First OSCAR Post here - mild OSA/UARS-type SDB. First night with Bi-Level.

[bruins2006]

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Hi all. This is my first post here, although I am not new to CPAP. That being said, last night was my first with Bi-Level.

Long story short, I was diagnosed with SDB and was given a MAD. I had an in-lab PSG, which showed an RDI of 30 WITH the MAD. Flow limitation and paradoxical breathing. Clearly the MAD was not doing what it needs to do. I then tried CPAP, but it did not help at all. I finally acquired a Bi-level (ResMed AirCurve 10 S). OSCAR for some reason still thinks I'm using the AirSense so a few of the stats are wrong so I'll show them here.

Min EPAP: 5
Max IPAP: 10
S Mode so PS=5
TiMin: 0.6s
TiMax: 2.3s
EasyBreathe: On
Trigger: Very High
Cycle: Medium

From my charts, it still seems like there is a lot of flow limitation despite the PS of 5. What do you think I should do? Thank you!

[Nocibur]

From my charts, it still seems like there is a lot of flow limitation...

Where?

[ozij]

Try to create a new profile for the new machine. That will make OSCAR identify the machine and report its correct settings.

[bruins2006]

Nocibur - thanks for taking a look. I was under the impression that the spikes in flow rate are flow limitation. Could definitely be wrong so please correct me.

Ozij- probably will have to do that…thanks.

[Pugsy]

I don't know if creating a new profile will fix the confusion problem with OSCAR and it not knowing which machine to report on. Worth trying though and easy to do. If that doesn't work you may have to remove some files from the SD card that go with the first machine. If that doesn't fix the problem report back and we can figure out something. I had this problem myself when I used the AutoSet 11 AutoSet and then went back to my AirCurve 10 VAuto machine in auto mode.

I was under the impression that the spikes in flow rate are flow limitation. Could definitely be wrong

Flow rate graph isn't the same as flow limitation graph. Flow rate is your breathing and probably the spikes are just big breaths or gulps of air and most likely just means you weren't sound asleep.
Can't tell for sure because you didn't share any zoomed in Flow Rate graphs to look for big breaths because you shared graphs that aren't particularly useful and omitted useful graphs.

There's a problem with the machine in S mode (or cpap mode) in that I don't think it records flow limitations so I don't think you can get a flow limitation graph. So if you don't see a named Flow Limitation graph it's because your machine in fixed S mode simply doesn't record flow limitations. You have no way to know if you had any FLs or not.

Here's a report from my VAuto machine in auto mode and you can see the FL graph (which is not very exciting).
If you can't get a FL graph then it's because your machine can't give it since it can't respond to any FLs it simply doesn't report them. FLs are something the machine will increase the pressure to try to kill when it is in auto adjusting mode.
Your AirCurve 10 S machine may not record FLs because S mode can't auto adjust. You would have been better off to get the AirCurve 10 VAuto (like I have) to get FL graphs and use auto adjusting pressure mode.
I haven't checked to confirm that S mode doesn't record FLs but I will shortly and report back.

[bruins2006]

Pugsy - understood.

I'm taking a look at the Oscar organization page that you generously put together. Seems like flow rate, pressure, leak rate, flow limit and snore are the graphs shown in your example page. That is noted for the future, although I guess I won't be able to do FL or snore so I just included tidal volume below instead. Unfortunately, I only have the 10S and it doesn't have Vauto mode. The seller said it was a Vauto and either lied/or was clueless. That's what I get for using Craigslist, I guess! I have heard that the non-reporting of FL is one of the main foibles with the 10S just from doing some digging, but appreciate you checking in there and confirming.

I also created a new profile and it unfortunately didn't do the trick. I'll probably have to do some troubleshooting there and will report back if it gets to the point where I can't figure it out.

I can provide a few close-ups of the flow rate - hope those screenshots are satisfactory. One period showing those spikes and one period later in the night with lesser spikes, although some weird "W" shaped breathing. Thanks for helping out.

And btw, your data seems to look pretty darn good! You must be pleased.

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[Pugsy]

Tidal volume is useless at this point. No sense in wasting graph space.
Tidal volume has way to many variables that are normal to put much emphasis on tidal volume results as meaning much at all.

You are either going to have to get and use a brand new SD card (or at least blank) or erase the other old SD card to get things cleared up and have OSCAR report correctly.

I am fairly certain that the zoomed in flow rate examples with big breaths just means you weren't sound asleep.

Here is an example that is easy to see. Asleep breathing is nice and rhythmic and boring with zero big gulps.
We don't take big gulps of air if we are asleep.
Awake breathing is very irregular when compared to asleep breathing but the machine only measures breathing or air flow......it has zero way to know if you are asleep or not. So it is possible for the machine to flag awake breathing irregularities as some sort of apnea event. Doesn't matter though....if you aren't asleep it doesn't count.

I circled the asleep breathing in red.



And here is a more zoomed out snap shot of the same time frame. All that irregularity AFTER the red circle ends is awake or semi awake breathing. Means nothing except the fact that I wasn't sound asleep for some reason or other.

[Pugsy]

FWIW when I had this problem with OSCAR and the 2 machines I just erased the SD card and start over but then I already had the data loaded in OSCAR so erasing the SD card wasn't a big deal.

[bruins2006]

Thanks Pugsy. You will never see a tidal volume graph from me again .

The asleep vs awake breathing theory makes total sense. I do actually gulp for breaths during the day (nasal breathing is terrible and we are working on that - possibly expansion). That being said, it looks to happen for half of the night, if not more, every single night I use PAP. I'll attach a SS from a few months back and you'll see what I mean. I'm wondering if that means I'm just not used to CPAP and it's keeping me in a "light sleep" that looks more like I'm awake with the big gulps or if there is something else going on. That could explain why I feel worse with PAP? Definitely doesn't feel like I am awake the whole night, but definitely not as deep of a sleep.

As it relates to the Oscar issue, I think I'll probably just erase the SD card. As you say, data is safe so shouldn't matter too much and hopefully that does the trick.

SS below.

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[Pugsy]

So...I tried S mode but I need to wait until after 12 Noon so the machine will start a new reporting day to see if I get flow limitation graph or not. What I got was the entire night's report and FL graph but no FLs showing up during the brief trial but it was still reporting last night's data which did have some FLs show up in auto mode. I won't know for sure until I try S mode with no other data clouding the results if there is zero FL graph with S mode. Will do that later this afternoon.

Odd though.....I see your old report (where it says cpap mode) but it's not cpap mode because I see your pressure lines moving and in cpap mode your pressures won't/can't change.
So I see the FL graph but I see pressures vary as well and that doesn't compute because in cpap mode the pressures won't vary.

So.....OSCAR is having trouble and that may affect accuracy of any of the data since I know for a fact that what I see isn't cpap mode because of the pressure changing.

Before we get too excited about what is reported lets fix the OSCAR confusion problem first and then evaluate that data once it is free of potential complications.

As far as the evidence of potential awake breathing goes......might be a sleep quality problem and not so much a control of apnea problem.

Do you take any medications of any kind? If so, what?
Any other physical or mental health issues going on?

[Nocibur]

There's a problem with the machine in S mode (or cpap mode) in that I don't think it records flow limitations so I don't think you can get a flow limitation graph. So if you don't see a named Flow Limitation graph it's because your machine in fixed S mode simply doesn't record flow limitations.

Well, it's been awhile, but I don't believe ANY bilevel machine records FLs because the inspiratory waveform contour is decided by the machine.

I could also see where fixed CPAP wouldn't report FLs cause nothing would be done about them.

And frankly, if that's the case, seems to me 10S isn't really a lotta help, especially if you want to DW.

[Nocibur]

Well, it's been awhile, but I don't believe ANY bilevel machine records FLs because the inspiratory waveform contour is decided by the machine.

That said, there's plenty of modes where certain aspects are augmented/enhanced/taken over completely...

Say, what is it you're trying to do, anyway?

[Nocibur]

Cause seems to me if you had

an RDI of 30 WITH the MAD. Flow limitation and paradoxical breathing.

You probably want a machine that monitors and treats

Flow limitation and paradoxical breathing.

That said, you can certainly review Oscar breath-by-breath and make your assessment and decide treatment options, but that's pretty labor-intensive.

[Nocibur]

-sws used to say

that said

a lot.

I thought it sounded cool.

So if it looks like too much blame him.

[Pugsy]

Do you still have the old machine that you first tried?