Waste of Time? - Pulmonary Visit

[mark.apnea]

I've been on CPAP therapy since last Nov with a single checkpoint of the effectiveness of my therapy.  I asked for and got a referral to a local hospital's Pulmonary and Sleep Study Office from my PCP (same place where I got my home sleep study setup).

I've been using OSCAR for quite a while and have been casually inspecting my results, without a real clue what it all means.  My CA and H events are high, and OAs are zero.  I've also had a good handful of CSR events flagged, but no clue if they were valid (some 20 to 40 minutes long, with clear periodic waveforms each followed by a CA or H event).  With help from the good folks here I managed to tweak my settings from the default settings with some success on the CA side.  I understand the tweaks should be made slowly over time and that the proper balance of settings can be a delicate task.  Still, my result are quite variable.  CAs are declining, but Hs increasing...  

So, I thought a visit to a pulmonary specialist would be a good idea.  I am in no way qualified to self assess and adjust my therapy.

I went to the visit this morning and as feared, the Nurse Practitioner noted my 90 day compliance data showed an ave AHI of ~3.2.  So, no problems, good to go (ugh!).  I asked if she was aware of OSCAR with its underlying data.  She said, Nope, never heard of it.  

I mentioned my concerns for strategies to improve the balance of CA and H events.  She was adamant that AHI only include OA events.  I explained it was my understanding (at least withing OSCAR's representation) is the sum of OA, CA and H events.  She became a bit more adamant, so I chose to conceded the discussion.  She was not going to back down, and I did not want to leave the impression I knew more than her (an armchair analyst).

I did explain I wake up many times per night and feel generally tired in the morning.  She could see my settings from the compliance report she pulled for me.

Pressure Range:  7 - 15
95%:  9.36
EPR: Full time, 2
Ramp: OFF
Humidifier:  ON
Mask:  Full Face (but I have been trying a nasal pillow recently)

As I re-stated my desire to address CA and H events, she proposed the following change:

Fixed Pressure:  10
EPR:  Off (as I can tolerate)

She wants me to give it a couple weeks, but to call her sooner if its intolerable.  Next visit is in a month.

So, as I feared, this was a very cursory review, without much though besides the basic AHI result.  I may or may not return for that next visit.

[staceyburke]

Please share your OSCAR charts. I have the list of what charts are needed. We can help

[Dormeo]

Sheesh. What does she think the "H" stands for in AHI??

As staceyburke says, it will be helpful to see an Oscar chart. You could also sign up for a free account at SleepHQ and share a link. (The advantage of this is that people using the link can zoom in on short segments of your graphs if they want to take a closer look at something.)

[mark.apnea]

Here's the data from a recent night.  I am curious about strategies for dealing with the periodic breathing, seen in the zoomed in view. The nurse practitioner deflected this question with "AHI of 3.2, that nothing to be concerned about.

   

   

[G. Szabo]

The number of CA incidences is not concerning.
The setting suggested by the nurse is not a bad idea in a CPAP regime.

However, the pressure you need was significantly higher than the suggested 10 cm because the 99.5% was 13.64 cm. Hence, staying in your current APAP mode (where the instrument tunes the pressure) with the following settings, which can reduce your OAs and Hs, would be better.

EPR=2, full time
Pressure minimum 10 cm
Pressure maximum 15 cm

[car54]

Mark.com,
I understand your waste of time statement. One time I talked to my respiratory therapist about the apnea board forum and Oscar. She said that she never heard of it and referred to them as basement hacks.
Working with the apnea board forum can get you very good results. All the healthcare industry cares about is if you are 5 events per hour.

[Dormeo]

I agree that it'd be worth trying a higher minimum. You could raise it gradually, stopping when your OAs and Hs come down some. So maybe start with 8 and see how it goes from there.

I imagine the idea with a fixed pressure was to try to eliminate the possibility that pressure changes were disturbing your sleep. But except for that cluster of OAs, your pressure is already almost unchanging. So your call whether you want a fixed pressure or not.

The cluster may have been related to your posture in bed. For example, you may have been on your back, or you may have tucked your chin down toward your chest. If you tend to have clustered OAs, changes to your posture might work better than changes to your pressure. So keep an eye on that cluster pattern.

I imagine the idea with turning EPR off was to see whether that would reduce CAs. I agree with G. Szabo that you should stick with EPR of 2. (For one thing, it may be helping to keep your flow limitations down.) I also agree with him that the CAs aren't something to worry about, if this chart is typical. You had a stretch of unstable breathing. This is pretty common and generally resolves on its own as your body gets used to the way the pressure slightly changes the amount of CO2 in your blood.

The next time you post a chart, could you include all and only these graphs:

Events
Flow rate
Pressure
Leaks
Flow limitations
Snores.

[SarcasticDave94]

Your choice, good results with more or less free advice from basement hacks or paid advice that mostly fails to help, with a side of condescending attitude thrown in.

[Phaleronic]

I like szabos suggestion of 10cm min 15cm max keeping EPR at 2 for now, try it for a 30 to 45 minutes before bed tonight to see how it feels though please.