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Please help with OSCAR data, getting desperate
#1
Please help with OSCAR data, getting desperate
Hello,

I was diagnosed with sleep apnea in May this year, with 25 stops per hour. I received the Resmed Airsense 11 with fixed pressure min 4 and max 7 and a N30i mask. After a month or so meeting with the provider the pressure was set to 5-8. Needless to say, it was s big struggle the first night, getting used to the mask and breathing with it. After some time, I could fall a sleep relatively easy but waking through the night numerous times. My deep sleep according to my Samsung 6 watch has also decreased which is weird since it is supposed to get better. I’ve tried different masks ( N30i, F30i, P30i) and switching currently between the N30i and the F30i. I prefer sleeping with the N30i and I have the feeling that it is slightly better (also looking at OSCAR). However, I have problems with my nose (sorry don’t know the word in English), my nostrils are somewhat closed, especially the one and it makes breathing more difficult. I had a corticosteroid spray for 5 weeks but it didn’t help. I am to see an ENT doc but at the end of July. My nose is also quite full/closed. Therefore, I am sleeping more with the F30 I and not finding it very good. Nevertheless, I have been using the machine every single night, for more hours, despite finding it quite difficult.

I mostly have an AHI of max 2, which is good, but I am still sooooo tired in the morning and throughout the day. Mostly my saturation (measured with Samsung 6 watch) is above 90 in comparison with before using the CPAP when it was mostly in the 80% range). But even so, there are some nights where the saturation is still under 90 for some time and I have been snoring even with the mask, with the F30i mostly. I know that because I record it with the watch. And that is definitely not how its supposed to be when using the CPAP, right? I know you should give the therapy some time to work but after nearly 3 months I am not seeing a difference at all ☹ This is very frustrating, I am tired and sad and don’t know what to do. I’ve watched numerous YouTube videos and read forums and finally downloaded OSCAR. Next week I have finally appointment with the doctor but I doubt she will be very helpful. All docs here see is the machine reading which is almost always good and that’s it.  That’s why I would like to ask for your help. 

I did some screenshots and I post these here. Unfortunately these are in Dutch but I think you can make sense of the graphics. The first row is the Incidents, the second is the Flow Rates, the third one is Flow Limitations and the fourth is snoring. I made 3 nights with N30i and 3 with F30i. Per night I made 4 screenshots, also zoomed in. A it much but I just want to give as much info as possible so that hopefully you can help me read these. I couldn’t post them as attachment so I’ve uploaded them and post links here. The screenshots from 10 June, 23 June and 11 June are with F30i. The ones from 26 June, 27 May and 8 June are with N30i. What I am noticing is that I have quite some RERAs, mostly with the F30i mask. I also have some CA, which I find a bit disturbing. I’ve tried to interpret the data but having not much success. I kindly ask you to have a look and tell me what you see, what is wrong and what and how could be improved. In that way I hope to be prepared for the meeting with my doctor and insist on some changes so that the therapy will finally give some results.

EDIT: Site doesn't allow me to post the links as I need to have at least 4 post... So for now I am attaching the allowed number of pics -3. Two with F30i, especially the one which has mostly RERAs and one with N30i. Later I may be able to post the links with the zoomed graphics as well.

Thank you in advance.


Attached Files Thumbnail(s)
           
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#2
RE: Please help with OSCAR data, getting desperate
Welcome

please read this wiki so we can see all the important charts. you can resize the event graph vertically to make space. can you also include the sleep study results? after redacting your personal info of course. Did they note positional issues? do you sleep on your back? Did they note centrals?

the first thing i notice is your significant flow limits which means your airway is obstructed. have you considered EPR? or APAP mode for an auto-adjusting pressure?
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#3
RE: Please help with OSCAR data, getting desperate
English would help to make sure what I am looking at. But I would turn on EPR to full time set to 3 to help the flow limits and make a better night sleep.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#4
RE: Please help with OSCAR data, getting desperate
I would try setting the minimum pressure at 10 in CPAP mode with an EPR of 3, the higher pressure may help your breathing problem.
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#5
RE: Please help with OSCAR data, getting desperate
Thank you all for your answers.

I will take a look at the wiki and try to resize the graphs. I am not very handy in it but I will do my best Smile Unfortunately I dont know if I will manage until tomorrow but if not, I will try later. 

I do not have the sleep study. The doc turned the monitor to me, showed me sth for a second, said I have 25 stops per hour and that I need CPAP therapy. They don't seem to give results from examinations here, you have to ask explicitly for it, which I will do tomorrow. I have no idea if I had CA in the study. I was a bit confused then and had no idea what she is talking about but now I know better and will ask her more than one question Big Grin

I was a stomach sleeper all my life but since I got the CPAP I taught myself to sleep on my side, or at least when falling a sleep. It was a challenge but I mastered it. However once asleep I am turning quite a bit and I always wake up on my back Sad


I have CPAP and EPR is on 1. I am not allowed to change my settings. Only the doctor can do that and I suspect (from stories of others in NL) that she will not see the need as docs here are looking at the AHI and these are low. My RERAs are another story but I am not sure if she will listen. I will try to convince her to higher it as suggested here and see if that helps. My only concern is that I am reading that with higher pressure is more difficult to breath. I am almost certain I inhale through my nose but exhale through my mouth and that is a problem with the F30i mask. I feel my cheeks thrilling, I drool a lot and it pushes my mouth open.  So i think with higher pressure it will be even worse. With the N30i when I open my mouth, the air shoots out and wakes me up, often I dont even notice it. Still I am sleeping better with this mask than with the F30i. I tried mouth taping but it's not for me, I am freaking out and can't sleep at all.

Once again thank you all for your response. Thanks
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#6
RE: Please help with OSCAR data, getting desperate
It looks like you have quite a few flow limitations, which means these settings are not correct for you. As others have said seeing the charts as described in the wiki or my signature link “Formatting OSCAR Charts” would be quite helpful.

I suggest changing your settings a bit so we can see how you titrate given a range of pressure. You can change your own settings regardless of what they say. If you are concerned about anyone saying something you can turn on airplane mode for a few nights to try the settings, then go back to the original settings and turn off airplane mode. Or, you can just say bugger it all and change the settings to find what works for you. It is your therapy and if your doctor is not helping, you have to help yourself.

However you go about it, try these settings.

Mode APAP
Min pressure 7
Max pressure 15
EPR 3 full-time
No ramp

That should help with the flow limitations and with the additional EPR should be more comfortable. The “chipmunk cheeks” you are experiencing will go away over time as you adapt to the new settings. If you learn proper sleep tongue placement (lips closed, tongue on roof of mouth, gently suck on tongue and swallow, then hold tongue in that position), you should have little trouble with chipmunk cheeks. It takes time to learn, but will be so worth it.

It sounds like you already realise that a low AHI does not mean a quality nights sleep. We try to help with both. Hopefully your doctor would do the same.
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#7
RE: Please help with OSCAR data, getting desperate
Thank you for your comment PeaceLoveAndPizza. If the doctor does not listen and act I might indeed try changing the settings myself. I am just a bit cautious because of the insurance. As far as I understood they are following everything and it will signal if sth has been changed. I tried asking the CPAP machine provider to change the pressure but they told me they can not do that without the doctor telling them to do it. Nevertheless, if doc does not listen to my complaints and problems, I might do it.

So you are suggesting to change from CPAP mode to APAP? I did not think this was possible once you have the machine. I will look into it.

Yes, I read quite a lot and watched youtube videos about sleep therapy as I was not given information at all. And I know now not all is about the AHI, well not for us anyway. For the insurance that is all they care about but it is our body and mind and we need to stand up. I am planning to do that because obviously despite all my efforts and not missing  single night without the mask, I do not see any results and still being very tired.

I am still training the tongue technique and hope with time my tongue will stay in place the whole night Smile
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#8
RE: Please help with OSCAR data, getting desperate
(06-30-2024, 11:02 AM)Sylka Wrote: Thank you for your comment PeaceLoveAndPizza. If the doctor does not listen and act I might indeed try changing the settings myself. I am just a bit cautious because of the insurance. As far as I understood they are following everything and it will signal if sth has been changed. I tried asking the CPAP machine provider to change the pressure but they told me they can not do that without the doctor telling them to do it. Nevertheless, if doc does not listen to my complaints and problems, I might do it.

So you are suggesting to change from CPAP mode to APAP? I did not think this was possible once you have the machine. I will look into it.

Yes, I read quite a lot and watched youtube videos about sleep therapy as I was not given information at all. And I know now not all is about the AHI, well not for us anyway. For the insurance that is all they care about but it is our body and mind and we need to stand up. I am planning to do that because obviously despite all my efforts and not missing  single night without the mask, I do not see any results and still being very tired.

I am still training the tongue technique and hope with time my tongue will stay in place the whole night Smile

if your airsense says "Autoset" on the left side of the machine then you have the automatic apap algorithm. to change the settings access the clinical menu by holding the 2 big buttons on the touchscreen for 3 seconds.
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#9
RE: Please help with OSCAR data, getting desperate
Yes, change the settings yourself. Personally, I would be dying on your settings, but I'm sure I could find a sleep doc out there who would tell me they're perfect.

Sleep is a very individual thing. You know your sleep better than the doc does! Just follow the recommendations here to refine the settings. And see how it goes.

Also, keep in mind, it takes quite a while for your body to adjust to the machine. You may very likely feel very tired for a while. But gradually, it gets better.

FWIW I'm getting a kick at the Dutch words for some of our sleep terms! They're onomatopeic (they sound like what they are).

You should have a humidifier with your machine, although I don't see one on your avatar. This is a comfort item that you might want to adjust at some point.
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#10
RE: Please help with OSCAR data, getting desperate
I know it can take some time  to adjust and see improvement but I still hoped that after 2 months I would see at least a bit of change in positive direction. I guess I should be more patient and hope for the best.

Hehe, Dutch is a funny language. A mix between German and English, some would say Smile

I received a humidifier with the machine, used it once and could not tolerate the warm air. Find it very stuffy and unpleasant to breath with. For now trying to manage without one though in the winter I suppose it won't be possible with the dry air.

@Narcil, thank you. I will take a look tonight.
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