review my OSCAR data please?

[chronicallytired]

Help interpret my OSCAR data? 

I'm 1 month into bipap therapy- finally found the mask I like and get seemingly good results with.
Problem is, my charts look okay (to me) but I am more profoundly tired than I was before treatment.

I have noticed I do get about 3-5 central apneas per night, and have since I started- is this something to worry about?

pretreatment total AHI: 26, supine AHI: 84.6


thank you! 

   
   
   

[PeaceLoveAndPizza]

The centrals are not a concern at that level. 

How did you end up with your current settings? Trial-and-error or doctor prescribed? 

There are a number of arousals, which would lead to feeling tired. If you have not tried it, I would back off the PS from 5 to 4 as a trial to help understand what is going on with the spikes. It may cause pressure to go up a bit, but the question is what effect it will have on the flow limitations and arousals.

Other than that, not much going on.

[chronicallytired]

Current settings were set through a titration study.

Just so I know, how did you determine there were a lot of arousals? Which part of the chart am I looking at for that? I will definitely talk to them about it! thank you!

[PeaceLoveAndPizza]

Look at the flow rate. You will see many spikes, which are mostly arousal breaths. You can zoom into them with a 2-3 minute zoom and see a slight reduction in flow, followed by a recovery breath. Voila. Arousal (aka RERA). Not enough flow reduction to get classified as a hypopnoea or obstructive, but enough to require a recovery breath.

It looks like classic UARS. Not much different from mine or many other members. We can handle the events and get a great AHI, but we still have arousals making us feel quite poorly in the morning.

[chronicallytired]

Thank you! Could you please tell me what decreasing the pressure support will do? Will it help with the arousals?

[PeaceLoveAndPizza]

The theory is we only have pressure to keep the airway open, so too much pressure support can allow the airway to collapse as the pressure is reduced on exhale. Just backing it off 1 cmH2O may be enough to tell us if that is the case.

Depending on how it goes, we may want to try increasing pressure a bit with the slightly lower pressure support to see how the airway responds. Something like decrease PS to 4 and increase EPAP min to 9.

If you want to give it a try, we can compare charts and some zoomed in areas (01:40 and 02:20) as an example in this particular chart.

[chronicallytired]

thank  you! I've attached my OSCAR from last night after adjusting the SP a few days ago- the "thickness" of the flow rate chart is getting smaller, which I guess means I'm breathing more steadily and not having those super sharp respirations which may be due to partial obstruction? 

I don't know that there's a major difference in the overall # of spikes, but I do feel a bit better.

Thank you so much! 

   

[PeaceLoveAndPizza]

Every night is different, so no worries about things. The thickness of the flow rate is relative to the min/max as the software scales things, so it is hard to judge things by looking at the width. Look at the left-hand table for the numbers. 

Overall things look a bit better. Flow rate is a little smoother, but we may be able to get it even better. Now we begin the tweaking of things to reduce the arousals if we can.

Before changing anything, I suggest giving it a few more nights to see if things settle down. If not, I would try the following steps:

Some flow of consciousness thoughts…

One thing, do you need ramp? If so, then leave it be. If not, turn it off as you get no therapy during that time. It’s not a problem if you have to use it.

The only thing we have to manage the arousals (spikes) is pressure and sleep hygiene. More or less pressure, more or less pressure support. Flatter pillow, warmer/cooler room, hose management, etc.

1. Reduce PS from 4 to 3. This would tell us if a bit less pressure support on exhale helps smooth things out.

2. Change pressure range from 8-17 to 9-14. This would tell us if a bit higher minimum helps.

From there, we can reevaluate. Thanks for hanging in whilst we tweak. It takes a bit of time, but should be worth it in the end.