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+--- Thread: Newbie and using OSCAR - SUPER LOST and looking for advice (/Thread-Newbie-and-using-OSCAR-SUPER-LOST-and-looking-for-advice)
Newbie and using OSCAR - SUPER LOST and looking for advice - DaveHirschler - 03-17-2023
Hello all, sorry in advance for the length of this! I am not quite a month into this journey. I started down a YouTube rabbit hole as my medical device company/therapist basically took my money and sent me out the door and have given me the runaround regarding some simple questions/requests.
IN THE MEANTIME - I have purchased a SD card (NOT a Resmed, though they say you can only use one of their cards. Shame on them!) and have downloaded OSCAR and have one week of generic data prior to the SD card and two and a half weeks of data from the card - all loaded into OSCAR.
I honestly am not sure what I'm looking at when I look at my graphs. It doesn't look good. I see lots of people post about needing help with their AHI in the 1-2 range, which concerns me a bit because I've been between low 4's and high 9's and in general have been in the 5-6 range.
I saw a video titled with something about 4-20 and almost skipped it because I thought it was suggesting an "herbal therapy" to treat apnea, which seemed counter-intuitive!
I discovered that those are the pressure presets and saw that you should check your pressure report and adjust the pressure accordingly. When I went into the clinical settings on my machine, I saw that my therapist had left all the factory settings, including 4-20 and not even entering that I am using a full face mask vs the factory default of pillows. My prescription was for 15 or 16 pressure.
Based on my studies, I had seen in multiple places a consensus that ramp and one other setting were no-good, so I turned those off. I also changed my max pressure to 17 as I noticed that when it was 4-20 it got as high as 18 but kept in mind my Dr. prescribed something in the 15 or 16 range. Obviously 4 was my low, but I was consistently at 9-10 in the medium range, so set my low to 8 and then bumped it to 12 and think I might have gone too far.
Initially I was having a lot of leaks - I think I have that under control now, even with the increased pressure, with the exception of last night when I bumped up that bottom pressure.
I appear to be having a fair number of Clear Airway and Hypopnea events, and also a fair amount of Obstructive Apneas, too. I'm wondering if anyone has suggestions on how I can drive these events and my AHI score down.
If someone who knows what all these graphs mean, I would GREATLY appreciate some input and ideas on how to improve my therapy. Thanks in advance!
RE: Newbie and using OSCAR - SUPER LOST and looking for advice - Gideon - 03-17-2023
4-20 is never right when it is used for more than 1 night.
Your machine is not designed to treat Central apnea. In general the settings that best treat obstructive apnea are the same ones that tend to make central apnea worse so it becomes a balancing act between obstructive and Central events.
So Higher Pressures, non-static pressures and EPR all tend to cause or increase centrals in susceptible individuals.
Did you have Centrals on your diagnostic tests? How many, looking for the CAI not the actual count. I'm suspecting little to none.
I'd like to start you anew.
Min press=8
Max press=20 (your 17 is ok)
EPR=2, Fulltime, likely this is one of the things mentioned to turn off. Do note that EPR does wonders on managing hypopneas, flow limits and RERAs.
I want to see if the application of EPR will stabilize your pressure and keep it lower before trying to work you into a single pressure therapy. 8 stays off the floor and allows full utilization of EPR. We should also see if EPR significantly increases your CAI.
RE: Newbie and using OSCAR - SUPER LOST and looking for advice - DaveHirschler - 03-17-2023
Gideon, thank you so much for your response/advice. You were correct about the EPR. I reactivated it, it’s set to full time and 2. I’ve got pressures adjusted to 8-17.
I’m interested to see how this works out.
I will grab my study and see if I can get the information you asked regarding Centrals and post back here.
I’ve got one more question that seems to be elusive: I am a mouth breather as I am perpetually stuffy-nosed, which is why I’m using the Amara View. Is this detrimental to my therapy?
I’ve yet to find a helpful explanation or definitive recommendation for someone in my situation. All I’m seeing is general recommendations saying not to mouth breathe and suggestions for chin straps or mouth tape but nothing addressing what to do when your nose is perpetually stuffed.
RE: Newbie and using OSCAR - SUPER LOST and looking for advice - DaveHirschler - 03-18-2023
Gideon - I checked my report only mention of centrals was in the results. Where it was listed in the index area was blank, along with UAI, OAI, and MAI also left blank.
My AHI from the study was 64.5
The analysis picked up 555 apneas, 299 obstructive and 256 central.
This was a home study using a ring device. So nothing pushing air. Only pulse, blood oxygen and whatever else a ring measures.
RE: Newbie and using OSCAR - SUPER LOST and looking for advice - fishfinderG - 03-18-2023
My ENT doc prescribed fluticasone 2x a day which helps a lot with my nasal congestion. I also take zyrtec daily even in winter.
I also find that it helps me to have a high tube temp (80-84) and manually adjust humidity as high as I can without causing rainout.
An air purifier can also help if you are dealing with an environmental allergy.
I’d recommend seeing an ENT if you want to understand if you have any structural issues with your nose that might be fixable. I have a deviated septum but decided not to get surgery since I can breath OK with fluticasone and humidity.
RE: Newbie and using OSCAR - SUPER LOST and looking for advice - DaveHirschler - 03-18-2023
Thanks fishfinderG! I’ll check with my doctor to see what he thinks and if that doesn’t have any interactions with my other meds
RE: Newbie and using OSCAR - SUPER LOST and looking for advice - DaveHirschler - 03-18-2023
Gideon - just thought I'd let you know that I made the settings you suggested and had a MUCH BETTER night last night!
Posting the results here.
Thank you so much!
RE: Newbie and using OSCAR - SUPER LOST and looking for advice - Gideon - 03-18-2023
Great!
Your numbers are mostly great but your flow limits are high.
I'd like to bring those down and maybe eliminate your RERA BUT mostly I'm looking for your comfort.
Also you numbers on your home sleep test showed Severe Central Sleep Apnea and Sever Obstructive Sleep Apnea, borderline severe on both. I'm not currently seeing signs of the Central issue so do keep an eye on that.
One change
Set EPR = 3. Subjectively which is better, EPR=2 or 3
RE: Newbie and using OSCAR - SUPER LOST and looking for advice - DaveHirschler - 03-19-2023
Gideon - I didn't get a chance to make the adjustment you suggested last night. I've got it dialed in for tonight.
Last night wasn't as good as the previous night. I had a couple of series of episodes in close succession and took some screen shots. I'm not sure what's going on or if you have any suggestions.
I magnified each of the two series and also have a shot zoomed further out where you can see how far apart they were from one another. I left a snippet of the last part of the first episode in the shot I took of the second episode so that you could see how far apart they were.
I don't know what I'm looking at, but I'm pretty sure it's not good!
RE: Newbie and using OSCAR - SUPER LOST and looking for advice - Gideon - 03-19-2023
IMHO most were driven by arousals and not centrals. A few were.
Forget about it and we will see about tonight.