Woofer777 - OSCAR Analysis

[Woofer777]

It's been a week now and unfortunately results have gotten worse not better.  I have attached 2 screenshots.  The first is last night 3-5 (AHI 15.3) and the second 2-26 (AHI 5.8).  I have not changed any settings from this time period.  The nights from 2-27 through last night have all been above 10.  The hope had been that with my collar adjustment and lower pressure increase to 10, that the new plateau would remain at the  reduced level that I experienced for 2-25 and 2-26.  I am discouraged to say the least.

I have some general questions and comments I will list below, as well as a request for those looking at my post to offer any further guidance as to what to do.

1. There are times where high pressure is waking me up, pushing the mask off my face, (making noises too)  even though it is snuggly fit prior.  Last night as you can see on my chart, I actually had to turn the machine off and back on so that the pressure would decrease so that I could go back to sleep.  I tried to breath normal when awake with the high pressure thinking that the machine would adjust back to lower pressure, but it didn't decrease.  

2. Related to 1 above, I assume the machine increases the pressure based on detecting obstruction, yet the outcome after being increased isn't resulting in eliminating the events.  To me its like the machine basically is not doing anything.  What if the upper limit was lowered, for example to 14? 

2. I have not been able to get my oxygen ring results downloaded and added to my chart data. It was suggested on here to add that information.  I am contacting tech support on what might be wrong with getting the data.  Not sure if that is a critical variable ( i.e. , what 02 levels are doing)  in what might be going on with my erratic results?  ( With the supplemental O2 connected O2 levels do stay above 88%.) 

3. My hope has been that with proper machine adjustments, the collar and pillow changes, using the supplemental O2 machine, that we could get my numbers down to desired levels ( below 5 AHI consistently).  A doctors visit will result in them wanting to complete an overnight lab sleep study. I'm not able to do that until at least June.  That's also the time when I would be able to see a pulmonologist. It's been a little over 2 months now, and there have been a few back to back nights of decent numbers ( for me anyway), with the rest in the 10 to 15 AHI range.    Why such drastic swings in the various nights? My patterns before bed are the same and no other differences I can think of. 

4. The one thing that seems consistent is that on the bad nights there is always a very heavy cluster of events from 1 to 2 hours, as opposed to constant event pattern all night.  (See attached from last night.)   I assume that is correlating to a deeper sleep stage? 

5.  Would changing the EPR setting to 3 from current at 2 possibly improve current situation?   (i have tried all the EPR settings at one or another and was unable to determine any conclusions on impact of changes).   

6. Would trying a more narrow range of pressure accomplish anything?  e.g 10 to 12 or 10 to 14?   ( Having the upper limit at 18 doesn't appear to be preventing events when its at that high level.) 


I appreciate thoughts and feedback on the above, as I am completely lost on what to do next. 

I know there are many variables going on and lots of question on my part trying to understand.  Being new to the forum, I'm not sure if its OK to continue with this thread only, but for now will keep everything on this thread as it does relate all to my "first time" issues.

[Gideon]

The title can be changed if you wish, but do keep with the same thread as it makes it soooo much easier to find/see your history.

You latest shows significant clustering of obstructive events indicating a positional apnea that is likely best addressed with a soft cervical collar which obviously is giving you issues.

I really would like to see your O2 charts, even if they are not integrated. The higher levels of CA events say to lower EPR, The fact that you are on O2 says not to. In fact your Obstructive events say to increase EPR (to 3) but as stated above the CA events and your O2 status say not to. Knowing your O2 sats may say a brief trial (1 night) would be OK.

Bottom line, You may be heading into advanced CPAP territory (read expensive) such as the ASV. June would be a reasonable target for this

[Geer1]

If my memory is correct all we did was increase min pressure and find a better fitting collar?

Your data shows clustered apnea, some central, some obstructive. In cases like this I don't trust the machines capability to flag the apnea type accurately though so this could be either central or obstructive. Your machine is only really capable of treating these apnea if it is obstructive. If central you will need to consider ASV and as mentioned best way probably is to do the in clinic titration study.

As you noted the higher pressure doesn't resolve these apnea. That is because they are either central or positional in nature. Trying a limited pressure range would be a good test to at least confirm if these are central or obstructive. The increasing pressure does seem to help at a couple times like 1:40 to 2:20 when you had high flow limits. 10-12 range would be a good test.

Increasing EPR from 2 to 3 probably won't make a significant difference because EPR doesn't treat either central or obstructive apnea. If anything lower EPR might help more than increasing it.

[Woofer777]

Gideon - I will work on getting the O2 data asap.  The technical issue I'm having relates to the interface of the device to the computer so that I can get a file version.  Hoping tech support reaches out to me tomorrow.  Also, I will order a different soft cervical collar from a different company that possibly is more supportive in design.  That will take several days for delivery.

Geer1 -  Yes, all we have done so far is try collar and min pressure to 10.  I'm wanting to try the pressure trial of 10 min to 12 max.  Since the machine is currently hitting high pressure levels without much apparent benefit, what might we see with lower maximum pressure settings?   Is the test to see if the numbers remain high at the lower max setting?  Could the absence of the high pressure actually improve results? 

I will make an appointment for June, anticipating that I might need more advanced treatment, and the overnight lab study.  And look to get pulmonary evaluation at that time as well.

My initial home study indicated all obstructive, if that was in fact correct.  The results I get now indicate predominantly high centrals, yet as has been noted the machines may or may not be flagging this correctly.   My question though, doesn't zooming in on the flow data allow the machine flags to be evaluated as accurate?

[lightwolf1]

Please continue to pursue tech support, however, if you are using the Wellue ring (as I do), I might be able to help.  The data is in a directory with /Users (on a Windows machine) as it's root.  You need to be able to see hidden files and folders under that directory (there is a setting for this).  Once you can see them, you'll see /AppData/Local then /O2 Insight Pro and you can follow the path down to your files.  If you don't turn on the hidden files and folders you'll never have the chance to add your data.


Hope that helps.  Best wishes.

[Geer1]

If these are obstructive in nature then lowering/limiting pressure will often allow more obstruction to occur. If these are central in nature the lower pressure may help reduce them. Apnea doesn't always respond as you expect it to though and a lot of the time you just need to trial different pressures to see how the apnea respond. Your worst looking apnea has occurred and continued to occur while pressures were high, the main question is whether the high pressures were making the apnea worse or if those were just bad periods of apnea keeping pressure high. Easiest way to figure out is try smaller limited ranges. In tricky cases where you are having trouble figuring out if pressure helps or hurts I like to use fixed pressure and run it for multiple nights at each setting to collect a lot of data at each pressure, then it becomes more obvious if higher or lower pressure is better.

10-12 is similar to effective range in a couple of nights and is a reasonable test to start.

[Woofer777]

lightwolf1- Thank you for information.  I do have the Wellue ring.  The problem is the USB cable at this point, I believe.  I must have lost the original cable and using a generic USB cable my computer is not recognizing it being connected.  Are you aware if a special  USB cable is needed?  I have not been able to reach tech support as of yet.  I recall reading in the manual that a special data cable was needed?   I've tried various cables I have lying around and none are connecting my device to the computer.

[Crimson Nape]

The cable is special.  It is a USB/HID connection.  Wellue sells additional cables on their website.  They are Supplier #40 (Currently the last one on the list)  I keep one by the CPAP for charging, and one by my desktop PC.  If you are like me and have various USB cables for different stuff, I would highly recommend attaching a tag on each cable and label it to its device name or intended use.

These USB cables seem to be the new RJ11 phone cord of the new millennia. Remember how everything used to come with the RJ11 phone cords?

[Woofer777]

Last night I tested the 10-12 range.  It was a huge relief not having the mask blowing off my face with the sustained higher pressure levels.  That being said it overall results seem about the same.  Looking at the obstructive events I can see where the machine did in fact increase up to higher level on almost every event.  As we've seen on my previous charts, the fact that the machine increased to higher levels (18) and remained in that range, the obstructive events were still occurring.  When I had the settings at 8-18, the median value was typically 9.  I'm leaning towards testing 9 -11 and 9-12.  

I know above in this thread there was reference to EPR levels.  I'm at 2 now.  If going to 3, where might I look to see if that is an improvement or not?  Should I see a potential change in hypopneas? 

I've been trying to read other posts from others to learn as much as I can from replies.  I came across some comments that relate to my situation that I haven't mentioned.  It relates to my full face mask, and the fact that I have had to tighten it very tight to maintain a good seal.  Even last night at max of 12 it was coming unsealed a few times.  ( Not nearly like it did at max of 18.)  My typical mask adjustment is very tight ( in the morning it is noticeable on my face area and sometimes a little sore).

I plan on getting on trying a large full face mask and seeing if that helps.  And I will also try a nasal mask.  ( I have my doubts on that as I believe chin dropping might be issue.) 

The question I have is, can an overtightened full face mask be limiting air flow and causing some of the positional or other events?

[Geer1]

Still looks like a mixture of central (~ 1:00 onward) and restriction at times (4:00-4:45).

Nasal mask would be an interesting test as full face masks can cause issues with some people.