Thank you for everything, this is very helpful ! 

   
   

[PeaceLoveAndPizza]

ResMed tends to call periodic breathing CSR. All it means is you have a varying breathing pattern of deep then shallow. Nothing to worry about unless you have heart issues.

If you are open to experimentation, try the following:

Min pressure 6
Max pressure 9
EPR 1 full-time

In comparing the charts posted so far I see that your smoothest flow rates were in the 6-9 cmH2O range. When you get to REM sleep after the break things go off the rails. I want to see how it looks at a lower pressure that is constrained, so think this is worth a go if you are willing to try it.

[boo2433]

thank you for your quick answer. I am in fact open for experimentation but I was wondering if one night is enough to really draw conclusions.
For example with the previous setting it happened to me one time to have a ahi as low as 0.6. What I have noticed though since I started using the cpap and analysing the data is that most events are clear airway.

[PeaceLoveAndPizza]

One night is not enough to draw a conclusion if it works, but it may be enough if it goes totally off the rails.

[boo2433]

Hey again. Here are the results with the new settings. I don't feel better but I don't except to feel better with one night of sleep after almost 2 years of untreated sleep apnea.