[Symptoms] Help with OSCAR Results - headaches and fatigue

[SleepyinCincy]

Hi All - 

Following up - I have attached a screen shot from lastnight's data.  I'm interested in any feedback that people would like to share.  

From my perspective - the good news is that I slept for nearly 5 hours strait before waking up.  That's very rare for me....I'm lucky to go more than 2 hours before waking up at least once.  On the other hand, I struggled to get much sleep after that initial wake up.  Something odd was happening - I kept waking up in short invervals, and noticed elevated pressures (enough to wake me up).  I keep my mouth taped....and I dont think air was leaking, but the discomfort of the pressure woke me up before I got back into a deep sleep.  My room was particularly cold lastnight, and that may have been a factor.  

FYI - Initially, last weekend, I adjusted my pressure up to 7, and left EPR at 3.  However, I had a hard time falling asleep - I think the change in pressure was a little to abrupt (pressure of 7 while inhaling and ~4 while exhaling was hard to get used to).  I guess I am too sensitive, and need to make adjustments more gradually.  So the following day, I put it back to 5, but turned off EPR.  That night went a bit better.

For lastnight - I bumped pressure up to 6.40, and left EPR turned off.  For reasons I don't understand - the data in the Oscar screenshot shows that the EPR is at 2, but that's not correct.  I double checked my machine before posting this, and it says EPR is off. And looking at the pressure chart, the pressure doesn't go below 6.4, which would imply that EPR is off.

I know there is some debate about using EPR - I'm not necessarily for it, or against it.  For now, my focus is to work on increasing my minimum pressure.  So far, I'm having better luck with keeping EPR turned off.  I intend to gradually increase minimum pressure to 7 or 8 as members suggested in the posts above.  And I'm open to experiment more with EPR.  

For anyone that has read this far (Sorry I got a bit wordy) - should I still aim for a minimum pressure of 7?  Oscar's statistics page indicates that my average pressure lastnight was 7.02, and screenshot shows median(?) pressure of 6.76.

Thanks!
Adam

[Deborah K.]

Read the following.

[Deborah K.]

Try 7 minimum tonight.  I would add EPR at 3, as I think that would be more comfortable, but it's up to you.  Most of us much prefer using EPR as it makes breathing more comfortable, and, more importantly, it lowers flow limits which are short, unreported apneas, which we need to lower as much as we can.  And yes, using EPR, especially set at 3, does lower flow limits.  You will be able to see it on your charts.

[Phaleronic]

EPR will reduce apnea control and @ 7cm of minimum pressure EPAP pressure is reduced to 4cm, many of us on this forum know that using EPR at low minimum pressure settings is compounding the problems of your sleep disordered breathing. We can assist you if you listen to the folks that understand how EPR works.

[G. Szabo]

EPR is a low-level bilevel therapy. When the EPR 3 setting is not enough to reduce your flow limits, a bilevel device with the capability to have even higher EPR settings is prescribed. 

It is a good practice to start with EPR=3 and optimize your minimum pressure under this condition unless the high EPR causes CAs that do not diminish with time. In most cases, they do diminish. 

It is also a preferred practice to use the APAP operation instead of CPAP along with the high EPR setting. In this manner, the instrument finds the needed minimum pressures suitable to your condition, including your sleep stage and sleeping position, which can change weekly or hourly. Hence, APAP does not overpressurize you, while CPAP does, leading to negative consequences. 

As for Phaleronic's claim on the negative impact of the Exhalation pressure drop at high EPR, yes, it drops, but the APAP operation will raise it when needed. The rise will be apparent from the pressure statistics. After that, the minimum pressure can be manually fine-tuned so the user experiences less pressure adjustment by the instrument during the night and has a restful sleep. Please, Phaleronic, realize that SleepyinCincy uses APAP and not CPAP. And he is right to do so.

[AshSF]

I suggest going to a fixed pressure equal to your 95%ile pressure from APAP. And switch off EPR completely. But first, you have to find that pressure. And for that, you need to do some trial-and-error (start with 7-20 rage with EPR =3, then keep narrowing the range until you find a stable 95%ile pressure and you AHI is under control). And then go to CPAP mode. Then you can keep experimenting with the single pressure and EPR and narrow it down further.

It's the Exhalation Positive Airway Pressure (EPAP) that cures apnea by stenting the airway. Machine Set Pressure = EPAP + EPR

So any time you add EPR, you are reducing EPAP. And if it falls below the pressure needed to keep the airway patent, the airway will collapse (partially or completely) and get you an (hypo)apnea event.

And if you are keeping EPR at 3, with a start pressure of 7, then you have an EPAP of 4. That is probably too low for taking care of the apnea, and may cause air hunger in some cases.

The reason people do a in-clinic overnight sleep study is to find that CPAP pressure in one go and then just set the machine to that.

My 2 cents. YMMV.