+- Apnea Board Forum - CPAP | Sleep Apnea (https://www.apneaboard.com/forums)
+-- Forum: Public Area (https://www.apneaboard.com/forums/Forum-Public-Area)
+--- Forum: Main Apnea Board Forum (https://www.apneaboard.com/forums/Forum-Main-Apnea-Board-Forum)
+--- Thread: [CPAP] New with CPAP Request Assist with OSCAR Charts (/Thread-CPAP-New-with-CPAP-Request-Assist-with-OSCAR-Charts)
Pages:
1
2
New with CPAP Request Assist with OSCAR Charts - YankeeLaker - 08-02-2023
I don't have symptoms of sleep apnea -- no daytime sleepiness, loud snoring, etc. But I had several findings that indicated a possible issue with chronic but intermittent hypoxia:
(1) My new Apple Watch kept waking me up with a "tachycardia" alarm (high heart rate). I had no symptoms and disabled that annoying alarm, but I reported this to my Cardiologist at my next visit. He had previously done a workup looking for a cause for a TIA, but my report of nocturnal tachycardia prompted him to order a 4-week ambulatory "event monitor" to make sure I was not having intermittent atrial fibrillation. (Tachycardia can degenerate into atrial fibrillation.) The test ruled out atrial fibrillation, but confirmed frequent bouts of tachycardia (heart rate into the 170s) most nights. He said he thought this pointed to sleep apnea.
(2) The prior TIA workup had included a brain MRI. The MRI showed that there was no stroke, but there were "white matter hyperintensities" that were treated simply as an incidental finding. But when I researched it, I found that this was an indication of chronic but episodic hypoxic damage to the small vessels in my brain.
(3) I have had "normal pressure glaucoma" since 2018. In spite of maximal medical therapy, I have had seven retinal hemorrhages, each one of which leaves a small degree of permanent vision loss. Dr. Google helped me discover a few small studies that implicated obstructive sleep apnea as possibly related to normal pressure glaucoma. I even found a very small study that showed treatment of sleep apnea had arrested the progression of normal pressure glaucoma in about 30% of test subjects.
So, I presented these three points to my primary care doc, and requested a referral for a sleep study. He obliged. The consulted pulmonologist felt these three points were compelling enough to warrant a full in-lab sleep study, in spite of the absence of the classical OSA complaints of daytime sleepiness and loud snoring.
I had my sleep study the end of May. I had a normal sleep pattern, zero obstructive apnea, zero central apnea, but an average of 30.0 hypopnea events per hour, with oxygen saturation dropping as low as 79%. I have attached my sleep study details.
I started APAP (pressure range set at 4-20) on the ResMed AirSense 11 on 18 June. Since I have a full beard/mustache, I had lots of trial and error with different masks dealing with leaks. I finally have succeeded with the ResMed AirTouch F20 (memory foam cushion).
Last night was my first night collecting data on an SD Card and first day to use OSCAR. Charts are attached.
The first part of the night I was on my left side. I usually shift to my back about 3 hours into the night, so that would have been about 12:30 AM or so last night, when the pressures started changing. I did not experience any conscious arousals until just before 4 AM. I didn't really get back to sleep after 4 AM and just got up at 5.
I think the bottom line is that I shifted onto my back and must have chin-tucked. Does that seem to be the likely interpretation? Of course, I am interested in understanding the charts in more detail than that. Please help me understand the pattern(s) represented by these charts.
RE: New with CPAP Request Assist with OSCAR Charts - Jay51 - 08-02-2023
Welcome to ApneaBoard. A few things stand out IMO.
0.0 AHI is as good as it gets. You have one large pressure increase during the night, but no Hypopneas or OA's. Your tidal volume is a low at 320 though.
A few things stand out in your sleep study IMO. It looks like you qualify for supplemental oxygen. 5 total minutes below 88% qualify a person for it according to Medicare. Your low gets to 79. Average for the night as 91 I think. That is lower than normal. Normal average for the night shoule be 95 or 96 or so. Supplemental oxygen could help you feel better (if you are not already on it).
During my sleep study, my pulse shot up to 155. Both were when I sat up in bed. My Cardiologist thinks it was POTS. Your surges up to the 170's might possibly be POTS also. But they may just be tachycardia. POTS starts with movement.
RE: New with CPAP Request Assist with OSCAR Charts - YankeeLaker - 08-04-2023
@Jay51: Thank you for looking at this for me. I wasn't aware of the Medicare criteria for supplemental oxygen therapy. At the very least, I perhaps should see about linked oximetry. I think the most recent software update for my machine made bluetooth links to oximetry machines available. I think I will also look into the threads on this Board relating to cervical collars for chin tuck. Thanks again!
RE: New with CPAP Request Assist with OSCAR Charts - YankeeLaker - 08-09-2023
Trying to learn how to interpret my Oscar graphs. Cluster of OA events last night. I did not awaken with any of these events, although I took my mask off (unaware) about 2:20 AM for a few minutes before I aroused and realized it was off. I apparently had even shut off the machine when I removed my mask.
I suspect the OA was from being supine, but I don't really know what my position was at the time. I always start the night on my left side. My sleep study did not show any OA episodes, only 30/hour hypopneas.
I'm not really understanding the Pressure graph. I guess the pressure goes up when I am obstructed. But, I thought EPAP was during the expiratory phase...
The respiratory rate bounces a lot during OA episodes -- I guess I am trying to breathe, but am efforting against obstruction?
Appreciate insights from those of you accustomed to interpreting these graphs. Thanks in advance!
RE: New with CPAP Request Assist with OSCAR Charts - Jay51 - 08-09-2023
The clusters of OA's are most likely postional. When the chin tucks to the chest, it can narrow or even completely block the airway. A few things to try in order would be: 1. lowering your current pillow height (smaller pillow, etc.); 2. Trying side sleeping instead of back sleeping (but you can still chin tuck in side lying postion, and 3. Use a soft cervical collar to prevent chin tucking. Just measure from your chin to the top of your chetst to get the estimated size of soft cervical collar.
Pressure usually increses to try to combat OA's, but when the airway is completely closed by chin tucking, no amount of pressure can open it up. You have to move substantially to get it open again.
Everything else in your charts looks ok IMO.
RE: New with CPAP Request Assist with OSCAR Charts - Jay51 - 08-09-2023
Also, tidal volume is a bit low at 300, but normal respiratory rate. If you blood oxygen levels are ok (SPO2) during sleep, then don't worry about the lower than normal tidal volume. If SPO2 levels drop too much (normal nightly average is around 95 or so) (and no substantial drops below 90), then it may need to be addressed.
RE: New with CPAP Request Assist with OSCAR Charts - YankeeLaker - 01-27-2024
My original sleep study last June showed no obstructive apnea, but 30/hour hypopnea. Started CPAP in late June, with starting pressures at 4 (auto up to 20 if needed).
After I tried and failed at getting a continuous nighttime oxygen monitor through my insurance, I decided to spring for it myself. The SP02 data showed nighttime averages 89-91, with routine drops into the low 80s, and about weekly into the 70s. After review with my pulmonologist, he ordered another in-lab sleep study with CPAP in December, to see if I needed increased pressure vs supplemental oxygen, or both.
I'm not always sure I am understanding what he is telling me, but my understanding is that what I needed was supplemental O2 at 2 liters/minute, and not a change in pressure. I think he thinks my low tidal volume is the main issue, but I am not sure of that. So, I recently received an O2 concentrator and have started using it at 2 liters/minute throughout the night. The attached Oscar Data is from last night.
SPO2 bottomed out at 89, but was really pretty good during the night. Cluster of desaturations the last hour of the night. Maybe I was on my back. I don't really know. (I always start the night on my left side due to reflux.) Lots of "heart rate events," but I have no idea if they should be of any concern. I really have no feel for how to interpret the OSCAR data, so any insights would be welcomed! Thank you in advance!
[attachment=58957]
[attachment=58958]
RE: New with CPAP Request Assist with OSCAR Charts - Jay51 - 01-28-2024
This is just my opinion. I am not a Dr. I have a Pulmonologist also. It looks like the move to supplemental oxygen during sleep was a good move. Spo2 is much improved (which means less hypoxia). Respiration (from OSCAR) and spo2 look pretty good. Tidal volume is a bit low, but is probably acceptable given the good chart.
In regards to the large number of heart rate events: I am not sure. The best move may be to show all the heart rate events from this chart to your PCP, Pulmonologist, and best of all, Cardiologist (if you already have one). Heart? It seems like if your respiration is pretty solid, and Spo2 now solid, then why the heart rate events? Maybe it might take some time for your heart to adjust to this new and improved set up?
RE: New with CPAP Request Assist with OSCAR Charts - YankeeLaker - 01-28-2024
Jay51: Thank you! It’s interesting about the cardiac events. About a year ago, I had worn a cardiac “event monitor” for three weeks, looking for a-fib. I didn’t have a-fib, but the cardiologist said I had MANY episodes of nocturnal tachycardia that were likely related to recurring apnea/hypoxia, and referred me to the pulmonologist for my initial sleep study. With the use of my CPAP and nocturnal oxygen, the hypoxia seems to be under control. But I might still have something going on with my heart rhythm. (Though, it isn’t a tachycardia at this point.)
I will definitely follow up with cardio. However, the excess number of events might just be the parameters OSCAR uses to flag heart rate events. I am using the default settings under the “Oximetry” tab in OSCAR. I think they are set to flag any heart rate change of 5 beats per minute (up or down) over any 8-second interval. No idea if that is how that should be set….
RE: New with CPAP Request Assist with OSCAR Charts - UnicornRider - 01-28-2024
Thank you for the well written descriptor of your situation, today I read your thread for the first time. I have family I am going to share this with, as they have similar conditions. Those of us in the family that were fortunate enough to get *PAP therapy before finding out about the O2 drops we were experiencing, were somewhat protected by PAP therapy.
Where you have no Apnea or flow limiting events to record, you would expect a 0.00 AHI about every night. I have only recently been able to achieve 0.00 AHI after more than 10 years of therapy. Those 0.00 AHI nights sparked my interest in the numerous Pulse change events I saw recorded on my charts. After zooming in for a 2 to 3 minute view, almost every pulse change event event could be associated with an abnormal Flow Rate.
Once again Thanks for the well written thread, I will be following this one.
