Degrading Scores :( Trying to learn how to read OSCAR data

[aurora]

Hello everyone.
Newbie here (and newbie to CPAP/APAP use also)
I started using my CPAP at the beginning of September, and have noticed my numbers trending in the wrong direction in the last month or so. I contacted the DME that I got my CPAP from and the sleep tech suggested I play around with the humidity controls, but I'm not finding anything obvious to try to get the numbers back down - I live in the desert southwest and we're finally getting cooler nights - my machine is set to auto control everything including hose temp and humidity.

Attached are the overview chart from OSCAR to see the increase in AHI (doesn't seem to correlate to leaks)

Oscar Overview.jpg (952 KiB) Viewed 1356 times

And a recent night chart - I'm not sure if I am waking up and am not awake enough to know and that's resulting in some false counts (possible - it's not abnormal for me to wake up around 4 or 5am because my cat comes looking for attention) but that doesn't explain it all.

screenshot-20191122-184601.png (67.94 KiB) Viewed 1356 times

Any insight you might be able to share would be greatly appreciated.
Thanks in advance for your comments.

[Pugsy]

Welcome to the forum.

Can you please post a detailed report from one of the early days with much lower AHI?
I would like to compare that report to this one.

Has anything changed in terms of medication or sleeping position? Are you on your side more or back more?
Do you know if your OSA is worse in REM stage sleep?

[Thumper68]

1. Show Pugsy the requested charts. You are in good hands. People here care about your therapy and are smarter than the "sleep tech".
2. The sleep tech at your DME doesn't care about your therapy. Humidly settings will not affect your AHI. Apparently you are not important enough for them to care about, because that answer was just blowing you off.

[palerider]

Based on what you posted, put the machine in Autoset mode, max pressure 20. Min 8 (probably 10...)

[aurora]

Has anything changed in terms of medication or sleeping position? Are you on your side more or back more?
Do you know if your OSA is worse in REM stage sleep?

I started in September with the N20 mask but it kept waking me up by leaking into my eyeball - and I would find myself sleeping lightly flat on my back (additionally I probably wasn't sleeping as I normally do because I was traveling). In late September (I think) I switched to the N30i mask - I've had some additional travel in October and early November, but I don't see a significant difference between nights sleeping in my own bed vs in a hotel though I'd have to cross reference my travel dates again to be absolutely certain.

I tend to fall asleep on my back or side, and historically have been a fairly restless sleeper...I probably toss and turn more now that I have a mask that connects on the top of my head vs over my nose. No new medications in the time since I started CPAP therapy.

I don't think my OSA is worse during REM stage sleep.
For example, here are my sleep modes for the date of the daily charts attached before.

Capture.JPG (24.97 KiB) Viewed 1332 times

Here are some more recent dates when my AHI scores were better, wearing the N30i mask with associated sleep stage

AHI5dot6.jpg (972.95 KiB) Viewed 1332 times

Capture1.JPG (23.26 KiB) Viewed 1332 times

[aurora]

and one more sample from a lower AHI night

screenshot-20191122-221621.png (68.59 KiB) Viewed 1332 times

Capture2.JPG (23.85 KiB) Viewed 1332 times

[Jas_williams]

You need more pressure move the max pressure to 20, and run in Autoset mode rather than Autoset for her mode. The clusters of obstructive apnoea indicate china’s tucking and are common in positional apnoea, a cervical collar may help.

[Pugsy]

I agree with Jas.....change over to regular apap mode.
Keep max at 15 for first night if you wish or your max is restricted because of aerophagia issues.
If it hits 15 much then consider increasing it to 20 max.
Or if it is being restricted for no special reason...change the max now. The machine won't go up without a good reason or need.
Leave everything else the same.
Then see how things look and we might want to increase the minimum but I want to see what it does in regular mode at these settings.

[aurora]

Thanks so much for the suggestions for all who have chimed in.

Out of curiousity, why the suggestion to switch to Autoset mode from Autoset for her? I read the thread here and what I gather is that perhaps my machine is not increasing pressure sufficiently to meet my needs on the for her algorithm, is that right?

Thanks again, I will make the change to Autoset mode first and then will follow with increasing the max pressure.

I appreciate all your willingness to help, this forum has been a wealth of information - I've perused the site previously when I was first diagnosed and i'm thankful you all are here to share your learnings.

[palerider]

Thanks so much for the suggestions for all who have chimed in.

Out of curiousity, why the suggestion to switch to Autoset mode from Autoset for her? I read the thread here and what I gather is that perhaps my machine is not increasing pressure sufficiently to meet my needs on the for her algorithm, is that right?

Yes

[Pugsy]

The for Her algorithm doesn't respond with higher pressures over 12 ish unless some significant flow limitations or snores are also present.
It just won't do it for OAs or hyponeas without much FL stuff happening along with them.
There are some people who just do better in terms of the machine's responsiveness in regular auto mode. It doesn't need as much FL or snores going on along with the OAs and hyponeas to get it to do its thing.
So for some people who seem to need around 10 to 14 pressures...the gentle for her mode isn't such a good thing.

Some people think the for Her mode won't respond above so and so pressure but that's not necessarily the case....it just won't respond well for lone events unless some other significant early warning signs of the airway trying to collapse (FLs and snores) are happening as well. For some reason you likely aren't having enough FLs or snores to drive the machine to be more proactive.

I can count on one hand the number of people who the for Her algorithm wasn't a good fit for their therapy.
Let's see if you are going to join that very small minority.

[aurora]

Greetings again (and more thanks for taking the time to help and respond - looks like this board sees a lot of traffic from folks like me relatively new to xPAP use)

So...here is the night before last prior to my changing settings - I wonder if I was sleeping more on my side or if I somehow managed to bump the nasal cradle slightly off my nose since the leak rate was fairly constant.

screenshot-20191124-140206.png (68.34 KiB) Viewed 1250 times

And here is last nights data - with the mode changed to APAP and the max increased to 20.

screenshot-20191124-140212.png (71.5 KiB) Viewed 1250 times

It appears I'm still getting clusters of OA reported, and it looks like my events seem to coincide with when I have leaks introduced at the mask (or so it seems with these last 2 nights in any case). I don't know if I'm inadvertently opening my mouth I have not tried a cervical collar or a chinstrap.

Any further insight and guidance would definitely be appreciated.

[Jas_williams]

Your leaks are not large enough to be causing an issue. Your machine maxed out its pressure at 20 trying to clear your obstructive apnoea, and failed. But your AHI was better than the first night. As the Obstructive Apnoea is clustered I would suggest that your issue is still positional and something to stop your chin tucking to your chest would help.


Maybe try a rolled up towel or one of those inflatable flight neck cushions something to stop your chin tucking to your chest. I see no need for a chin strap to stop mouth breathing.

[Geer1]

The increasing leak rate could be in part due to the higher pressures. As mentioned it isn't a large enough leak to be an issue though.

I think positional makes sense as well and I would look into that more. You may have been sleeping on your side more in the beginning of treatment, getting some better sleep while on APAP may have transitioned you to sleeping on your back more often which could explain why your results have gotten worse as treatment has progressed. Sleeping on your back more could be increasing the occurrence of positional obstructions as well.

Even during good periods/nights your pressure requirement rarely drops below 10 cm, I would increase your minimum to 10 (at a bare minimum 8 ).

[Aggiehorntwins]

I was advised to switch to regular autopap versus the “for her” mode by Pugsy and it has made a big difference. Reduced my flow limits and am doing better in all other ways. I do not snore much but apparently needed more pressure and the “for her” mode was not responding to what I needed. My minimum was also set at 4 and I ended up increasing it to 9, 10, 11, and now 12 and stopped waking up with tachycardia. Best of luck to you figuring this out. You will get better advise here than at the sleep clinic or from the DME company.