Can someone understand OSCAR data ?

[Morgan Bateson]

Hi,

I was wondering if there's anyone here who can say something about this data. I've been on CPAP for almost 2 months now. I started at a pressure of 7.5 but since then (as advised by my doctor) increased the pressure to 8.5 since my AHI remained mostly above 5. She's due to check on me in 2 weeks time and I wanted to check a few things.

First let me show you:

This is my night with ResMed Airfit P30i, it's a comfortable mask now that I'm used to it.

ResMed Airfit P30i

ResMedAirFitP30i.PNG (347.62 KiB) Viewed 900 times

This is my night with a ResMed Mirage FX nasal mask, it's ok I guess

ResMed Mirage FX

MirageFX.PNG (343.5 KiB) Viewed 900 times

My questions are:
- Do you see significant difference between these two data, and would you say one works better for me than the other?
- Is there anything in particular you think I should discuss with my doctor, based on this data ?
- My Doctor says "AHI below 5 is what we want" others say that's not true, what is my goal ? It's an average of 3 - 4 now, should I try to improve ?
- Would it help my therapy if I set my Philips Dreamstation to not be constantly at pressure 9, but adaptive from 9 to (say) 12 ?

Because, bottom line here, I'm comfortable with my device now. I'm using it since April 14, so I'm well on my way. I sleep well and I feel rested when I wake up.

However, I still don't have the energy they say I would regain (yet) and I have not seen any other improvement other than I think I'm feeling more rested when I wake up.

Thanks!

edit: I'm on fixed pressure 9 since May 23

edit (2) : I've had 2-3 nights where my AHI went between 1.20 and 1.8. But mostly 3 - 4 which is why I showed these 2 images which represents the average

[Norma45]

Morgan, Just because I am the first person responding (not the most knowledgable)....
They are going to want to see your graphs to give you good feedback.
Check out this link:viewtopic/t158560/How-to-post-images-for-review.html

[Morgan Bateson]

Morgan, Just because I am the first person responding (not the most knowledgable)....
They are going to want to see your graphs to give you good feedback.
Check out this link:viewtopic/t158560/How-to-post-images-for-review.html

Wow that was long read, thanks for your help. I have edited my message to (hopefully) comply with those requirements. I'm really hoping someone can say something that I can discuss with my doctor.
And hopefully I can finally get some sense on how I'm doing atm.

[Pugsy]

You have included graphs that aren't needed and by doing that you make the needed graphs so tiny we can't really evaluate them.
If you post images again...please review that thread again as to which graphs to include and which not to include and the size of the graphs.

But I will try to answer your questions based on what I can see

Do you see significant difference between these two data, and would you say one works better for me than the other?

No. In situations like this I tell people to use the mask that they simply like the best in terms of comfort, fit, use and overall sleep quality.

- Is there anything in particular you think I should discuss with my doctor, based on this data ?

Very minor clustering is seen occasionally. When this happens we look at either supine sleeping related or maybe REM stage sleep related and you might need a little more pressure to break up or prevent the clustering.
Ask your doctor if there is any evidence as to your OSA being worse on your back or during REM stage sleep.

My Doctor says "AHI below 5 is what we want" others say that's not true, what is my goal ? It's an average of 3 - 4 now, should I try to improve ?

Doctors tend to target numbers and not look at the overall big picture. AHI is the cut off line for earning the OSA diagnosis. AHI of 3 or 4 means you technically no longer have enough events to meet the diagnosis criteria but it doesn't always equal great sleep and feeling great. I know people who notice a big difference in how they sleep and feel when they have an AHI between 1 or 2 and 3 and 4.
So lower is usually better. Don't go chasing AHI of 0.0 though...it will drive you crazy and isn't needed anyway.

Would it help my therapy if I set my Philips Dreamstation to not be constantly at pressure 9, but adaptive from 9 to (say) 12 ?

It might help reduce the AHI if the machine could increase the pressure when you see those clusters. They aren't horrible but they are enough that they could be a disruptive factor in terms of sleep quality and this therapy is all about how well you sleep more than it is numbers. If you don't sleep so great you won't ever feel so great no matter what the numbers are.
Auto adjusting mode trial will let the machine adjust upwards if it thinks you need it plus it turns flow limitation flagging on. Right now you show 0.0 Flow Limitations but it's not because you didn't have any...it's because the flagging for FLs doesn't happen in fixed cpap mode. FLs and snores are part of what the machine will try to kill with more pressure because they are early warnings signs of the airway trying to collapse. Even if they don't grow up to earn the OA or hyponea flag they can still mess with your sleep. It's one of the reasons I hate Respironics fixed cpap mode. It doesn't even bother to flag something that is critical to therapy.

[Pugsy]

If you decide to try auto adjusting mode....
minimum of 9 and maximum of 20 would be the settings I would start with.
Flex setting of your choice.

[Dog Slobber]

Remove the AHI, Resp Rate and Tidal Volume, they don't add anything of value.

And yes, I would change from fixed 9 to APAP with min: 9, max: 20. One of the advantages of APAP is; if we see the pressure increase constantly we can reasonably conclude your minimum pressure should be increased.

Right now we have no way of knowing if your AHI of about 3.5 is because that as low as your going to get it, or if you're simply not getting enough pressure.

Your goal is to reduce your AHI to as low as possible, while maintaining tolerable pressures. It is not a number.

And this Mantra of under 5 and you're treated is hogwash.

Typically when ones AHI is under 5, it is not considered high enough to be put on CPAP. That doesn't mean that under 5 is treated.

Here's an example:
To be a candidate for gastric bypass typically one needs to have a BMI over 40. That doesn't mean that having a BMI under 40 and we are treated or the goal.

[Morgan Bateson]

You have included graphs that aren't needed and by doing that you make the needed graphs so tiny we can't really evaluate them.
If you post images again...please review that thread again as to which graphs to include and which not to include and the size of the graphs.

But I will try to answer your questions based on what I can see

I'm not sure exactly what I could do about that, except using imgur, but if you right click the image and choose "open image in new tab" it shows the image at 3500+ pixel size, that ought to be more than enough for detail ?

Example 1 : download/file.php?id=11818
Example 2 : download/file.php?id=11819

No. In situations like this I tell people to use the mask that they simply like the best in terms of comfort, fit, use and overall sleep quality.

Well, it's settled then. The P30i fits like a glove and after some early issues it's now my favorite.

Very minor clustering is seen occasionally. When this happens we look at either supine sleeping related or maybe REM stage sleep related and you might need a little more pressure to break up or prevent the clustering.
Ask your doctor if there is any evidence as to your OSA being worse on your back or during REM stage sleep.
[...]
It might help reduce the AHI if the machine could increase the pressure when you see those clusters.

Yeah I was thinking along the same path. Now the thing is, the doctor will check up on my therapy 3 times. Within 2 weeks, she will call me for the last time. Unless there's nothing special that's it.

I'm eager to try the setting of 9 as low and a setting of 12 as high. And let the machine adapt according to what's needed. Next see what OSCAR will tell after a 2 weeks of trying about my average pressure setting and more importantly what my AHI will be then.

Like you said, it might fix the clustering and it might as weel bring my AHI from 3 -4 back to 1 - 2.

There's just one thing... I would be changing the default setting without consultation. I'm not sure if that's frown upon. Last time I spoke with her, she said we should try 8 and if that didn't work 8.5 because my average was > 5 AHI on average. She said "I will make a note for the company to change your settings" and I told her because of Corona, everything went by phone and they told me over the phone how to enter the therapy setting and I could change the settings myself. She then said "oh, ok then, you do it no problem".

I've been naughty already because I tried pressure of 9 where it currently sits (1.5 week already). But I agree with you there is still something to gain. Now, I'm not sure if cranking it up to 10 fixes my issues when it's "Fixed 10". I'd like to try adaptive from 9 - 12.

Just not sure if I'm waiting another 2 weeks to consult, or try this out myself and know the story when she calls. lol.

Thanks anyway so far!

[Morgan Bateson]

If you decide to try auto adjusting mode....
minimum of 9 and maximum of 20 would be the settings I would start with.
Flex setting of your choice.

ok, you were quick to send another answer lol, while I was still answering the other one

I've seen many video's about CPAP and APAP and adaptive settings and I was warned for this. It's ridiculous the guy said, to have your self endure a setting of 20. Have a very limited bandwidth like 5 - 10 or 8 - 12 is what I was 'warned'. But hey, so many people, so many views. It's just that he also added "if you try a very high upper limit, do it for only a few days and check OSCAR to see where your average is. And lower your upper limit !

Well, I'm going to try to change the setting off of fixed. Think I'm allowed this 'test' to get a better understanding of it's outcome and have more to discuss with my doctor in 2 weeks time.

[khauser]

Pugsy wrote: ↑Wed Jun 03, 2020 5:18 pm
You have included graphs that aren't needed and by doing that you make the needed graphs so tiny we can't really evaluate them.
If you post images again...please review that thread again as to which graphs to include and which not to include and the size of the graphs.

But I will try to answer your questions based on what I can see

I'm not sure exactly what I could do about that, except using imgur, but if you right click the image and choose "open image in new tab" it shows the image at 3500+ pixel size, that ought to be more than enough for detail ?

OSCAR/SleepyHead lets you re-organize the graphs. Move the ones that aren't important below the ones that are. Then you can create a capture of just the information that is needed.

[Pugsy]

I wish people would stop with this idea that people have to endure a setting of 20 just because they set the max to 20.
The machine will only go to where it thinks it needs to go no matter what maximum we might set it at.
If the machine could go to 100 and we set the max at 100 it still chooses its own path.
Heck might not even go to 10 for all we know.
The maximum available is a moot point if you never go near it. Your car can go to 120 mph but I am betting you don't see it or experience it because the foot doesn't do it.

I doubt seriously that your machine will go anywhere near 20 but it might need to go to 18 cm for 10 minutes because of REM based events that need more pressure. I speak from personal experience here...my own OSA is 5 times worse in REM and I often see the machine increase 6 to 8 cm during probable REM (you can sort of spot the REM cycles). If I limited my max to 12 and it really needs 18 for 10 minutes....I end up with a cluster of apnea events happening because the machine couldn't do its job.

You don't experience the max or anywhere near the max unless the machine has a pretty darn good reason for giving it to you.

[Morgan Bateson]

Pugsy wrote: ↑Wed Jun 03, 2020 5:18 pm
You have included graphs that aren't needed and by doing that you make the needed graphs so tiny we can't really evaluate them.
If you post images again...please review that thread again as to which graphs to include and which not to include and the size of the graphs.

But I will try to answer your questions based on what I can see

I'm not sure exactly what I could do about that, except using imgur, but if you right click the image and choose "open image in new tab" it shows the image at 3500+ pixel size, that ought to be more than enough for detail ?

OSCAR/SleepyHead lets you re-organize the graphs. Move the ones that aren't important below the ones that are. Then you can create a capture of just the information that is needed.

Thanks, yes I know I can change them. But the link the first person gave me showed:
1 - Event Flags
2 - Flow Rate
3 - Pressure
4 - Leak rate
5 - Flow Limit

I don't have Flow Limit, but unless I'm mixing rows up with others (forgive me, I'm quite computer savvy, but I am being OSCAR noob) I think I showed exactly those rows ?

[Pugsy]

The graphs....they can all be resized and/or moved off screen so that the primary graphs are of a size for optimal evaluation.
You included a lot more graphs than was needed and by doing that the graphs that I did need were tiny.

I couldn't make yours easier to evaluate because the boxes themselves were so tiny.

At any rate...I don't need these redone but I mention it for future image sharing. For us to help you we need to be comfortable reviewing things. If I can't see well then I normally just don't say anything because I am uncomfortable commenting on something I can't see well.
My job is to help here but people have to help me do that job by making it easy for me to see what they want me to look at.

See how much easier it is when the boxes are large???

[Pugsy]

You don't have a flow limitation graph to show...that's a ResMed report graph and I do believe that in my instructions I mentioned that fact.
I didn't go to the link you were given...I wonder if it is an old thread but this is the one I usually give people
viewtopic/t158560/How-to-post-images-for-review.html

Again...no need to redo these images for me anyway but for future images it might be more important to have them in an easier for us to view format.

[Dog Slobber]

It's ridiculous the guy said, to have your self endure a setting of 20. Have a very limited bandwidth like 5 - 10 or 8 - 12 is what I was 'warned'.

This is the advise given by people who haven't thought things through.

If you're machine needs to get to 13 to stop your throat from closing and you've configured it to maximize at 12, what do you think is going to happen?

If your machine typically stays in the 10-12 range, occasionally goes to 13, and once in a blue moon goes to 14. And your maximum is set to 20, then what will happen is your machine will typically will stay in the 10-12 range, occasionally goes to 13, and once in a blue moon goes to 14.

You will NOT have to endure pressure of 20, your machine won't get to 20 unless it needs to get to 20.

It's just that he also added "if you try a very high upper limit, do it for only a few days and check OSCAR to see where your average is. And lower your upper limit !

This doesn't make sense.

Is he telling you to prevent the machine from going to where it needs to go?

But hey, so many people, so many views.

And how many of those views are well thought out?

There are valid reasons to limit the maximum pressure, but to create an artificial ceiling, especially one that your machine might need to use occasional, isn't one of them.

[Miss Emerita]

You are getting a lot of excellent advice, Morgan. Two additional comments: For many of us, we think of our AHI as good if it's under 2 and excellent if it's under 1. But also, apnea isn't the only contributor to daytime sleepiness. It looks like you got 6.5 - 7 hours of sleep the two nights for which you posted charts. Your body may simply need more. Can you try changing your schedule a little so you can consistently sleep for 8 hours? A two-week experiment would be interesting.

And you probably know the other guidelines for more restful sleep; they seem kind of mickey-mouse, but they actually help:

• Keep a consistent sleep schedule. Get up at the same time every day, even on weekends or during vacations.
• Set a bedtime that is early enough for you to get at least 7 hours of sleep.
• Don’t go to bed unless you are sleepy.
• If you don’t fall asleep after 20 minutes, get out of bed.
• Establish a relaxing bedtime routine.
• Use your bed only for sleep and sex.
• Make your bedroom quiet and relaxing. Keep the room at a comfortable, cool temperature.
• Limit exposure to bright light in the evenings.
• Turn off electronic devices at least 30 minutes before bedtime.
• Don’t eat a large meal before bedtime. If you are hungry at night, eat a light, healthy snack.
• Exercise regularly and maintain a healthy diet.
• Avoid consuming caffeine in the late afternoon or evening.
• Avoid consuming alcohol before bedtime.
• Reduce your fluid intake before bedtime.