Oscar CPAP Optimization Results-Awesome!?

[SeePak]

[attachment=62593]

I have used CPAP for 30+ years.
I have been very tired for the last few weeks or so, probably longer, off and on, mostly on !
My original sleep test showed that although i would 'stop breathing' for over a minute at times, my Oxygen levels did not drop.
My prescription was for 6 cm .
I have had to adjust up to 7 cm in the past due to OA events, as suggested during a Zoom call with a sleep doctor.
Long story a bit shorter..
I checked out and read much of the literature on ApneaBoard, including the Mask Primer by Jeffy1958, and the How to Optimize post.
I then analyzed and interpreted to get to my last nights data that I include here.
I could not believe it when i woke up and felt good and saw AHI <2 !
But also, the events list was very short as compared to the previous 2 nights where i had the settings at 6 cm without EPR, and 7 cm with EPR1.
Leaks were almost gone too!
All that i have left was a dozen CA events and a couple H events. I can include 3 min shot of typical event if you wish.
My question is,  does this now look like a decent result?
I feel better for sure, better than i have in weeks!
Comments appreciated.

[PeaceLoveAndPizza]

30+ years is amazing. Well done!

I see two immediate areas to monitor. The first is the leaks, which is a major contributor to general feelings of being tired. From the looks of things I will venture a guess that it is either a mouth leak or you are sleeping in such a way that your mask is getting pushed slightly away from your face which is causing the leaks. 

The second issue is flow limitations. With a 95% of 0.17 you are 3x what we recommend as a minimum for FL’s. If you were using a machine capable of APAP the pressure would be much higher. FL’s do not affect everyone equally, but it is a good and proper indication of something going on that is obstructing the flow of air.

By way of suggestion, try the following:

Pressure 9
EPR 3 full-time


The increased EPR will help manage the FL’s, which should also make the higher pressure more comfortable. If that pressure feels like it is too much, you could start with a pressure of 7 or 8, then increase by 0.2 every other night or so until things settle down.

I would be remiss to not suggest that an APAP or Bilevel may be needed to manage things more completely. I personally recommend to most that if they can get a Bilevel new or used, that offers the most options unless an ASV is indicated. We will know more once we see how you respond to an EPR of 3 with higher pressure.

[SeePak]

Thanks for the reply.
Yes I have mouth leaks and have to adjust quite often my mask.
I was trying to keep the pressure down because of the leaks that I always get and I thought these were the lowest that I've seen yet .
I get drool from the side of my mouth and I think I might have noticed that a touch last night.
Also the night before last I was at 7cm/ EPR1 with huge # of events.
Hey I'll try anything really, but I did think though that I was getting close so I guess I have something backwards in my analyzing and understanding.
I just got this machine 2 years ago insurance covers everything that I do and I just saw the Sleep people the other day and they thought my numbers were looking good for the last week or so and I definitely have not been feeling good so I kind of ignored what they said and made the adjustments that I had last night.
Will let you know what I try and how it goes thanks

---

Meant to say that I also use a chin strap not too tight but not too loose and also I ordered a neck collar the Caldera relief suggested by a board member

[SeePak]

Also want to add that the physical layout of my mouth is small with all my teeth and a big tongue.
It was felt that that was part of my obstructive apnea during my sleep testing.

[SeePak]

       


Pizza, i have attached last nights results using 8 cm and EPR3 as suggested.

I also attached from april 9, where i had tried 7 cm and EPR1, for comparison.

I feel ok this morning so far, no yawning at all, a bit groggy but not bad.
I did not think i would continue the night at first, seemed really high pressure, but i think i got used to it, but lots of tossing and turning and wakeups

I feel that the original post i gave for April 11 just needed some tinkering maybe?

Like maybe 7 cm and EPR2 ?

For sure i got some things going on probably with mouth opening and mask fit.
I may go back to my full nose mask as it is much newer than the under nose i am using, not sure.
I have the neck collar coming next week, will see how that goes for possible chin tucking that i know i sometimes do.

[SeePak]

BTW, regarding Flow Limiting, FL...
Somewhere on this site i read that 0.2 is a number to shoot for or something like that, keep it under that.
So i set the dotted line for that.
Am  I mistaken?

[SeePak]

Another question....

What is happening when i find that the inspiration time is LESS than the exhalation time on my sleep data?
There is no FLow limiting and no Flow restriction during this time period which lasts about 24 seconds

[PeaceLoveAndPizza]

Thanks for giving that a go. It tells us quite a bit about what is going on.

Here is the short version…

1. Your leaks are bad and need to be controlled through any means necessary, likely a full-face mask or mouth tape/soft cervical collar
2. A machine limited to 3 cmH2O of pressure support is likely not going to help 
3. You need a bilevel or at least an APAP

Here’s the TL;DR version…

First, your leaks need to be brought under control. You can keep trying with your nasal mask, but if so you will need to use one or both of mouth tape and a soft cervical collar. For more than 50% of the night you are near to or above the 24 l/min large leak threshold. Which means that for ~50% of the night you are getting minimal to no therapy. My recommendation is to get a full-face mask if it is not too much of a financial burden. Using a FFM is much easier in my opinion than continuing to fight the nasal mask, but it is your choice. Your insurance may even cover a new mask and/or tape/collar.

Second, your current fixed pressure machine is not what you need. I know it is not good news, but given that even with EPR of 3 you cannot control your flow limitations and the fixed pressure is going to continue to be a struggle. You may end up finding something that works with higher pressure, quite possibly 11 with an EPR of 3, but I doubt that will give you the rest you want. You can give the pressure of 7 with EPR 2 a go, but I do not expect it will be much better.

To which end I think getting by hook or crook a bilevel, preferably a ResMed AirCurve 10 Vauto, is the best thing for you. You can show your insurance that the fixed pressure is not doing the job and logically an APAP with pressure support limited to 3 will not do the job either. They may make you try it anyway, but we can cross that bridge when we come to it.

You can continue to try tweaking your pressure and EPR, but while you may be able to get a good AHI for a night or so, it is not going to address the underlying flow limitation issues. The only way to do that is through adaptive pressure changes in response to flow limitations and more pressure support to manage the limitations.

If you are okay with how things are going then we can continue trying to tweak things. Happy to keep giving it a go whatever you decide. If you do want to continue working with your current machine, I suggest getting some mouth tape and a soft cervical collar to get things under control.

[PeaceLoveAndPizza]

Regarding your q’s on FL’s and inspiration/expiration…

FL’s 95% should be less than 0.05%. 

https://www.apneaboard.com/wiki/index.ph...ng_therapy

Inspiration to expiration ratio is an individual thing. Typically I:E is around 1:2 or so, but in heavily flow limited cases we have seen it be 2:1. Some of us have a lower one, for example mine is 1:1.5 but my wife is 1:2.5.

One thing to remember is that just because you do not see flow limitations in the FL graph does not mean there is no flow limitations. If you look at the individual waveforms by selecting a short time window of around 2-3 minutes, you will likely see the peaks flattened by flow limitations.

[SeePak]

thanx again Pizza!

Mouth tape tonite.
Collar ordered coming next week.
I could use one tonite that my dad has, but it seems a bit loose and too soft.
Dont wanna cause impingement.

Will try full face mask in July 

Leaks. Yes, working on that.
But i want to ask, do you not think they went up with the higher pressure, at least thats what oscar shows.

Yes i do want to continue with the CPAP, thankyou.

Just need to understand all the relationships.

Observation..!!
After my trial , which was the day before your trial, i had commented in my notes about how it was the best day in awhile, but on reflection, i remember hitting a huge wall later in the day and getting some of that fuzzy, heady, etc. bad feeling. Could not wait to get to bed later in early evening.
Today, i have not even yawned yet!!

So here's why that is weird, (though explained in the 'Flow Limitation/UARS article ) and i fully appreciate this too.....

The AHI on my trial was 1.85 and on the one we did with your suggestion, AHI 14.46  !!

And i am proof positive that AHI is not my slave !