[Pressure] Many Settings - Same Result - OSCAR Detectives take a look?

[BionicBreather]

Hi, and thank you for having a look.

I continue to have the same results, despite different machines, settings, and mask:

1. Wake up out of breath.
2. Usually need to urinate.
3. Feel physically amped up.
4. Usually can fall back asleep anyway.

Daytime:
1. Sleepiness.
2. Cognition - words, memory, complex ideas.

This began after my first surgery, a UPPP in 2016.  These effects persist across the years to even just last night, two different machines, and multiple setting configurations.  I have uploaded screenshots (since that's what I see other people do) from both machines and at different times in my CPAP data history.

I have a substantial amount of data including five overnight lab studies, three take home studies, and of course a couple of eons of CPAP data.  If you guys find my situation curious I'm happy to wrap it up in a zip file and upload.

My current team is not able to find a settings issue.  They also don't have the same capabilities as OSCAR does with whatever software they're running in their clinic (I asked).  I brought them screen shots and still no idea.  I am currently awaiting evaluation for a third surgery but the COVID situation at hospitals has placed that appointment on hold.

I have also used two MADDs with about as much success as these multiple CPAP configurations have provided.

I also have a pulse oximeter that can hold about three nights of data at a time.

Since I am slowly wittling away options any insight you can provide is very much appreciated.

Thanks and sleep well.  

[Gideon]

1. Wake up out of breath. You have been breathing with an assist device, it can take a couple of minutes to adjust on waking
2. Usually need to urinate.  Normal in the morning on waking
3. Feel physically amped up.  Isn't this a good thing?
4. Usually can fall back asleep anyway.  Me too

Daytime:

1. Sleepiness.
2. Cognition - words, memory, complex ideas.
These tend to imply an oxygen issue. What are your sats and more importantly your DeSats thru the night, how much time at and below key values?

Historically you have had an issue with flow limits, current charts don't show these on the surface, What are the results of your deep dive into Flow Limits and RERAs?

Your numbers are awesome so we need to look deeper at the breath by breath level and identify the number of arousals and flow limits leading up to them.

[staceyburke]

I’m sorry that the people trying to help you are clueless. You have changed your upper pressure, WRONG one. You need to raise the lower number. The lower number is the inhale pressure and if you have a good seal that is ALL the air you get. 

4 is used for children an adult would typically use around 8 to get enough oxygen. No wonder you wake up breathless. 

Settings I would try

Min 8
Max 20
EPR 3

Please give it a try for one night I believe you will feel much better.

[Gideon]

Stacey note that the OP is currently in a bi-level is S mode with settings of 4/9 so PS of 5.

Your suggestions for an autoset do not apply.

[staceyburke]

My apologies to both of you I was thinking it was an autoset not VAUTO. I’m glade you saw that!!

[Gideon]

He did display Autoset example

[BionicBreather]

Gideon:

Those waking episodes - are in the middle of the night.  Not in the morning at normal wake up hours.  Sometimes my heart is beating fast enough that I will roll over on my right just to avoid feeling my heart beat against the matress.   Sometimes that feeling continues into the day.  I used to take the mask off so I could feel like I could breath.  Lately I've tried to power through.  Figured the worst that can happen is I would just pass out and breath normally again.

On the metrics: So I will power on my Pulse Ox and get to work capturing data.  I think OSCAR can import it from the model I have so I can present one seamless data set.  I only know what RERA stands for and I don't understand flow limits.  I will read up on these on the wiki.

Because of server limitations I can only upload three screenshots and those are from different models (an Autoset 10 and a Vcurve) and very different masks.  After surgery 2 in 2019 I was able to completely breath through my nose and began working at nasal CPAP.  So, my screenshots are gonna have a ton of different settings all over them.

You said a deep dive into flow limits and RERAs.  Is there something more I can upload to allow you to see that?

You are guys are awesome.  Thank you!

[ubersteiny]

Gideon:

Those waking episodes - are in the middle of the night.  Not in the morning at normal wake up hours.  Sometimes my heart is beating fast enough that I will roll over on my right just to avoid feeling my heart beat against the matress.   Sometimes that feeling continues into the day.  I used to take the mask off so I could feel like I could breath.  Lately I've tried to power through.  Figured the worst that can happen is I would just pass out and breath normally again.

On the metrics: So I will power on my Pulse Ox and get to work capturing data.  I think OSCAR can import it from the model I have so I can present one seamless data set.  I only know what RERA stands for and I don't understand flow limits.  I will read up on these on the wiki.

Because of server limitations I can only upload three screenshots and those are from different models (an Autoset 10 and a Vcurve) and very different masks.  After surgery 2 in 2019 I was able to completely breath through my nose and began working at nasal CPAP.  So, my screenshots are gonna have a ton of different settings all over them.

You said a deep dive into flow limits and RERAs.  Is there something more I can upload to allow you to see that?

You are guys are awesome.  Thank you!

There's some good info here to learn about flow limitations and how to identify them: http://www.apneaboard.com/wiki/index.php..._The_Guide

By deep dive, I believe he means to manually go through your flow chart and identify any breath that was flow limited but not identified by the cpap.

[Gideon]

Deep Dive.
1. I want to see your nightly O2 Sats and more importantly DeSats including time at and below key values.
2. Look at a 5-minute view of the flow rate and scroll thru to document, illustrate, and count the arousals and what proceeds them
3. evaluate the above

4. then After the review increase pressure to s if we can help the cognitive issues you are reporting.

[BionicBreather]

Uber:

Wow, this good info.  I am especially amazed that we can get an idea of what manner of obstruction exists based on the general shape of the flow curve.  I also read the wiki entry about UARs, but its taking me a minute to fully get my head around it.  I might need to get a used text book or two.


Gideon:

You got it man. I work 53-55 hrs/wk so its gonna be a minute before I can assemble all the pieces.  I am working at it.  I will post an example of the flow curve shortly to ensure I'm getting this documentation right.