need help understanding OSCAR data

[k888]

Greetings,

I am a newbie CPAP user in need of your expertise (just under 2 weeks.)  I have made some progress learning about the equipment and managing leaks.  At first I thought my problem was entirely a leak issue, as I have a very thin face.  Because I was getting much worse leaks at higher pressure settings, I tried experimenting / reducing the max pressure setting.  Last night I actually got to max pressure with no leaks, but ironically, this seems to have simply made the number of events worse (all-time high of 43/hour.)  I am contacting my doctor, but the office I would greatly appreciate some direction and advice from you all.  I have other health problems, and it is sometimes  difficult to know the source of any given problem, but I can see that thus far the CPAP is not helping me (plus I don’t sleep very well when using it.)  Could you please help me understand these charts?  k888

I am attaching last night's data - hope I have followed protocol.

[k888]

I see my attachment failed.  Another try:
[attachment=55222]

[Old Steve]

I am not an expert, just a long time user. 

When you are having very large leaks not only does the CPAP machine not treat your apneas it will not recognize that you are having them.  You fixed your leak problem now you are seeing the apneas. Your chart appears to be showing positional apneas (clusters) caused by sleeping on your back or chin tucking.  Also, your min pressure is most likely too low.  I would start out with a min of 7cm, leave your EPR and your max pressure where it is for now. Do just one thing at a time.   

Unfortunately, just raising the pressure will not help with positional apnea.  Imagine your airway as a garden hose, if you bend it the water stops, so will your air.  If you run the CPAP with maximum air it will not help, you must unbend the hose... I would try sleeping on your side, you can prop pillows behind your back to stop you from rolling over on your back when you are sleeping.  For some it helps to use a thinner pillow. Some use a neck brace to help stop chin tucking.  

[k888]

Thank you for the advice and encouragement.  I had actually already ordered a cervical collar which arrived yesterday evening.  I do sleep on my back and somewhat raised.  It's hard to change that due to GERD, right shoulder with rotator cuff damage, and a stent in the left arm that I am afraid to bend too much.  So the collar arrived and I used it.  Raised low pressure to 6 (will go to 7 tonight) and I also reduced max pressure from 15 to 12.  (While I was finally able to get rid of leaks at the max 15 setting, it was only by allowing air into my mouth.  That puffed out my cheeks making a good seal.  But, it also meant my mouth was hanging open.)  At any rate, the setting of 6-12 + cervical collar = 4 events per hour.  WOW.  I have not been even remotely close to that.  

[OpalRose]

That's great k888!

Old Steve nailed it with the "positional apnea".  This happens a lot, but a soft cervical collar usually makes the difference or changing the position you sleep.  But considering your situation, it's understandable why you prefer sleeping on your back.

Just want to show you an article on what positional apnea looks like.  Do you see the resemblance?  

https://www.apneaboard.com/wiki/index.ph...onal_Apnea

If you can, post an updated chart that shows the improvement, as others will benefit from seeing the difference.

[k888]

Thank you for the article.  I still have quite a bit of learning to really understand these things, but at least I am starting.  Here are the charts from last night.
[attachment=55253]
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[Deborah K.]

Your AHI is greatly improved.  Excellent!  You need to raise your low-pressure setting up to at least 7, and you need to raise your high-pressure setting up to at least 17.  The machine won't go higher than you need, and you will likely feel better with the higher settings.

[k888]

Thanks to all for your help.  Currently at 7-12 + cervical collar.  Last night was 4.96 AHI.  I can see my max pressure hits a "flat mountain top" at 12, presumably because I need more pressure?  I am waiting for a nasal mask to increase the max pressure.  Due to my very thin face, my current full face mask whistles and farts at higher pressures.  Even if I don't lose too much air, I can't sleep.  I am hoping a nasal mask will work better.  But, even with this less than perfect report, overall there has been a big improvement.  Last night, I actually used the CPAP for almost 8 hours, and with a respectable AHI (compared to the 20-40/hour figures previously.) I will report after I get a new mask.  Please do let me know if you think I should be managing things differently, or if you have nasal mask suggestions.  The DME has not contacted me yet about the new prescription.  This forum has been so helpful, far more than the medical group.

When I spoke with the sleep center last week, they were very firm that I should NOT use a cervical collar.  I nodded meekly, thinking "why would I stop the one thing that has made a huge difference?" k888

[attachment=55375]

[CPAPfriend]

I just want to second that your obstruction looks mainly position, even the residual stuff / your waveforms with the AHI of 4. Experimenting different sleeping positions with your soft-cervical collar, for example, why elevating the bed, putting your head in x position, etc. could lead somewhere. There's a chance too that finding an even better-fitting cervical collar or proper chinstrap could lead to more benefits.

[k888]

Greetings and follow-up:  This is primarily – I think – a question about flow limits.  I have experimented with soft collars and collar management, and I have played with settings.  My AHI is, most nights, finally looking very good, and that is real progress, since my original sleep study showed 31 apneas per hour.  And I am feeling better, but still more tired than I think I should be.  (I have other health issues and age, so it's hard to know for sure what "normal" should be.)  I think I still have too many flow limits – is that true?  And I don't see that raising the lower pressure has made much difference.  See below the results for various settings.  They are not 100% comparable, since I was working out various issues over time.  I tried to pick my best night at each setting so as to reduce extraneous variables.

DATE, MIN - MAX PRESSURE, AHI, FLOW LIMITS
11/1:    7-12.4,  15.29,   .20-.33
11/5:    7-12.4,  2.42,   .14-.23
11/6:    8-12.4,  5.4,   .12-.21
11/11:  8.4-12.6,  .38,  .13-.23
11/16:  8.6-12.6,  .64  .16-.31
11/17:  8.8-12.6,  .78,  .13-.25
11/25:  9-13.2,  .48,    .21-.54
11/21:  9.2-12.6,  2.25,   .08-.23
11/26:  9.2-13.2,  1.55,   .13-.30

Here is last night's chart (I'm not clear about the last half hour.  I was basically awake, had the mask on and thought it was working, but no pressure reported?)  I would greatly appreciate your input, k888
[attachment=56494]