[Treatment] What Do My Graphs Mean? | OSCAR

[TiredTim]

Hi All,

Short time reader, first time poster. Symptoms severe: EDS, anxiety, disabling brain-fog, basically no energy to do anything all day, every day. Diagnosed with a bad at home study, 6.2 AHI. 85% oxygen (whatever its called).

I have Resmed 11, F20 full face mask, pressure set at 5-15. Treatment has been hit-or-miss, generally still felt very tired every day, but brain fog and low-energy level is gone about half of the days so far (other half its almost as bad). Feels to me like the 5 setting is too low for me (also have noticed when I wake up the screen says its at 10, but feels significantly weaker than when its set at 5).

Recently diagnosed and on CPAP for about 3 weeks. Downloaded OSCAR and I have no idea how to read this thing, so any insights appreciated!

[Expat31]

Firstly, can you repost your graphs in this order you so we give clear explanations:-

1.Events
2.Flow rate
3.Pressure
4.Leak rate
5.Flow limitations 
(Note. Please exclude pie charts and calendars so that all settings are visible)

Or you can also set your display to the standard view by:-

(View > Reset Graphs > Standard)
Take a screenshot of your Daily screen.
   * For Windows or Linux: Use the F12 key
   * For a Mac: Use Fn+F12


Reading of the following is strongly advised 

Oscar chart organisation

Optimisation of therapy

Thanks 

[TiredTim]

       

Hi and apologies for the mis-format. Is this more useful?

[Expat31]

Hello,

Better, but a little more resizing to do. In the left hand column, you have cut off the top and cannot see your AHI result for the night. 

Also, this column is too narrow and you have "wrap around" of thd figures. Resize with your mouse, 

Or alternatively at too of page, left View / Reset Graphs/ Standard. 

Then, take a screenshot of your Daily screen.
   * For Windows or Linux: Use the F12 key
   * For a Mac: Use Fn+F12
 
It is useful also to browse through other peoples posts on graph presentation, and to read through the wiki explanations on any terms youvare not sure of. 

Again, reading of the following is strongly advised 

Oscar chart organisation
Optimisation of therapy
Attaching graphs etc. 

There is no real short cut, just spending a lot of personal time learning all this new stuff. Not easy with a backdrop of accumulated tiredness, but that's the nature of what we have had to deal with. 

EXPLAINING THE GRAPHS. 

Some general explanation of the graphs and what they are for, and what they can tell us. 

Please note, below are brief explanations to give you a general idea. Please spend time perusing the wiki page to drill down for complete explanations and reasoning. Please don't skip this. It takes a lot of time and patience!

(You will see that the graphs below are all interrelated in some way) 
  
1.EVENTS

This first graph gives us a quick overview of the nights events, a breakdown of the events making up the AHI, obstructive, central and hypopneas, together with leaks which can really mess up the efficiency of the therapy. 

This graph gives us clues at a glance where to focus.

The details of the night's results ard contained in the following graphs. 

2.FLOW RATE

This graph shows us fthe breathing patterns during the night, breath by breath. We see when arousals happen, when we pause breathing, and other disturbances. We can even zoom in to drill down to get greater detail. 

3. PRESSURE

This obviously shows variation in pressure during the night. Increases in pressure can be caused by the algorithm reacting to a need to open airways due to apnea events. It may also be a reaction to leaks, (see below) or flow limitations (see following graphs below) 

4. LEAK RATE

These can be either mask or mouth leaks. These often cause considerable arousals and generally disrupt the therapy. Large leaks are defined for Resmed machines at 24l/m and over. 


5.FLOW LIMITATIONS 

These are precursors to apnea events, with a narrowing of airways, often accompanied by a resulting pressure increase and an accompanying arousal, and sleep disruption. You will see lots of references in posts to this, and the use of EPR (search EPR (Expiratory Pressure Relief) in the board's Wiki pages
http://www.apneaboard.com/wiki/index.php...lief_(EPR)

Repost once you have had a chance to adjust your graphs, but certainly a good start.

[TiredTim]

Thank you for the detailed response and I feel bad for posting images directly (can't find a way to delete/edit my previous posts.)

I think this screengrab should finally be correct! https://imgur.\\com/a/HQqIaAR

(remove "\\" since I'm not allowed to post links).

[Expat31]

No problem, it is always pretty difficult in the beginning, especially with the backdrop of great fatigue of apnea, and on top of this all the stuff that goes with it.

I couldn't get your link. Try doing this. I have attached accompanying screen shots to show what I did. 


Chose file
Add attachment

You will see there is a final option to delete if you wish.

Also some further info

Uploading images and charts.

[PeaceLoveAndPizza]

Here is the screenshot from Imgur.

[attachment=59058]

[Expat31]

@PeaceLoveAndPizza
Thanks for helping us out. We would have been stuck otherwise.

@TiredTim
Thanks for your excellent graph, and the good results you have obtained, and hoping that the quality of sleep will have started to improve.
I have some general overall observations to make as below:-

EVENTS
You had only one clear airway (central apnea) and just one obstructive, total duration time 26 seconds. Remarkable! 

FLOW RATE
Your flow rate graph looks "nice and clean". I don't think you can improve much more. All good. 

PRESSURE 
Here I have a bit of a problem. Your pressure is jumping around quite a bit and is likely causing you discomfort in your sleep. I am talking here about micro arousals. 
I am trying to link it to your flow limitations graph, but this scaling is not quite right. The y axis goes right up to 1.0 which is not of much use. We need to fine tune this, to say something like 0.25 tops. (see flow limitations section below).
The reason is that we need to be more granular, as the objective should be 95% value at 0.1 or ideally under. It would then be possible to hopefully tie in the pressure spikes with this pressure section.

I have a suspicion that your maximum is set unnecessarily high, and is not needed at all, it is just causing these arousals for no therapy benefits. But we need to be sure. I think it may be useful in the meantime to reduce the max pressure a bit to see what happens. Maybe to 10cms.      

LEAK RATE
Looks pretty good, just some spikes probably caused by the mask being displaced somewhat. 

FLOW LIMITATIONS 
Hover over the scale column, right click, select Y-Axis, override, min 0.0, max, 0.25

That's about all at the moment. Repost when you need to. 

[TiredTim]

Thank you again for the detailed reply! I made the adjustment to flow limitation you suggested and it does look like it correlates with the pressure increase. So you believe that the top pressure is too high, which is causing me to wake up in my sleep? Would setting EPR make a difference here?

[Expat31]

The short answer is yes. 

I suggest you try these steps to hopefully improve things. 

Leave the minimum pressure as now, at 5, and the EPR at 2, and focus on starting to reduce the maximum pressure gradually, in steps of say 0.4 and until the  AHI starts to rise, then move back a bit to get the “sweet spot”for maximum pressure.

Then we use all the tools to reduce flow limitations. This would be achieved by raising the minimum pressure to 7, and increase the EPR to 3, which is the maximum possible EPR level available. This will give us an inspirational pressure of 7 and an expiration pressure of 4 and should reduce the flow limitations. 

I prefer this two stage process, instead of adjusting minimum pressure, maximum pressure and EPR all at the same time, so to be able to more easily isolate problems that may occur.
Then we can review 

Hope  this makes some sense