Oscar Charts Input

[Mchezaji]

I was diagnosed with mild sleep apnea in 2010 and put on a pressure of 6cm/H2O and on a Resmed S9 Elite CPAP. Initially, I was very involved and monitored my progress using Rescan (thanks to a link provided in this forum that allowed me to download it plus the numerous tips that I received). Anyway, fast forward a few months and I lapsed and continued to use the CPAP without seeing a sleep doctor or actively monitoring my therapy. The only parameter I checked was the AHI and I was under 2-3 for several years, although I didn’t feel that great. At some point I raised the pressure to 7cm/H2O and used that until November 2019-when my faithful S9 Elite died on me.

I had another sleep study in November 2019, since I continued to feel lethargic and fatigued during the day. The study left much to desire (with the quality of the set-up and the fact that I didn’t sleep well). Anyway, the report indicated that once again I had mild sleep apnea and the doctor wanted me to continue remaining on a CPAP device with a pressure of 6. He wasn’t even willing to write me a script for an APAP and after a few weeks of back and forth of delays with the doctor and local DME, they provided me with a Resmed Airsense10 Autoset.

A few days after I started using the Airsense10 Autoset, I changed the settings to APAP from CPAP with a pressure range of 6-9. My AHI continued to be low (less than 2-3 most nights) but I continued feeling extremely fatigued and lethargic during the day-not sleepy though. No matter how much I tweak the settings, nothing seems to make a difference. Recently, in the past few weeks, I experimented with EPR, turning it on and tried all 3 settings, which didn’t make things much better or worse. I have also tried taping my mouth for the past couple of weeks, since I am a mouth breather to see if this made a difference. Overall, I sleep decent throughout the night with a few exceptions here and there.

I am posting a few charts inline because of the limit(am I correct that it's 3?) and uploading and sharing a link to others (with and without EPR) to see if I can get input from you folks, since I am at a loss as to whether my symptoms are connected to sleep apnea or not. I have also been seeing specialists for the past several months to rule out any other medical causes but so far am drawing a blank. There are no changes in any of my medications or environment in the past several months.

Currently, I am set at a pressure of 7-10, EPR turned off and humidifier/heated tubing set to Auto for the past 10 days or so.

Thank you in advance for the assistance and a special shout out to Pugsy, who has been very helpful with queries that I had recently with the loss of data on my SD card.

OSCAR 09-24-1.png (321.36 KiB) Viewed 1642 times

OSCAR 09-24-2.png (314 KiB) Viewed 1642 times

OSCAR 09-24-3.png (355.29 KiB) Viewed 1642 times

Link for other screenshots:
https://1drv.ms/u/s!AjHAB0kvkgwFgSHh2ec ... z?e=uuFpYp

[LSAT]

All of your events are Central in nature (CAs). Pressure changes will not fix them. As long as the leaks do not bother your sleep, you can ignore them. The machine can easily compensate for leaks up to 24L. Your charts indicate that there is nothing to fix. Sleep well!

[Pugsy]

There is a 3 attachment limit per post. So you can do more than 3 but you have to do them in multiple posts.

You might want to check those CAs/Centrals and see if they look like they are arousal related or asleep centrals.
http://freecpapadvice.com/sleepyhead-free-software

It wouldn't be impossible for there to be some poor sleep quality happening here that is unrelated to apnea or airway issues.

[Mchezaji]

All of your events are Central in nature (CAs). Pressure changes will not fix them. As long as the leaks do not bother your sleep, you can ignore them. The machine can easily compensate for leaks up to 24L. Your charts indicate that there is nothing to fix. Sleep well!

Thank you for the feedback LSAT. The leaks don't bother me. Although, I am still in the search of a mask that works better for me since the F30i, which I started using recently seems to be irritating both the inside of one of my nostrils and also seems to be causing some teeth pain? I have my straps snug but not too tight-any looser and they cause large leaks. It seems that finding the perfect mask is always an ongoing effort.

[Mchezaji]

There is a 3 attachment limit per post. So you can do more than 3 but you have to do them in multiple posts.

You might want to check those CAs/Centrals and see if they look like they are arousal related or asleep centrals.
http://freecpapadvice.com/sleepyhead-free-software

It wouldn't be impossible for there to be some poor sleep quality happening here that is unrelated to apnea or airway issues.

Thank you for the feedback Pugsy! I looked at the Centrals and almost all of them seem to be true Centrals. A majority of them are 10-13 seconds, while I have a few that are 17-18 seconds. What is really weird is that during the sleep study they didn't find a single CA but a significant portion of my apneas are CA's over the past 10 months or maybe even longer while I was on the S9 Elite since I had stopped tracking my therapy.

I also played with the Response setting over the past several weeks, setting it to soft from standard. While on the soft setting, the CA's seemed to increase to some degree, so I went back to the standard setting.

One of the things that I have noticed is that my respiration rate on most nights averages around 11.20-11.60. Not sure if this is something you experienced folks see out there?

Is there anything in the inspiration, respiration or minute ventilation that you guys see that raises any flags?

Adding a few screenshots from last night.

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OSCAR 10-9-2.png (305.47 KiB) Viewed 1591 times

OSCAR 10-9-3.png (347.39 KiB) Viewed 1591 times

[Mchezaji]

Adding CPAP Stats and additional screenshot for last night...

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OSCAR 10-9-4.png (342.08 KiB) Viewed 1590 times

[Miss Emerita]

Your AHI is in the good-to-excellent range. Your MV values are within a normal range. It is *possible* you are having some other form of sleep disturbance, e.g., restless leg syndrome or periodic limb movements. Did your most recent sleep study report have anything to say on that subject? Do you have any reason to think that these kinds of disturbances are a regular thing for you?

I'm glad you're getting workups from other specialists. Some of the broad areas I hope are being investigated: thyroid, autoimmune disease (esp in the connective disease family), generalized markers of inflammation, Lyme disease, chronic fatigue syndrome, heart and pulmonary function.

Fatigue as a primary presenting symptom can be frustrating to diagnose -- frustrating for both physician and patient. The more clear you can make your descriptions of how you feel, the better this will go. For example, if you are not feeling any desire to nap, it's important to say so. If you feel a strong drive to lie down during the day but no drive to sleep during lie-downs, that's important too. Does the fatigue feel like something you've experienced with a known illness, e.g., flu? If you are fatigued all day, or mainly during certain times of day, do mention that. Finally, it's important for the doctors to know whether or not your fatigue is worse after exertion.

[BlueDragon]

I am most definitely not an expert on CPAP treatment but have looked at my own charts in detail. Here is what I see in your charts.

Overall the numbers look good, as you know. But quality of sleep is more important than the numbers. I recently went through an extensive process of trying to figure out why I was still so fatigued despite "good" numbers (average AHI about 1.7). The result for me was switching from an AutoSet to a VAuto and using EERS (Enhanced Expiratory Rebreathing Space). My AHI now averages under .5, sometimes I even see 0.0, and I feel more rested.

You have a sporadic increase in flow limits that drives the increase in pressure (as it is supposed to). And during those periods of pressure increase your tidal volume drops and your respiration rate increases -- suggesting shallower, faster, but irregular breathing. I would think that might disturb your sleep in itself.

Might the pressure increase itself be disturbing your sleep? You could try fixed pressure and see if that makes any difference.

Looking at the flow chart itself, I see that it sometimes looks like a solid bar, while at other times it looks "fuzzy." If you are breathing regularly, with minimal variation in breath-to-breath volume, the flow graph will look like a solid bar. The fuzzier the bar, the more varied the breaths. I suggest zooming in so only 10 minutes is shown. Do that both where the bar looks solid and where it is fuzzy. Maybe one around a CA too.

[mper!?]

One of the things that I have noticed is that my respiration rate on most nights averages around 11.20-11.60.

Is there anything in the inspiration, respiration or minute ventilation that you guys see that raises any flags?

Adding a few screenshots from last night.

Hi,

_ Interesting this one more limb case kind of "low AHI-very long duration sleep/not feeling good", which I have seen so many times around. All these limb/lingering cases, which one way or another have to do with mine (main drawback is arousal/awakenings-UARS-related, with difficulties to maintain REM sleep complete episodes, sometimes leading to not always good night sleeps) usually call my attention;

_ As Pugsy and others commonly say: many possiblities could be involved. Tough cases! We could eventually add somethinng trying to narrow down some of those. At worst scenario, maybe I could learn something else on my own case;

_ I think preliminarily see you facing problems with flagged flows limitation/increasing pressures at some 90min schedule. Trying to go further, could you please post some 10min-duration windows (somebody already asked this) where your pressures get higher?...scales could be max 700 for TV; -100 to 100 for FR ?; complete parameters table on the left? It could be instructive, if possible, see how often you have arousals/awakenings,to begin with;

_ couple of questions: (a) do you sleep on your backs or sides? (b) have you experienced the soft collar? (c) if you don't mind: what kind of medications you are on; your height and weight?

all the best and good luck

[mper!?]

....in time: could you please add the median reference line in all your charts?

Thanks

[Mchezaji]

Thank you for the input Miss Emirita. I will take the feedback to heart, using your guidance as I see specialists as well.

I am attaching my sleep study here-although I must say I slept very poorly and the set-up wasn't that great, so I am not sure how representative it is of my regular sleeping pattern.

Your AHI is in the good-to-excellent range. Your MV values are within a normal range. It is *possible* you are having some other form of sleep disturbance, e.g., restless leg syndrome or periodic limb movements. Did your most recent sleep study report have anything to say on that subject? Do you have any reason to think that these kinds of disturbances are a regular thing for you?

I'm glad you're getting workups from other specialists. Some of the broad areas I hope are being investigated: thyroid, autoimmune disease (esp in the connective disease family), generalized markers of inflammation, Lyme disease, chronic fatigue syndrome, heart and pulmonary function.

Fatigue as a primary presenting symptom can be frustrating to diagnose -- frustrating for both physician and patient. The more clear you can make your descriptions of how you feel, the better this will go. For example, if you are not feeling any desire to nap, it's important to say so. If you feel a strong drive to lie down during the day but no drive to sleep during lie-downs, that's important too. Does the fatigue feel like something you've experienced with a known illness, e.g., flu? If you are fatigued all day, or mainly during certain times of day, do mention that. Finally, it's important for the doctors to know whether or not your fatigue is worse after exertion.

OSCAR Sleep Study.png (73.26 KiB) Viewed 1509 times

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OSCAR Sleep Study 2.png (248.3 KiB) Viewed 1509 times

[Mchezaji]

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[Mchezaji]

OSCAR SLeep Study 6.png (209.78 KiB) Viewed 1509 times

[Mchezaji]

Thank you for the input BlueDragon. I am trying to get a good sleep doctor, so that I can even try an get on a VAuto. Recently I lost most of the data on myn SD card and although I was able to retrieve it using software, it's the folder/structure that it's in is not understood by OSCAR. I have another post that I have requested assistance from OSCAR developers on how I can get the data integrated into OSCAR. I am hoping that extensive data, can enable the MD to write me a VAuto that will be covered by my insurance company.

I am most definitely not an expert on CPAP treatment but have looked at my own charts in detail. Here is what I see in your charts.

Overall the numbers look good, as you know. But quality of sleep is more important than the numbers. I recently went through an extensive process of trying to figure out why I was still so fatigued despite "good" numbers (average AHI about 1.7). The result for me was switching from an AutoSet to a VAuto and using EERS (Enhanced Expiratory Rebreathing Space). My AHI now averages under .5, sometimes I even see 0.0, and I feel more rested.

You have a sporadic increase in flow limits that drives the increase in pressure (as it is supposed to). And during those periods of pressure increase your tidal volume drops and your respiration rate increases -- suggesting shallower, faster, but irregular breathing. I would think that might disturb your sleep in itself.

Might the pressure increase itself be disturbing your sleep? You could try fixed pressure and see if that makes any difference.

I will try and shift to a CPAP mode for a week or two to see what it does?

Looking at the flow chart itself, I see that it sometimes looks like a solid bar, while at other times it looks "fuzzy." If you are breathing regularly, with minimal variation in breath-to-breath volume, the flow graph will look like a solid bar. The fuzzier the bar, the more varied the breaths. I suggest zooming in so only 10 minutes is shown. Do that both where the bar looks solid and where it is fuzzy. Maybe one around a CA too.

I'll work on some screenshots and add them shortly.

[Mchezaji]

One of the things that I have noticed is that my respiration rate on most nights averages around 11.20-11.60.

Is there anything in the inspiration, respiration or minute ventilation that you guys see that raises any flags?

Adding a few screenshots from last night.

Thank you for contributing to the discussion mper!? Hopefully, we are able to have discussions that can help both our cases and other members as well. This forum is such a great resource for those of us who are dealing with sleep disorders.

I have included answers to you questions below- also working on the screenshots. How do I add a median line to the graphs? I looked and couldn't find an option that I could identify.

Hi,

_ Interesting this one more limb case kind of "low AHI-very long duration sleep/not feeling good", which I have seen so many times around. All these limb/lingering cases, which one way or another have to do with mine (main drawback is arousal/awakenings-UARS-related, with difficulties to maintain REM sleep complete episodes, sometimes leading to not always good night sleeps) usually call my attention;

_ As Pugsy and others commonly say: many possiblities could be involved. Tough cases! We could eventually add somethinng trying to narrow down some of those. At worst scenario, maybe I could learn something else on my own case;

_ I think preliminarily see you facing problems with flagged flows limitation/increasing pressures at some 90min schedule. Trying to go further, could you please post some 10min-duration windows (somebody already asked this) where your pressures get higher?...scales could be max 700 for TV; -100 to 100 for FR ?; complete parameters table on the left? It could be instructive, if possible, see how often you have arousals/awakenings,to begin with;

_ couple of questions:
(a) do you sleep on your backs or sides? On my back most of the time. I have some issues that prevent me from sleeping on the side.
(b) have you experienced the soft collar? No, I currently do use a chin strap. Forgot to add that in my post.
(c) if you don't mind: what kind of medications you are on; your height and weight? I am 5-11 and 195Lbs. Take blood pressure medication and some pain meds at times.

all the best and good luck