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+--- Thread: High CSR, plz review my OSCAR data, thank you! (/Thread-High-CSR-plz-review-my-OSCAR-data-thank-you)
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High CSR, plz review my OSCAR data, thank you! - MfG2023 - 07-30-2023
First and foremost, I want to express my sincere thanks to the Apnea Board Forum for providing such valuable information and knowledge on the treatment of sleep apnea! Thanks to the Apnea Board, I have finally succeeded in using Oscar to read my sleep results.
Three years ago, i began using ResMed Airsense 10 and FFM Airtouch F20 for my sleep apnea treatment. However, over the past three months, I have encountered higher AHI readings from time to time, as well as frequent large leaks. In order to address this issue, I recently switched from a small cushion size to a medium one, which has seemed to be effective in providing a better seal. I have experienced two consecutive nights of pretty good seal quality.
However, I am still concerned about the CSR (Cheyne Stokes Respiration) as you can see which represents 27.55% of the hours. Upon reviewing my data history, I noticed the CSR started appearing in March of this year and was not present at all before that time.
I have attached two screenshots: one showing last night's daily results and the other specifically displaying a period of CSR. I would greatly appreciate it if someone could take a look at my results and let me know if the CSR is a cause for concern or if my sleep treatment is not as effective as it supposed to be. Thank you in advance for your help!
RE: High CSR, plz review my OSCAR data, thank you! - MfG2023 - 07-30-2023
Anyone could help me with my data? Thank you!
RE: High CSR, plz review my OSCAR data, thank you! - Millstone50 - 07-30-2023
Only from what I can see, a couple things are apparent... the cap at 14cm is being hit repeatedly, as the machine is reacting to what it thinks are OAs that could really be CAs in CSR. (edit: looking again, the ebbs/flows in CSR are usually pretty uniform but yours are fairly erratic. It is possible that you really do have OAs and the pressure needs to be increased.)
I also notice your EPR is turned off; was this in an effort to try and limit CSR or?
The flow limits are also making the machine want to deliver higher pressure, but the EPR being off may be contributing to the flow limits. You could try opening up the max pressure to see what happens, with EPR on. My guess is it will not help the CSR (edit: if it actually is CSR) but may help the flow limits.
If you cannot get results with this, it is likely you need to get checked by a cardiologist and/or get an ASV.
RE: High CSR, plz review my OSCAR data, thank you! - MfG2023 - 07-30-2023
Thank you Millstone 50 for your advice! They are very helpful and valuable. i really appreciate that! Could you let me know what is EPR for? Shall I set it at auto? I did not have CSR before but suddenly from March, the CSR is recurring. I checked the forum, people who are asking about CSR, only experience 5% of the sleeping hours, compared to over 20% of mine. I think you are right on the pressures. The machine is trying to climb to higher pressures than 14. I did an echocardiogram a month ago which shows generally healthy heart condition. But it would be better for me to visit the cardiologist and show him the CSR. Thank you again!
RE: High CSR, plz review my OSCAR data, thank you! - FromOZ - 07-31-2023
Hi — from the ResMed site
Quote:What is expiratory pressure relief (EPR™)?
EPR™ gently lowers the pressure delivered to you as you exhale – making it easier to breathe out against the air pressure. When EPR is enabled, the delivered pressure will not drop below 4 cm H2O.
It is generally considered best to set EPR to full-time, either at 2 or 3 (I'm currently trying 2). Using EPR can help with RERA and other events. There are a number of posts I've seen which discuss EPR that go into details.
But obviously your CSR number is something you will want to investigate, especially if it started without any change to your equipment.
RE: High CSR, plz review my OSCAR data, thank you! - OpalRose - 07-31-2023
(07-30-2023, 11:56 PM)MfG2023 Wrote: I did an echocardiogram a month ago which shows generally healthy heart condition. But it would be better for me to visit the cardiologist and show him the CSR.
Although, I don't think you are experiencing CSR, it's not a bad idea to be rechecked by your Cardiologist.
CSR pattern is similar, but we normally see Clear Airway after the waxing and waning pattern. Read this excerpt from The Guide:
https://www.apneaboard.com/wiki/index.php/OSCAR_-_The_Guide#Issue_-_Periodic_Breathing_.28CSR.2C_PB.29
Also note, that ResMed labels what is PB (Periodic Breathing) as CSR, which is quite often incorrect. But, it may be best to be rechecked for piece of mind.
Now what I do see on your graph are "Clusters of Obstructives". Assuming that this is all it is, you are experiencing what we call Positional Apnea.
You may have been sleeping in a way that cuts off your air supply. This can happen on your side or back. Do you use more than one pillow? Downsize to just one pillow, somewhat thinner, but still supportive. This will prevent "chin tucking", whereas a tall fluffy pillow may cause your head to tilt forward into your chest and simply cut off your air.
Please note: When you see "positional apnea", raising your max pressure is not the answer.
No amount of pressure will clear through that.
Try a different sleeping position first... maybe on your side or use a thinner pillow.
If that doesn't help, you may have to try a Soft Cervical Collar to help keep your chin up and head and neck aligned properly.
I do agree that you would benefit from using EPR. You can try that now and set it to 2. Although, you may or may not see a benefit until you solve the "Positional Apnea" issue first.
RE: High CSR, plz review my OSCAR data, thank you! - MfG2023 - 07-31-2023
Thank you, FromOZ! Thank you for explaining ERP and the advice! I will ask my doctor about EPR and adjust that.
RE: High CSR, plz review my OSCAR data, thank you! - staceyburke - 08-01-2023
You are having a lot of positional apnea. Positional apnea can NOT be controlled by pressure changes. You have to find out what position you are getting into and cutting off your own airway. Have you changed your sleep position? Sleeping on your back? Using more (or new) pillows? These things can cause positional apnea by chin dropping to your sternum and cutting your airway. Think of it of a kinked hose – nothing can get through – you have to unkink the hose…
IF you can’t make a simple change like changing to a flatter pillow helps then you will need a collar. I have a link to collars in my signature at the bottom of the page. It shows people who are not wearing a collar and the SAME person wearing a collar. There is a huge difference between the two.
RE: High CSR, plz review my OSCAR data, thank you! - MfG2023 - 08-01-2023
Thank you, OpalRose for taking the time to share your knowledge and information! I greatly appreciate it!
The link to CSR explanation is very helpful. Please see the attached screenshot of enlarging flow rate marked as CSR with CA, OA and UA there. As you mentioned, it does not appear to be a regular CSR. I will follow your advice and check with my cardiologist tomorrow.
Regarding pillows, I recently switched to a fluffy one, thinking it would be better, but it's not very thick or high. I mostly sleep on the back. Could you please suggest the type of pillow you recommend? Are there any particular types of pillows that are beneficial for sleep apnea patients? Soft Cervical Collar is a good idea. I will follow your advice, turn on the EPR and to see the result.
Thank you so much again!
RE: High CSR, plz review my OSCAR data, thank you! - MfG2023 - 08-01-2023
Thank you, Staceyburke for your insights and knowledge! i just read the introduction on Soft cervical collar in your signature part which is very detailed and helpful. I changed several pillows and just switched to one which is not flat. I had initially believed that higher pillows would do better but now I understand that I probably have misunderstood the right approach. I will definitely find a flat one and if you happen to know any particular type of flat pillow that works best, please let me know. I usually sleep on my back, and prior to March, I hadn't experienced any positional apnea. Since March, it seems to have become an issue. Probably it is better for me to set up a video recorder to observe my sleeping positions when positional apnea occurs. Once again thank you very much!