Dentist treating self w/ dream station. Oscar results

[Kenny878]

Hello,

Similar to Nee I am a dentist who's become trained in "airway dentistry". I've recently purchased a respironics dreamstation to treat myself and need some help interpreting OSCAR data to find tune my settings.

I've had poor sleep since I was 15 or so. I'm now 26 y/o, male, 200lbs, 6'0. Very athletic but body fat a little high as well. Mouth taping and sleeping on side helps but only so much. Still have EDS, depression, anxiety, low energy etc. Sleep study (both take home and in lab) showed "no apnea" . AHI was about 4 on both of them. RDI was higher i believe but the in lab one the tech told me I had "many smaller/shorter events that were too short in duration and too low of O2 sat drop to count as apnea." i apparently had 17 of these per hour. Probably IFL/UARS that is not apnea... yet. So while i'm waiting for MMA surgery I have been using the dream station w/ classic nasal mask. Results below are from normal average night of sleep, fairly unrefreshing. Using 7 min and 20 max. Very arbitrary settings like I would like help tweaking. I'm comfortable w/ higher pressure but get aerophagia above 8 minimum. Thanks in advance for any help you can provide and let me know if you need any more info. I have about 100 nights logged in OSCAR.

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[nee]

Hey Kenny,

Interesting about your AHI, RDI, and O2 sat drop. My AHI, RDI, O2 were similar to yours and was told "no problem" by an ENT before looking into it more myself.

From what I can see, you have EPR set to 3 cmH2O?

Can you zoom in on the hypopneas and post just the flow rate graphs? I'm interested in seeing how your breathing looks when it's zoomed in.

Could you also zoom in to around 2:45 am and post that, where the flow rate increases?

[Kenny878]

Nee,

Thanks for the reply.I believe EPR is 3. Is that the default? I don't believe i've ever changed it. Hope these are the screenshots you asked for.

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[Pugsy]

You need to zoom in much closer.
Like maybe a 4 to 5 minute segment so that each individual breath can be seen.
Something like this

[nee]

See the vertical green bar over your hypopnea event in the flow rate graph of the second picture? Just keep left clicking on it, it'll zoom it in. You can do this for any area. Right clicking zooms back out.

[Kenny878]

Okay i believe i got the right screenshots now

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[Kenny878]

more shots

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[nee]

So, in every graph except for the last one, those events look like you're breathing in just fine, and on the exhale there's an obstruction.

If the obstruction is coming from your palate flopping up into the nasopharynx, then EPR is your enemy. Basically, you want to have steady pressure coming from the CPAP against your palate, keeping it where it's supposed to be. If there's a release in pressure (EPR), the palate has a chance to flop upward. Hope this makes sense.

It looks like your exhalation pressure never goes past about 6.5 cm H2O. Maybe set your minimum pressure to 7 cm H2O and turn off EPR ... I'd be curious to see your results. If it feels too difficult to breathe, maybe do an EPR of 2 for a couple of nights, then 1, then turn it off.

Here's more info: https://sites.google.com/view/palatal-prolapse/

[Pugsy]

One way of using EPR but you want/need the relief for comfort reasons but maybe not use it all night is to make use of the ramp feature and set EPR to ramp only.

Example....you don't have to use ramp starting at 4 if you want to start at a higher pressure...you can start ramp at anything you want and just set a time limit on it and have EPR available only during ramp.
You could use Nee's thoughts about 7 cm but if it's a problem to go fixed at 7 and EPR makes it easier for you but you want to evaluate how things go during the night without EPR...just set the ramp pressure to start at 7 and turn EPR on at whatever setting you want but limit the setting to "ramp only" then once whatever time you select is up...EPR will turn off.
That way you have the comfort you might need with EPR and can still experiment with EPR off while asleep.
It doesn't have to be all night and it doesn't have to start at 4...EPR can start much higher if that is what a person wants or needs.

[ChicagoGranny]

See the vertical green bar over your hypopnea event in the flow rate graph of the second picture? Just keep left clicking on it, it'll zoom it in. You can do this for any area. Right clicking zooms back out.

Thanks. Have never tried that.

You can also click on the Events tab and get a list. Clicking on any one of the events zooms the line charts into a good level.

[Kenny878]

Thanks all you guys for the reply. So “EPR” i believe is a function om res med machines. I have a phillips respironics dreamstation. So it has “a-flex” “c-flex” and “off”. Last night mine was on a-flex setting 2 (goes 1 to 3).

What should i have it on so that the EPR is “off”. Would that be turning a flex off or going to a-flex one?

Thanks so much

[Pugsy]

ERP is ResMed's term for exhale relief.
Flex (C or A) is Respironics term for exhale relief.

Setting either to 0 effectively turns it off.

With Flex 3 is the highest amount of exhale relief but the most anyone can get is 2 cm drop during exhale even at a setting of 3.
ResMed has a direct per cm drop per setting.
Each brand goes about their exhale relief differently though. Respironics is flow based meaning a person may not even get the full 2cm available at a setting of 3 if they don't breathe forcefully enough.
While both EPR and Flex are forms of exhale relief....they can't be compared equally to each other because it is obtained in entirely different ways.

Also...with Flex the minimum setting needs to be 6 cm or above for Flex to engage. It simply won't work at pressures less than 6.

[Pugsy]

Oh....ResMed is the only brand with a choice for EPR ramp only....Respironics doesn't off that option.
With Respironics you have to actually push the ramp button to start the ramp process. Doesn't matter if it is "on" in the setup menu with a time limit...you still have to push the ramp button to start it.

[Kenny878]

Pugsy,

Thank you. So for tonight i will turn a-flex off and see how i do.

[Kenny878]

Thank you guys very much for your help. I have not looked at my OSCAR data but with a-flex turned off i was having quite a hard time falling asleep and kept taking it off at night. I had a question though. If i have palatal prolapse then EPR is the enemy bc the pressure drop allows the palate to flop upward and cause an obstruction. I believe I understand that. But i also have UARS and it is my understanding that UARS patients need more expiratory pressure relief to get into more restful sleep, ideally with the use of a bipap machine.

So if i have palatal prolapse and UARS am i sort of SOL either way? I am on the waitlist for MMA surgery but i want to know if until then i should keep trying to tweak cpap settings or if it is all a bit redundant. I’m not a cpap expert so i very much appreciate the experts taking the time to help me.