OSCAR Analysis

[PeaceLoveAndPizza]

It is not a long enough time to draw any conclusions, but from a numbers perspective things look better. AHI is now under 2, flow limitations have not dramatically increased, the rest of the numbers are in an acceptable range. I cannot see the respiration rate graph, which I like to think gives an overview of how the night went from a comfort perspective, but I expect it follows the flow rate based on what I am seeing. We are seeing very few arousals that are not related to a leak or apnoea event.

I suggest leaving it as is for a few more days. The general feeling of fogginess will likely go away over time as you adjust to the machine. You are in the fine-tuning phase, so we want to be gentle with changes and give them a bit of time to get used to them.

Depending on how things look I think over a few days, the next step would be to increase the pressure by 1 and maybe add back 1 cmH2O to EPR. Something like:

Min pressure 8
Max pressure 10
EPR 2

or you could even set it up as a fixed pressure with EPR=1 or 2

Min pressure 8 (maybe even 9)
Max pressure 8 (ibid)
EPR 2

It is a trade-off of comfortable pressure, pressure support, AHI, and flow limitations. You may need EPR=2 or 3, but when you get that much your CA's increase. Not enough pressure and you get OA and H events. A balancing act in the end between comfort and therapy.

[Narcil]

if you still have issues understanding CA events:

it means the machine is detecting your airway is not obstructed but for some reason you're still not breathing. it's basically the same thing as central apnea.

if you want too much info about central apnea: https://www.ncbi.nlm.nih.gov/books/NBK578199/

note the different types of CSA which includes 6. Treatment emergent CA

Treatment-emergent central sleep apnea (CSA), previously referred to as complex sleep apnea, is detected in approximately 5 to 15 percent of patients who undergo positive airway pressure (PAP) titration for obstructive sleep apnea (OSA).

In more than half of cases, treatment-emergent CSA is a transient phenomenon that resolves within the first few months of PAP. Less commonly, the abnormality is persistent and requires a change in mode of ventilation.

https://www.uptodate.com/contents/treatm...leep-apnea

Did you have a sleep study before cpap? did it include CAs? if not they are likely treatment emergent. nad they have nothing to do with mouth breathing as far as i know, mouth breathing will show up as leaks which you barely have any.

 I'm also wondering why there is 2 plot on the time at pressure, didn't look like this before.

that's what EPR does, it lowers the pressure when you are exhaling to make it easier and more comfortable. what you see is a plot for epap and ipap: expiration and inspiration pressures. epr 2 means it will lower epap by 2 cmh2o on exhale but the machine cannot go under 4.

https://ap.resmed.com/knowledge/what-is-...relief-epr

reducing epr can help sometimes with CAs but they should hopefully go away on their own.

i'm obviously not a doctor, just some info...

[boo2433]

Thank you for your quick answer I will keep these settings for a few days.
Here is the respiratory rate chart. 
   

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if you still have issues understanding CA events:

it means the machine is detecting your airway is not obstructed but for some reason you're still not breathing. it's basically the same thing as central apnea.

if you want too much info about central apnea: https://www.ncbi.nlm.nih.gov/books/NBK578199/

note the different types of CSA which includes 6. Treatment emergent CA


https://www.uptodate.com/contents/treatm...leep-apnea

Did you have a sleep study before cpap? did it include CAs? if not they are likely treatment emergent. nad they have nothing to do with mouth breathing as far as i know, mouth breathing will show up as leaks which you barely have any.


that's what EPR does, it lowers the pressure when you are exhaling to make it easier and more comfortable. what you see is a plot for epap and ipap: expiration and inspiration pressures. epr 2 means it will lower epap by 2 cmh2o on exhale but the machine cannot go under 4.

https://ap.resmed.com/knowledge/what-is-...relief-epr

reducing epr can help sometimes with CAs but they should hopefully go away on their own.

i'm obviously not a doctor, just some info...

Thank you very much for the explanation.
In fact I did a sleep study which did not detect central apnea. I will do a new sleep study on thursday with the CPAP and the current settings.
I will let you guys know as soon as I have the results.

[PeaceLoveAndPizza]

Thanks mate. It is what I expected to see.

Take a close look at the RR and flow rate charts. Note the nice flat areas in the RR line and compare it to the FR line. In the flat line portion you are sleeping very well. As the flow limitations start appearing, the RR and FR both show the disturbance to sleep quality. 

To show the extremes, I have attached a good and bad night RR for me. Respectively, my AHI on the good example was 0.2 and on the bad was 2.1. The good night I slept well, the bad night I had to rely on my friend Mr. Espresso Machine.

[boo2433]

Hey here again after a few days with the previous settings. I think I will follow your instructions and change the pressure and EPR to min 8 max 10 and epr 2. 
As we can see on the chart; I have huge variation of pressure during the night and also for my respiratory rate. I'm going to do a sleep study with the CPAP tonight. I will give you guys an update. 

   
   
I was wondering something, I didn't have the EPR activated before and honestly it doesn't make much a difference to me ? Is it only a confort thing ?

[boo2433]

Hey I'm back !

So I made several changes and I tried new settings. First thing i did since last time is going from 6 to 9 to 7 to 10 with EPR1, results below.
   
As you guys can see the pressure fluctuations were still very high so I changed and did 4 nights with the same pressure setting but with EPR = 2. 
The nights all looked the same. You can see below. 
   
   
As you can see the profile of pressure is pretty good and centered around 7.5, so my goal was now to smooth the respiratory rate. 
To do so I tried constant pressure of 8 without EPR and indeed the respiratory rate is looking better but I don't like it. I feel worse than with the previous setting.
But with the previous setting I was feeling good but also not completely normal, still a bit tired.
I did a new polysomnography with the settings [7-10] epr 1 and still had 7 apnea every hour.
what should I do.  The only event I have seems to be clear airway which is like central apnea.

By the way is there a page dedicated to sleep apnea surgery on this forum. I'm thiking of doing one.

Thank you guys for everything.

[boo2433]

Hey guys ! I'm still not feeling better, actually some days are really bad lately.
I was thinking I could work on the flow limitations which might be the cause of why I'm still feeling tired. Do you guys have any idea on how to make flow limitations as low as possible ?

[Expat31]

You have just said you had a polysomnographie, can you post the results please? 

Just redact your personal details.

Thanks.

[staceyburke]

You control flow limitation with EPR full time. 

You have not been on EPR 3
 That will help flow limits. The min has to be 7 or higher for EPR 3 to work.