Help Interpreting OSCAR Data!

Hi everyone,

Brand new CPAP user here! I was diagnosed with mild OSA with an AHI score of 10. I did a CPAP trial with an AirSense 10 AutoSet, ClimateLine tubing and P10 nasal pillows, EPR at 3 and ramp on.

Attached are some of the "good" nights I had with my CPAP trial - the Dec 31 data being the best (I slept a full 7 hours with the CPAP mask on). Any observations/advice would be appreciated!

Some of the primary issues I've had with the trial are:

1. Troubles falling asleep - obviously it takes some adjusting to sleeping with the CPAP on. I found it hard to focus on keeping my mouth closed (as I'm used to having it somewhat open during sleep). The concentration required to keep my mouth closed made it a bit harder to sleep. I was able to somewhat get around this issue by using sleep aids such as trazodone/zopiclone (this would just be short-term of course, until I'm acclimatized to the CPAP).

2. Waking up with a feeling of being unable to breath - during many of the nights, I'd wake up and almost subconsciously rip the mask off due to a feeling of being unable to breath through my nose. I'm not sure what the exact cause of this is. My RT who was following me suggested it may have been that I opened my mouth and thus there was a small air leak and not enough air making it into my lungs. Any ideas about this problem would be much appreciated too.

Thanks so much for your help!

Franko

EDIT: images didn't attach, here they are instead:

https://ibb.co/9GQZqb9
https://ibb.co/HVHCZP4
https://ibb.co/zSvKhQ5
https://ibb.co/1MbgmR3

Franko39 wrote: ↑

Wed Jan 03, 2024 1:09 pm

Waking up with a feeling of being unable to breath - during many of the nights, I'd wake up and almost subconsciously rip the mask off due to a feeling of being unable to breath through my nose.

A minimum pressure setting of 5.0 is very low. Many of us, myself included, get a feeling of suffocation below 7.0 minimum.

Franko39 wrote: ↑

Wed Jan 03, 2024 1:09 pm

Hi everyone,
I found it hard to focus on keeping my mouth closed (as I'm used to having it somewhat open during sleep). The concentration required to keep my mouth closed made it a bit harder to sleep. I was able to somewhat get around this issue by using sleep aids such as trazodone/zopiclone (this would just be short-term of course, until I'm acclimatized to the CPAP).

You don't say which image, if any, is with the medication.
And the nights you posted don't have the same settings.
Sleep medicines will not keep you from opening your mouth and "mouth leaking".

Consider using a Full Face Mask. FFM's don't really cover you face, they only make sure the pressurized air doesn't escape through your mouth.

https://www.cpap.com/search?query=full

2. Waking up with a feeling of being unable to breath - during many of the nights, I'd wake up and almost subconsciously rip the mask off due to a feeling of being unable to breath through my nose. I'm not sure what the exact cause of this is. My RT who was following me suggested it may have been that I opened my mouth and thus there was a small air leak and not enough air making it into my lungs. Any ideas about this problem would be much appreciated too.

A small air leak can be handled by the machine - your leaks are not above the machine's ability to handle.
When you write "unable to breathe" do you mean can't inhale or can't exhale.

An EPR=3 doesn't even kick in before your pressure gets up to 7. And then it suddenly gives you an exhale pressure of 4. You're chugging along at pressures lower than that for more than half the time. That means that only when you need the higher pressure, you exhalation pressure drops by 3 and it's possible the return to inhale pressure is too slow for you. I would not touch the minimum pressure at this point, since you're doing reasonably well on it. I would start lowering the EPR - maybe you don't need it at all.

ozij wrote: ↑

Wed Jan 03, 2024 11:03 pm

You don't say which image, if any, is with the medication.

The first linked image (Dec 31) is the night that I took the medication.

ozij wrote: ↑

Wed Jan 03, 2024 5:28 pm

When you write "unable to breathe" do you mean can't inhale or can't exhale.

Probably that I couldn't inhale. It's hard to say for sure, because the feeling of breathlessness is what would wake me up, and then once awake, I'd more forcefully take a breath to overcome that feeling. So, I'm not 100% sure what I was experiencing in the moments before I woke.

ozij wrote: ↑

Wed Jan 03, 2024 5:28 pm

An EPR=3 doesn't even kick in before your pressure gets up to 7. And then it suddenly gives you an exhale pressure of 4. You're chugging along at pressures lower than that for more than half the time. That means that only when you need the higher pressure, you exhalation pressure drops by 3 and it's possible the return to inhale pressure is too slow for you. I would not touch the minimum pressure at this point, since you're doing reasonably well on it. I would start lowering the EPR - maybe you don't need it at all.

Thanks for the advice - I'll try lowering the EPR. When you say that the EPR = 3 doesn't kick in at all before the pressure hits 7, is this because the absolute minimum pressure on the machine is 4? (ie: the EPR is not doing anything at pressures 4-6, but once I hit 7, the EPR lowers it to 4 on exhale?)

ozij wrote: ↑

Wed Jan 03, 2024 5:28 pm

An EPR=3 doesn't even kick in before your pressure gets up to 7. And then it suddenly gives you an exhale pressure of 4. You're chugging along at pressures lower than that for more than half the time. That means that only when you need the higher pressure, you exhalation pressure drops by 3 and it's possible the return to inhale pressure is too slow for you. I would not touch the minimum pressure at this point, since you're doing reasonably well on it. I would start lowering the EPR - maybe you don't need it at all.

Thanks for the advice - I'll try lowering the EPR. When you say that the EPR = 3 doesn't kick in at all before the pressure hits 7, is this because the absolute minimum pressure on the machine is 4? (ie: the EPR is not doing anything at pressures 4-6, but once I hit 7, the EPR lowers it to 4 on exhale?)

Yes, that's exactly what I'm saying.

Thanks for the advice again. I've tried a couple more nights now with some updated settings (6-12 pressure range and EPR = 2). Used the nasal pillows and a sleep medication both nights (will stop the sleep med once I'm more acclimatized to the CPAP).

https://ibb.co/VDKT0Xq
https://ibb.co/rfHRMPh

The feeling of breathlessness has gone away - thanks for the suggestions!

I seem to have fairly significant leaks now - are these leaks still "ok" and manageable by the machine, or should I consider a chin strip or face mask option? I think the leaks are from my mouth opening while asleep and/or shifting around while asleep, which loosens the seal around the nasal pillow.

TIA!

Franko

While not a real pretty leak line the bulk of the leaks are well within the machine's ability to compensate for.
As long as those leaks didn't wake you up....I wouldn't worry about them. Any time above the large leak threshold is minimal and you didn't really go all that deep into large leak territory (red line in the sand is 24 L/min).
That red line (conservative line IMHO) ....the further you go the worse it is and unless you start seeing much time above 30 L/min I wouldn't be doing anything myself. Sometimes measures meant to tame leaks makes sleep itself more difficult and getting good sleep is your primary goal.

Quick update - I tried the suggestions you both made and the breathlessness has improved significantly. I'm slowly adapting to the CPAP in general. Here are a couple recent nights of OSCAR data:

https://ibb.co/q1zdqjF
https://ibb.co/JB64jQ9

The leaks are likely due to a combination of my mouth falling open while asleep and/or the nasal pillows coming loose due to my tossing and turning while asleep.

Any more comments or insights would be much appreciated!

Look at those "ski jumps" in your flow, at the way flow limitations appear and push the pressure up once the machine lets you go down to your minimum.
To me that indicates the minimum is not a good place for you to be, so if it were me, I'd keep the machine from going there. i.e. I'd raise the minimum or try an EPR of 1, and then none.
For most of us, when our breathing interruption are properly treated we stop being a "restless sleeper".

With a minimum of 6 and and EPR of 2 you're still going down to 4 during exhalation.

ozij wrote: ↑

Thu Jan 18, 2024 9:57 pm

Look at those "ski jumps" in your flow, at the way flow limitations appear and push the pressure up once the machine lets you go down to your minimum.

Thanks for the suggestion. Would you mind expanding on the above explanation of what is happening? The terminology is all new to me and I don't quite follow. It sounds like you're saying that when the EPR kicks in and drops my pressure to 4, it creates a flow limitation, and so the machine jacks up the pressure to compensate for that, on the next inhale. Is that right?

Much appreciated.

Franko39 wrote: ↑

Fri Jan 19, 2024 12:52 am

ozij wrote: ↑

Thu Jan 18, 2024 9:57 pm

Look at those "ski jumps" in your flow, at the way flow limitations appear and push the pressure up once the machine lets you go down to your minimum.

Thanks for the suggestion. Would you mind expanding on the above explanation of what is happening? The terminology is all new to me and I don't quite follow. It sounds like you're saying that when the EPR kicks in and drops my pressure to 4, it creates a flow limitation, and so the machine jacks up the pressure to compensate for that, on the next inhale. Is that right?

Much appreciated.

Almost.
By giving the machine a minimum pressure (regardless of EPR) you're basically giving it permission to go as low as that minimum. So your breathing stabilizes at a higher pressure, your machines says " Oh great, I can drop the pressure" the pressure drops, and once it's at the minimum, you rarely stay there. This APAP algorithm never learns "not to go there" again, so this up and down and up cycle keeps happening.
Correct me if I'm wrong, but it seems to me your charts consistently show your median pressure to be in the vicinity of 6.8. That means 6.8 is the pressure at which, or above which you're spending half your night.
Now we add EPR to the mix.
I don't know for sure if it's the EPR=2 or the Min=6 that's causing the flow limitations.
You'll have to try - and I don't know which you should try first:
Setting your minimum at 6.8 or 7, and leaving the EPR as it is
or
Stopping the EPR (gradually or totally) without changing the pressure.
Give each option a few days, and look at it effect on the flow limitations and on how you're sleeping.
You may eventually decide to do both.
Whatever you choose, keep us posted.

Hi all,

It's been a while, but I thought I'd post a quick update and ask for further opinions and advice. I spent a bit of time struggling with getting the right settings to let me fall asleep with the CPAP and not wake up at night with feelings of breathlessness, etc.

I believe I've found the right mix of settings now (turns out I do prefer EPR and ramp, after all - keeping these settings on helped me fall and stay asleep). I've posted the last few nights of OSCAR results at my (hopefully) stable CPAP settings. I've felt a bit more energy most mornings, on the nights where I was able to keep the CPAP on all night. Although, the difference in energy isn't so pronounced that I could confirm for sure whether it was a placebo feeling or not.

Any insights into the results would be appreciated. I'm continuing to get some central apneas, which is a bit of a concern to me still.

TIA!

Franko