OSCAR Interpretation Help Please

[CPAPUser73]

Hello,

My 73 year old father has been using a CPAP for about 20 years and continues to struggle with fatigue, high blood pressure, and was also diagnosed with A-Fib one year ago.

I would like to help him improve his CPAP device and possibly lower his AHI.

He has a ResMed AirSense 10. Ramp is set to 4, min is 12 and max is 20. His average AHI is around 6, but some nights are as high as 11.

I imported his SD Card data into OSCAR and uploaded the screenshots here: imgur.com/a/efUPhBP and attached 3 below.

We would truly appreciate any insight and recommendations! Thank you!

   
   
   

[staceyburke]

Welcome to the group.  There are a lo9t of very good people here that can and will help.  

This is not my best area of expertise as my problem has never been central apnea.  You will get people here that have had a lot of experience with centrals that can give you good advice.  But I will add my 2 cents.

Many people have centrals when they first start pap therapy and it goes away after a couple of months.  Your father is NOT in that category, his are present after years of therapy.
 So we would try to minimize them.  Minimize them because the type of cpap machine you have will not treat centrals.  That is done with an AVS machine that is about 2X the money and hard to get insurance to cover when you have a AHI of around 5.

A couple of things to understand.  Flow Limits are apnea, only smaller and not timed events you can see how they are determined in my signature).  They do 2 things - first disrupt sleep and not allow people to get into deep sleep.  second the Resmed machines raise pressure to stop them from becoming larger events (O and H).  Your father has a lot of them.  EPR (exhale exhale pressure relief) is what we use to help with flow limits.

It looks like you are using EPR at 3 but I'm not sure because I can not see the setting.  As I said EPR is used to help with flow limits - now the problem, they also CAN cause centrals.  So my suggestion is to try for one night the following settings for one night.

EPR OFF
Min 9
Max 9

That is a straight cpap like what was used years ago.   I hope that these settings will help with the centrals.  He will have to evaluate if this helps or the increase in the other events are worse for him.

IF sleeprider or Dave come along - they have much more experience in this than I do but again, I think it may help him.

[GuyScharf]

Stacey: difference between Pressure and EPAP looks like EPR=2 to me.

[Geer1]

Stacey the easy way to determine EPR/PS is to look at the statistics and subtract med EPAP from med Pressure.

OP tried EPR off one day (Jan 16th), we could just get a screen shot of it to see what EPR off looked like. From overview looks like it didn't have a huge effect at reducing the centrals and resulted in more hypopnea (highest amount in recent history) which makes some sense.

The Statistics page tells us he appears to have always been reporting ~ 4 CAI since the beginning of treatment (at a minimum the last year). AHI doesn't appear to have fluctuated first year at low pressure and EPR off to second year at higher pressure with 2 EPR.

My first gut feel is that there is restriction present but perhaps not too bad for obstruction. In order to help ease the restriction and breathing I want you to try a lower pressure with 3 EPR. The lower pressure may also help with the central apnea.

Min pressure 7 cm, Max pressure 15 cm, EPR 3 cm full time. Give that a go for a night and then post the results.

[CPAPUser73]

Stacey the easy way to determine EPR/PS is to look at the statistics and subtract med EPAP from med Pressure.

OP tried EPR off one day (Jan 16th), we could just get a screen shot of it to see what EPR off looked like. From overview looks like it didn't have a huge effect at reducing the centrals and resulted in more hypopnea (highest amount in recent history) which makes some sense.  

The Statistics page tells us he appears to have always been reporting ~ 4 CAI since the beginning of treatment (at a minimum the last year). AHI doesn't appear to have fluctuated first year at low pressure and EPR off to second year at higher pressure with 2 EPR.

My first gut feel is that there is restriction present but perhaps not too bad for obstruction. In order to help ease the restriction and breathing I want you to try a lower pressure with 3 EPR. The lower pressure may also help with the central apnea.

Min pressure 7 cm, Max pressure 15 cm, EPR 3 cm full time. Give that a go for a night and then post the results.

Thank you all for the feedback so far! This is very helpful. You are correct that he did try turning off EPR for one day to see how it would affect things and he said it was actually his highest AHI and so that is why he turned it back on. I will have him try the "Min pressure 7 cm, Max pressure 15 cm, EPR 3 cm full time" settings and see how things go.

Do you think he may need an ASV device instead of a CPAP or that his CPAP can be better with some adjustments?

Thank you!!

[Geer1]

Lets see what the results look like with these changes, it doesn't appear he has tried similar settings yet and I have a feeling it will improve things.

His data looks similar to my grandfathers data although my grandfathers is even worse and has a more noticeable obstructive side. The best settings I could find for him are similar to this. In older individuals the higher pressure makes it hard to breath out and finding the balancing point between high enough pressure to treat obstructions but low enough pressure to make breathing easy is key. I left max pressure higher to see what the machine does (machine will raise the pressure automatically if obstruction is occurring) and if there is no obvious obstruction then your father can try fixed or a small range of lower pressure.

If he has original sleep study and it indicates central apnea was present before CPAP then that would support ASV but with his AHI being right around 5 most doctors would already consider him treated adequately at these settings (although I don't necessarily agree with that).

[CPAPUser73]

Lets see what the results look like with these changes, it doesn't appear he has tried similar settings yet and I have a feeling it will improve things.

His data looks similar to my grandfathers data although my grandfathers is even worse and has a more noticeable obstructive side. The best settings I could find for him are similar to this. In older individuals the higher pressure makes it hard to breath out and finding the balancing point between high enough pressure to treat obstructions but low enough pressure to make breathing easy is key. I left max pressure higher to see what the machine does (machine will raise the pressure automatically if obstruction is occurring) and if there is no obvious obstruction then your father can try fixed or a small range of lower pressure.

If he has original sleep study and it indicates central apnea was present before CPAP then that would support ASV but with his AHI being right around 5 most doctors would already consider him treated adequately at these settings (although I don't necessarily agree with that).

Hello again,

So after trying the recommended settings last night, my dad's AHI was 7.76. Below are the screenshots. Please let me know if any other adjustments are recommended. I greatly appreciate it!

           

[staceyburke]

Again, I believe he would do better with

EPR OFF
MIN 9
Max9

It should help with the centrals.

[CPAPUser73]

Again, I believe he would do better with

EPR OFF
MIN 9
Max9

It should help with the centrals.

Sounds good! He will try those settings tonight. Thanks

[Geer1]

I would be curious to see a 5 minute duration view starting just after 6:00 (start it about a minute before the flurry of apnea started).

When you get the data from him tomorrow ask him how the two settings felt to him (if they were comfortable, if one felt better than the other etc).