[Treatment] Help review my OSCAR Data, please!

[naman919]

Hey, 

I'm new to the forum and I've been a lurker for a few weeks. For the past year and half i've been on Auto CPAP treatment and my AHI is usually between 3 and 5, which i would love to bring down. I don't really experience consistent leaks with my full mask, though from time to time there will be some that cause my eyes to be puffy in the morning which i know is from a leak up near the bridge of my nose. 

My sleep technician and doctors have been worthless in providing much assistance in tweaking my machine to help lower my AHI, insisting below 5 is fine. Lately my quality of sleep (last 3-6 months) is getting worse and my machine is showing some higher numbers. My lifestyle hasn't changed. I'm 6'3" 230lb with an athletic build in my mid 30's and i'm healthy. 

Could y'all help me look at my results over the past 4 out of 5 days? (Friday i was unable to use my machine, that's why there's a gap) To provide the full report i exported OSCAR reports for each day in PDF format and have provided links. Thanks in advance. I could really use some help. The only thing i've changed is upping the minimum pressure to 8 from 6 (as can be seen from first night to the second), which hasn't seemed to help much. 

I could really use some help finding ways to optimize this machine. I'm reading up on the wiki's and trying to learn as much as i can about reading the OSCAR data and making sense of the events and correlated settings. Thanks in advance!

Update: could a mod allow me to post links to pdf files hosted in GDrive? I'm too new to the forum.  I'd like to give the full summary of my report versus trying to paste together lots of OSCAR content.

[naman919]

Here are the links until i can properly post them. sorry for the need to cut and paste. Also, i can't edit the original post since it's been over 10 minutes. Attached as photos are also high-level views of the OSCAR Data.

July 17th [https://drive.google.com/file/d/1ZzvrvcKRw_76uvO5D0dEbEXwAWf2lsHy/view?usp=sharing]
July 18th [https://drive.google.com/file/d/1CkKtuRWN8TYXX1Z9pbK3hYDMWdwuuKSx/view?usp=sharing]
July 20th [https://drive.google.com/file/d/1dWjbbxp71fmc9zUNvwzSfIFbKkgVWChy/view?usp=sharing]
July 21st [https://drive.google.com/file/d/1CHt0SK-LXjRQ3Mgyj49kpMprocHbIsnw/view?usp=sharing]

[Gideon]

Welcome to the forum

Overall not bad but to improve you need to trim a bit off of everything

1. You have some Central Apnea and the numbers are bouncing around which is expected.  Your machine cannot treat these, you can only avoid them.  We are going to try to minimize this by turning off your Flex.
2. You show signs of chin tucking to the point of obstruction.  You see this as clumps of OAs.  The solution to this is to wear a loose-fitting soft cervical collar to resolve this positional apnea.
3. You have a number of RERAs which don't count toward your AHI but do toward an RDI and they are disruptive.   RERAs are defined as a series of Flow Limitations (you are showing no Flow Limitations in the events BUT they have to be there by definition) followed by arousal. Arousals are bad.
4. Your Hypopneas are a bit high also, so I am real, real sure that you have Flow Limitations which aren't showing.  Please check the 2 dropdowns at the bottom of your charts and see if anything is turned off (is Red).
5. You also have some remaining persistent snores which is implying that your airway is not being fully splinted open by your pressure.  Another reason for a pressure increase.

The central apnea requires that we minimize pressure differences and minimize pressure to avoid it. 
The RERAs, Hypopneas, and Snores are best treated with Pressure Support (PS) the difference between EPAP and IPAP which we just set (Flex) to 0/Off for the Central Apneas (polar opposites for treatment) Flex does a poor job of it anyway so LATTER, not now, we will likely increase pressure to help resolve those.  Note that increasing pressure may also raise your central apnea.

Because we have conflicting indications with the desire to reduce both central and obstructive events it is important to try to only fix 1 at a time via pressure.  The Cervical collar works independent of pressure and has no impact on centrals so we will do that, and as I have said before Set Flex to OFF

so 2 changes for now
1. Add a soft cervical collar, loose-fitting to prevent the chin from tucking and obstructing and
2. Turn Flex Off

I anticipate increasing pressure after we see what these changes actually do.

[naman919]

Fred, 

Thank you so much for the step-by-step breakdown of my results. Did you find the screenshots the most useful or were the links to the pdf larger reports more helpful? Just asking for future reference since the screenshots only capture so many rows. 

Attached are updated screenshots of my four nights which were missing the periodic breathing and the flow limitations. Thanks for helping me get those turned back on in the dropdown. 

Replies:

1. Tonight i'll switch the Flex to off. roger that. 
   
2. I 100% chin-tuck so that makes sense. i'm a back sleeper so a soft cervical collar could help for sure. great observation!
   
3. Let me know if the new screenshots add more information for this space
   
4. Same as 3
   
5. Will wait to learn about how the new adjustments impact my overall experience. 
   

Thank you again for the detailed breakdown of my information. It means a lot to me that you would take the time to help make my experience with CPAP better. Over the next few days i'll try to find a cervical collar and turn off my Flex and compile more data. Let me know if there's anything else i could provide in the short-term. 

Have a great evening!

[Gideon]

These 5 charts, plus Flow Limits for ResMed, are whats most important for CPAP/BiPAP without COPD or ASV. We all will ask if we need to see more. I never opened the PDFs.

Work on getting the collar but do show tonights results including how you feel and the collar status tomorrow.

[naman919]

Hey Fred, 

Last night's results are attached here. Overall i don't feel any better, and I feel slightly worse as the evening has progressed. Last night I turned off the FLEX, and in place of a cervical collar i subbed in a travel u-shaped neck pillow oriented sideways (while i remained on my back) to help support the back of my neck and my chin. 

Today I went to Target and failed at finding a cervical collar. Tomorrow I'm going to stop by Walgreen's and if that fails then Walmart. Last resort i guess will be Amazon. 

Any thoughts on tweaks i can make to what you see going on? Thanks in advance for your help.

[Gideon]

Keep in mind that we are not trying to support the neck, only keep the chin from tucking.

Too many obstructive events so I'd like to slowly bump pressure up. so set min pressure to 9 cmw

[naman919]

Good morning Fred, 

Thanks for your input. It's been a great help. Over the past few weeks I've not had much capacity to get my info up on the boards here. Could you take a look at some updated screenshots? 

I was able to get a cervical collar which has helped lower the AHI overall by about 2-3 points, considering i was in the 5-8 range consistently. Now i'm seeing more like 2-3 on average. My quality of sleep still feels a bit lacking and i'm waking up with some fogginess still, and a slight headache. I am getting benefit from the machine, my energy during the day is on par with what i expect when the machine is working properly, so i'm still hopeful we can work through some of the other areas of the treatment. 

Let me know what you think. Thanks in advance. :]

Side note: there was a large lightning storm last night between 12 and 2, so the 8/7 screenshot might not be the most useful. Lots of being awake.

[Gideon]

In this set of charts the RERAs are elevated, the last bunch too., before that they were there but not bad.
To put more awareness on them I'm going to have you change OSCAR to report RDI instead of AHI.  RDI = AHI + RERAs

RERAs by definition are a series of flow limitations ending in arousal. Obviously, Arousals are bad as they are sleep disturbances.
On your machine we must raise pressure to fight this so set your min pressure 10 10 cmw

[naman919]

Thank for the quick reply. I'll make the adjustments as indicated. Is there a max adjustment i should make as well, or do you feel 12.5 is fine?