Newbie Oscar results insight

[Nevergiveup13]

Hi everyone,
I am new and just downloaded Oscar and am trying to get some insight how I am doing. I have been using my CPAP for about 3 weeks. I have tried 4 different masks and am trying to get used to using CPAP and the tube. I don’t have a hard time falling asleep but am woken up often with air pressure after falling asleep and seem to keep waking up like that for 2 hours or so. I usually will turn the machine off and back on to reset the pressure.

Below are some pictures of my most recent night with a mask that I am trying for second day. I prefer the resmed nasal pillow mask but I developed a sore on edge of my nose so got switched to dreamwear nasal pillow mask. I feel like my results are pretty good but notice increased episodes before I am waking up and looked to have a mask leak maybe.

Any insight would be greatly appreciated!

Thanks!

[Cpapian]

your starting pressure is uncomfortably low for an adult. You probably would feel more comfortable if you were to raise it.

Your 95% pressure is 10 .96 so you could go to 8 or 9. You might want to make the change in small increments if you feel uncomfortable going from 4 to 8. Your choice.

Your pressure is going up and down and possibly that is what is waking you. When you raise the pressure to 8 or 9 you will have less fluctuations in pressure and probably less disruption to your sleep. You might also see a slight improvement in your AHI.

To adjust the pressure press the 2 buttons together and hold for a bit. Then you should get the clinical menu. Scroll down till you find the minimum pressure.

[Julie]

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[mper!?]

Any insight would be greatly appreciated!

Thanks!

Hi,
_ your charts look mine in my early days of APAP (just 1.5 months), that is, your FLs run all night through. In my case this used to be deleterious;

_ However, how do you feel in general?

all the best

[LSAT]

Since your median pressure was 7.5, I think a minimum pressure setting in that area would be sufficient. Your maximum pressure could be increased to at least 15. The 95% number means that you were at that pressure OR BELOW 95% of the time. Most of your events were CAs which can probably be ignored. Without them, you were almost perfect.

[Miss Emerita]

I agree with others that you might be more comfortable if you raise your minimum. But a few additional observations.

As LSAT points out, most of your events are centrals. If that's typical for you, then be aware that higher pressure won't reduce them.

They may well just indicate arousals during the night. You can zoom in to see whether this is the story: does your flow rate trace go higher/lower and then get irregular looking before you have the CA? That would tell you you semi-woke up and then had a pause in your breathing. The bad part there is the arousal, not the CA.

You seem to be saying your sleep is disrupted by pressure changes. Your pressure is being driven by your flow limitations. It goes up in a fairly fruitless effort to reduce the FLs.

You might want to try an experiment to see whether it helps you sleep more soundly. Try setting your maximum to be the same as your minimum. You could try, for example, a minimum and maximum of 8.

If that winds up giving you a bunch of OAs, then inch it up.

Whenever you experiment, give your new settings a few days before you decide how it went, unless you have an awful night.

By the way, would you be able to take screen shots rather than photos of your computer screen? And could you close the calendar before you grab your image? (Just click on the little triangle to the left of today's date.) It'd also be great if you could fill out your profile with information about your machine and your mask.

The early days are the roughest, and I'm betting things will improve for you. You have a great machine, you're using Oscar, you're using the machine all night, and you've found a group of people here who want to help you.

[palerider]

You seem to be saying your sleep is disrupted by pressure changes. Your pressure is being driven by your flow limitations. It goes up in a fairly fruitless effort to reduce the FLs.

You might want to try an experiment to see whether it helps you sleep more soundly. Try setting your maximum to be the same as your minimum. You could try, for example, a minimum and maximum of 8.

That's almost always a bad idea.

People have restless sleep, look at the data and point to the pressure changes and say *that's the cause*, like they used to point at innocent women and yell "WITCH" then murder them, when they weren't the cause of the problem in the first place.

Respiratory problems are *proven* to disturb sleep, and that includes flow limitations. People struggle to breathe, waking up by that, and at the same time, the machine is trying to do its job, then someone screams "WITCH"..

A very likely better plan is to set the min high enough to open up the airway, say 8 in this case, and stop restricting the machine with a way too low max, set the max to 20, where it belongs (absent of aerophagia).

[Nevergiveup13]

Thank you for all of this insightful information! This really helps. Someone mentioned CA but weirdly when I had my sleep study I did not have any central apnea events so maybe all of those are arousals. Last night I slept 5 hours in a row (which is really long for me) but didn’t feel as rested as you would think I should. The doctor wants me to take trazadone to sleep but Benadryl seems to help but maybe it isn’t? It’s a work in progress but this really helps me. I saw my pulmonologist today and showed him my graphs and he said to raise the minimum to 6 to start off. As someone else mentioned, what’s the harm in raising the maximum since it is an apap? If you need it, it will allow your machine to go there. If you don’t, then it won’t. Is that correct?

[Nevergiveup13]

Also here are my results from last night. This is the one I showed my doctor.

[palerider]

please just take a screenshot, and post that.

http://cpaptalk.com/wiki/index.php/Oscar:organize

[Nevergiveup13]

I have Oscar on my computer but attach from my iPad so it’s easier to take a picture with my iPad. I rarely use my computer and honestly don’t know how to save and attach pictures. It may take some time to figure that out. Sorry that I can’t do that yet.

[mper!?]

Hi,
"It may take some time to figure that out"..

_ please, take your time, I think it well worth for better help from people here..... I am afraid I would have to say this: poor data > poor information > poor insights > poor diagnostic > poor solutions eventually.

all the best

[Miss Emerita]

You seem to be saying your sleep is disrupted by pressure changes. Your pressure is being driven by your flow limitations. It goes up in a fairly fruitless effort to reduce the FLs.

You might want to try an experiment to see whether it helps you sleep more soundly. Try setting your maximum to be the same as your minimum. You could try, for example, a minimum and maximum of 8.

That's almost always a bad idea.

People have restless sleep, look at the data and point to the pressure changes and say *that's the cause*, like they used to point at innocent women and yell "WITCH" then murder them, when they weren't the cause of the problem in the first place.

Respiratory problems are *proven* to disturb sleep, and that includes flow limitations. People struggle to breathe, waking up by that, and at the same time, the machine is trying to do its job, then someone screams "WITCH"..

A very likely better plan is to set the min high enough to open up the airway, say 8 in this case, and stop restricting the machine with a way too low max, set the max to 20, where it belongs (absent of aerophagia).

Thanks for the perspective, PR. I suggested the experiment because the OP's original post seemed to identify pressure changes as a source of disturbance. (I'm also not so convinced that the machine-produced increases in pressure do much of anything to treat FLs; they seem to respond instead to increases in pressure support.) Broadly speaking, I think there's some value in experimenting to test an hypothesis, so long as there would be no harm done if the experimental changes didn't improve the results.

[palerider]

Thanks for the perspective, PR. I suggested the experiment because the OP's original post seemed to identify pressure changes as a source of disturbance. (I'm also not so convinced that the machine-produced increases in pressure do much of anything to treat FLs; they seem to respond instead to increases in pressure support.) Broadly speaking, I think there's some value in experimenting to test an hypothesis, so long as there would be no harm done if the experimental changes didn't improve the results.

I've seen the results of that hypothesis in the past, but sure, have at it.

increasing pressure enough will stop flow limitations, that's the entire reason that all auto machines increase pressure when they sense flow limitations.

[mper!?]

Hi, Nevergiveup13, dear folks

_ While revisiting this case more fully, I would like to add:

_Nevergiveup13, apologies, your data and information are not that poor, as I thought initially; you were doing best you could for the moment. Good insights already came in on your case. Good points from Cpapian, LSAT, Miss Emerita, and palerider;

_ Cpapian's observations, and trying to add something from my own experiences and observations on some hundred cases, maybe: “Your pressure is going up and down and possibly that is what is waking you”. Yes, maybe, either pressure fluctuations and non-tailored can be very disrupted, so much so I only use fixed pressure since long ago, on my 2.5 year therapy. After a quite while, I realized those fluctuations did not pay off disruptions by repeated punches on my FFM while responding to false events (OSA and FL), very often occurring during arousals/awakenings of UARS people like me (and maybe Nevergiveup, I suspect). And, on the contrary, pressure increases does not occur where it should, such associated with unflagged ridiculous FL, quasi-hypopneas, followed by arousal/awakenings.

_ LSAT's: “ Most of your events were CAs which can probably be ignored”. Yes, I agree.

_ Miss Emerita's: “….your events are centrals. If that's typical for you, then be aware that higher pressure won't reduce them. They may well just indicate arousals during the night….The bad part there is the arousal, not the CA”. Totally agree.

…”Try setting your maximum to be the same as your minimum. You could try, for example, a minimum and maximum of 8…. then inch it up..” Tend to agree, maybe not so high, rather at 7.0 .

….(I'm also not so convinced that the machine-produced increases in pressure do much of anything to treat FLs; they seem to respond instead to increases in pressure support.). This, I definitively agree up on. PS= > 4.0, as I have seen in so many cases, is the most important parameter to battle FL. Actually, I am afraid, as far as I remember, I have never seen a case in which person succeeded with PS < some 3.6, maybe.

_ Palerider's: “Respiratory problems are *proven* to disturb sleep, and that includes flow limitations. People struggle to breathe, waking up by that,…..Yes, indeed, respiratory effort, whatever origin is a crucial drawback to chase, in particular for the very-high sensitive UARS people. That is my case: after battle my FL to absolut zero (p95 always zero, and max < 0,1), still remain residual arousals/awakenings due to ridiculous minor unflagged flow constrictions (two or three FL-limited inspirations are able to awake me up, and so on). When one gets FL absolute zero there would be also a general improve on FR, with very little or none not-rounded inspirations. There would be a tendency to improve TV/MV when FL gets absolute zero. I think we all know that, on Bilevel machines, such as VAUTO, getting absolute zero on flagged FL is a rather easy task. It would happen pretty automatically once one get the fine-tuned EPAPmin and P.S > some 3.6. Therefore, maybe I should say: don’t be paranoiac, but do chase flagged FL to the very last spike if you can.

All the best to all you guys