[Treatment] OSCAR data showing concerning info?

[Hypop686]

Hello! 

I’m a male in my 30’s. I had my first surgery a few months back and the first thing the doctor told me was that I needed to get a sleep study done immediately. 

The sleep study showed 35 events per hour. So I was prescribed an AirSense 11 with pressure settings of 4-20. The p30i with the pillows was highly recommended by the DME so I chose that. I had a hard time finding which size pillows worked best, and eventually settled on large. I’ve had the machine for a little over a month, and in that time haven’t been able to keep it on for more than five hours a night. Like last night, I slept for about 8 hours, but only had the mask on for about 5.

I sleep on my side and sometimes on my face. I’ve tried to just sleep on my side but it’s pretty tough. Sleeping on my back doesn’t seem like an option at all when I try to. 

My leak rates have been over 15 for most of the time. I have issues keeping my mouth closed, but that was more with the mediums. 

I started using OSCAR a few days ago and am kind of confused about the results. I never remember what caused me to take off my mask, but more often than not I do. I also added the Dreamwear blackstrap to my p30i thinking it would hold my head better, and it does, but I’m not sure if it was the right call. 

I turned off patient view so I could have more access to the settings. I turned off ramp, and it looks like EPR is set to ramp only. I have not changed my pressure settings, not because I’m worried about upsetting the DME, but because I don’t want to upset my primary doctor and have a track record of not following doctor instructions. I have a mask fitting scheduled for tomorrow at the DME and a doctor’s appointment in a few weeks.

Based on the data from last night, are there any recommendations? Can I reach out to my doctor and ask to increase the pressure or should I wait until my next appointment?

[G. Szabo]

Based on the data from last night, are there any recommendations? Can I reach out to my doctor and ask to increase the pressure or should I wait until my next appointment?

Suggesting settings to your doctor may not be advisable, as some may be sensitive if the patient appears too knowledgeable. However, here is what seems to be a reasonable approach: You can reduce flow limitations by increasing the minimum pressure to 9. You will tolerate the treatment better with continuous EPR. Start with a setting of two; you can increase to 3 if your central apneas are not appearing.

[SarcasticDave94]

Welcome to Apnea Board,

Your doctor didn't help much with your therapy, giving default out of the box pressures. 4-20 is that default, it takes zero skill to do this.

You're going to want to at least increase min pressure to 7, 8, 9 somewhere about there, and turn on EPR 3 full time. EPR will help you exhale a bit, adding min pressure to 7 as minimum allows EPR 3 to work fully. Mask removal is in most cases based on feelings of air starvation, which will be addressed by increasing pressure from 4 up to 7.

[Hypop686]

Awesome! Should I do this without telling my doctor? Or just kind of wait for them before I do anything?

---

Hello! Thank you! Y’all are welcoming and knowledgeable and I appreciate it! 

My doctor is kind of use to me looking into my conditions. They’ve been willing to listen to me and all that, thankfully. Do you think I could do this without asking and hope they wouldn’t have an issue with it? Do you have any suggestions? 

I have a mask fitting appointment tomorrow with the DME. Should I mention any of this to them? I’m thinking if they ask me to bring the machine in, I’d let them know I know how to do it myself. But I’m not sure. I don’t want to upset anyone, but I want to be able to sleep!

[SarcasticDave94]

If me, what I'd do is change the settings on your CPAP yourself. Compare the before and after OSCAR charts and how you're feeling for the changes. Maybe note this info down. Then next doctor visit make mention of what you did and the results.

On the DME, it's your call how to handle them. I didn't mind telling them I'm running my settings.

It's legal for you to edit these CPAP settings with no script update.

Consider ordering your CPAP setup manual at the top of this page. It's free.

This is how to access the settings according to a Google search for the ResMed 11

press and hold the blue "My Options" button and the purple "My Sleep View" buttons until the screen background changes from black to white, and the label "Clinical Home" appears

Go to wherever minimum pressure is located, edit and lock it in. Find the exit. Try the suggested settings a night, look at OSCAR charts to compare, you can post it then. Comment on it if it made things better or worse. Further suggestions will follow.

Best to ya.

[Hypop686]

Thank you so much! I’ll try that tonight! 

I’ll reply with the results tomorrow!

[Hypop686]

        Hello again!

It looks like it worked! 

I wasn't able to sleep very long because I had to get up early and didn't get to sleep early enough. 

I think I woke up in the same position I slept in. I felt an immediate difference. It's like I could actually breathe. It was surprising!

What do you think of the comparative results and settings?

Thank you so much for your help!

[SarcasticDave94]

You're welcome.

It looks good from here. You could try it a few more days as is, if you're getting more benefit setup this way.

[Hypop686]

Awesome! Any worry with the long leak? I’m not sure how it happened. I switched from medium pillows to large because I thought that’s what the issue was. I then added the dreamwear “arms” to my p30i mask because I’d heard that it holds it more secure, and it does. 

I did notice the large were easier to leak from, but I have “abnormally large” lungs, according to my doctor, and my nostrils are pretty big. I figured since the pillows didn’t touch together that it was the right size. 

Any pointers? I have that mask fitting and I’m not sure if I even need to switch now. It doesn’t seem like I have issues with mouth leak since the EPR change.

[SarcasticDave94]

Apologies I missed that leak in question. If it's one off then no big deal. To me, when looking at OSCAR chart, that look of rounded but rather flat, makes me think of a mouth leak. Compare to other's charts you will see here where they have sharp jagged leaking. That to me is indicating mask leaks.

P30i, I tried it myself but I'm better with full face. A pointer I'd heard was with this was that the tapered pillow ends would just rest in the nares of your nose, not inserting. Size should be large enough to match close as possible to the nares spread. This particular leak again if one off isn't terribly bad. If happening more frequent per night or frequent nightly, or if it becomes a disturbing thing address then.

We're not after perfection, just reasonably controlled, minimal disturbing, comfortable, and well rested.

PS that mask fitting is up to you, if you're happy with current fit, feel, etc, maybe you're in good status as is, masks are most important decision for success next to the machine and settings