[Pressure] Doctor can't see detailed data - Can my OSCAR data save me from another sleep study?

[KidCharlamagne]

I've been using the auto pressure mode for my CPAP machine and I'm still having a bunch of central apnea events. The doctor wants me to try 2 weeks with the pressure set to 9 and see if that helps. But I can see from my data in OSCAR that when the pressure automatically hits 8 or 9 over the course of the night, I still have a bunch of events.

I told the doctor this but she said she can only see aggregate data over the past 30 days. That is, she can only see that I've been using the auto setting and having 12 AHIs on average. She can't see any per-night data at all, which blows my mind! How are they supposed to do their job without this information? 

Since it looks like OSCAR is telling me a pressure setting of 9 doesn't solve the problem, I'm trying to save myself some time and go straight to BIPAP. I'm thinking of taking some screenshots and emailing them to my doctor to see if she can expedite things, but I wanted to hear from you guys first. What do you think? And are there other metrics in OSCAR I could provide my doctor that could save me from another sleep study?

[willaien]

I am not qualified to help, but I know that the full settings may help. Can you post the settings pane from the left-hand side?

[OpalRose]

KidCharlamagne,
Welcome to Apnea Board!

Do you have a copy of your original sleep study?  Do you know the results.... did it show central sleep apnea?  This is important to know as your OSCAR chart shows many central apnea.  This could also be "treatment emergent", meaning it would settle down in time. If you have a copy, please post it here redacted of personal info.

Your doctor more than likely suggested a static pressure of 9cm as this is what your 95% pressure shows. That's probably a good start, but I also suggest that you also turn the EPR setting down to 1 (full time). Let's see if that makes a difference in the Clear Airways.

Just so you're aware, your current machine will not treat Central Sleep Apnea, only a
BiLevel with a backup rate or a ASV. But it's too early to jump to that. Try your doctors suggestion of static pressure of 9 and turn EPR down to 1.

[clownbell]

I wonder whether, in this case, the wide difference of pressure settings (4-16) contributes to the problem. Trying a fixed setting of 9 may help, and it's a free experiment. Also it appears there is some Positional Apnea involved here. Perhaps a soft cervical collar.

Can't help but wonder why the doc can't see detailed data. ResMed is a known brand and the doc "should" be able to see the details. Is it possible that the doc doesn't want to pay ResMed to view the data?

[pholynyk]

The 'standard' report that most DMEs create is only a thirty day summary. Unless the doctor can run ResScan themselves, or tell the DME exactly which reports they want, they will be stuck with the suammary.

I would hope that a competent sleep doctor would know how to use either the manufacture's software or OSCAR. If not they are practising medicine without any data. Also, a competent doctor would know the capabilities of the devices they are prescribing...

[Gideon]

Welcome to the forum.
Your charts, minimize the calendar by clicking the triangle to the right of the month so we can see more of the left sidebar.
Your pressure is increasing without either hypopneas or Obstructive apnea events. This implies flow limits, despite the excellent 95% flow limit value you have, are driving your pressure.

Now let's talk about the elephant in the room, your Central Apnea. The treatment of these will depend on their cause. The first question is did they exist, and at what level, during your diagnostic Sleep Study. As stated above please show us a redacted copy of your complete Diagnostic sleep study oluding the charts and tables in addition to the narrative. Centrals are known by a lot of names many of which don't hint that they mean central. Complex or mixed apnea being among the more common here. A strong presence of centrals would indicate ideopathic (I don't know) central apnea and the likely need for an ASV machine.

A lack of Centrals on your Diagnostic Study tends to indicate that Treatment Emergent Central Apnea is likely.
Any PAP machine improves your breathing. This means also improving the removal of CO2 from your system. The primary drive to breathe is a result of the need to remove CO2 from our system, not the need to get oxygen. If your CO2 levels drop below your apneic threshold a Central Apnea will result. Some people, not all, are real suseptible to this and it results in a breathing pattern of waxing and waning breaths with your effort being driven in this cyclic pattern by CO2 levels.

To see if this is the case post a 15-20 minute view of your Central apnea. If this is the case, and it has been suggested to take action assuming this is the case, to actually decrease the efficiency of your CPAPS assisted breathing by both lowering your pressure and more importantly lowering your EPR to 1. These actions are targeted at likely lowering your central apnea, avoiding them, not treating them with the side effect of likely increasing your obstructive events. It is a balancing act.