OSCAR Data Review

[Mcca21]

Hi Everyone,

This is my first time posting here, I hope that I am posting my chart data correctly. This is the first nights data from my machine. I know it may be too early to give some input but I was wondering if anyone could look at this and give me some advice on what you see. 

Thanks!
Steve


   

[G. Szabo]

It would help us to learn your CA score in your sleep report.

Much will change in the coming months,  but you might want to try the following settings:
Standard response
EPR=1 full time 
Pressure min/max = 8/14 cm.

[coutherino]

Welcome. If you could post some zoomed in screenshots of the periods where the apneas are being tagged it would help a lot.

Those appear to be some pretty severe centrals. As opposed to obstructive apneas and hypopneas where your airway is being physically blocked off by tissue in your throat/airway, central apneas occur when your body is literally not trying to breathe at all, or barely trying to breathe. This can happen for many reasons, but it's not that uncommon for new users of CPAP to experience something like this. It is commonly called TECSA (treatment emergent central sleep apnea). 

One of the reasons this can happen is because CPAP has a slight ventilatory effect, meaning it changes the CO2/O2 balance within your body, and causes you to breathe out more CO2 at any given time. It is the buildup of CO2 within our bodies that trigger the drive to breathe, and if more of it is being expelled the drive can go away for a period of time, where you stop breathing completely. Also called central apneas.

Which is potentially what we're seeing here in your data, with that waxing and waning pattern. Large, deep breaths followed by very shallow breaths, or no breaths at all. One thing that could potentially be causing this is something called EPR, which you have set to the highest level, 3. EPR stands for expiratory pressure relief, and it aims to make it more comfortable to breathe out against the pressure, by physically lowering it every time it senses you exhale. So if your pressure is set at 8 with EPR on level 3, you will be inhaling at 8, but only exhaling against a pressure level of 5. All it does is subtract the difference. So if you're on 8 with EPR level 2, you'll be exhaling against 6. And so on.

The reason this is important and I'm explaining it is because EPR increases the ventilatory effect of CPAP, by allowing you to expel more CO2 at any given time. Which is my guess for what's causing the back to back central apneas you're seeing, that are absolutely disturbing your sleep. My recommendation for now would be to turn EPR off entirely, and see if the centrals go away. If you don't know how to change EPR or your pressure settings, there are videos on YouTube that tell you how to access your clinical menu on the AirSense 11.

I have more recommendations, but I don't want to overwhelm you with too much information. I like to explain everything to make sure people understand what they're changing and exactly why they're changing it, so for now just consider giving this a try and post your data afterwards to see if it helps.

[Mcca21]

Welcome. If you could post some zoomed in screenshots of the periods where the apneas are being tagged it would help a lot.

Those appear to be some pretty severe centrals. As opposed to obstructive apneas and hypopneas where your airway is being physically blocked off by tissue in your throat/airway, central apneas occur when your body is literally not trying to breathe at all, or barely trying to breathe. This can happen for many reasons, but it's not that uncommon for new users of CPAP to experience something like this. It is commonly called TECSA (treatment emergent central sleep apnea). 

One of the reasons this can happen is because CPAP has a slight ventilatory effect, meaning it changes the CO2/O2 balance within your body, and causes you to breathe out more CO2 at any given time. It is the buildup of CO2 within our bodies that trigger the drive to breathe, and if more of it is being expelled the drive can go away for a period of time, where you stop breathing completely. Also called central apneas.

Which is potentially what we're seeing here in your data, with that waxing and waning pattern. Large, deep breaths followed by very shallow breaths, or no breaths at all. One thing that could potentially be causing this is something called EPR, which you have set to the highest level, 3. EPR stands for expiratory pressure relief, and it aims to make it more comfortable to breathe out against the pressure, by physically lowering it every time it senses you exhale. So if your pressure is set at 8 with EPR on level 3, you will be inhaling at 8, but only exhaling against a pressure level of 5. All it does is subtract the difference. So if you're on 8 with EPR level 2, you'll be exhaling against 6. And so on.

The reason this is important and I'm explaining it is because EPR increases the ventilatory effect of CPAP, by allowing you to expel more CO2 at any given time. Which is my guess for what's causing the back to back central apneas you're seeing, that are absolutely disturbing your sleep. My recommendation for now would be to turn EPR off entirely, and see if the centrals go away. If you don't know how to change EPR or your pressure settings, there are videos on YouTube that tell you how to access your clinical menu on the AirSense 11.

I have more recommendations, but I don't want to overwhelm you with too much information. I like to explain everything to make sure people understand what they're changing and exactly why they're changing it, so for now just consider giving this a try and post your data afterwards to see if it helps.

Thank you for this in depth comment. I don’t feel overwhelmed at all. I prefer to have things explained in a detailed method when it comes to health related things. It helps me understand things better. Because sleep apnea is new to me, I am trying to learn all I can.

[Phaleronic]

Welcome to the forum Mcca21.

I'm in the middle of the suggestions on these last two posts to help you figure this out

ERP on fulltime at 3 does soften the transition from inspiration to expiration and also inserts a delay in expiratory pressure when compared to any other vendor's form of exhalation pressure relief (this is also part of the reason why CAs crop up more with folks running fulltime @ 3, unless they are running high pressure). Apnea control is also lost when EPR is set to 3 without raising pressure (as the airway is not being kept open with both the delay and the -3cm of pressure).

I would suggest turning EPR off (as you're at a very low minimum pressure to begin with @ 5cm) and setting max pressure to 15cm).

I would also like to see a zoomed graph of the waveform around a cluster of the CAs please to see if it's valid cheyne stokes respiration (and also if you had CSA reported/diagnosed in your sleep study-if it was a type 2).