stroke and original ahi 53

[Cranksberry]

Background: My hb is a stroke patient and his spo2 will move up and down to below 60% at night when he sleeps. Started on a philips asv recently and ahi drop from 53 to current.
I would like to seek your help

a) are my leaks acceptable? or the low ahi coud be misrepresented cos of my leaks?
b) often, when i put on the mask for him, his spo2 drops and snoring will start and then stabilise about half an hour or 1 hr later. is this cos he is adjusting to the high pressure or could be neurological issue?
c) sometimes i put on the mask on him when he naps in the afternoon, how do i adjust the oscar data so that can only view the data at night (from a certain time onwards)
d) based on the data, is the pressure settings suitable for my hb or too high?


His dr is busy and hardly sees us. Thank you in advance for all your help

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[Pugsy]

a) are my leaks acceptable? or the low ahi coud be misrepresented cos of my leaks?

The machine isn't reporting any large leaks so I would assume that the AHI is accurate.
Respironics machines report leaks differently and what you see is actually what we would expect to see since the machine reports total leak which is the mask's vent rate plus any excess leak. At his pressures I would suspect he would need to be upwards of 90 L/min for the top leak line number which is the total leak number, for him to hit large leak territory.
The machine will flag a large leak if it happens.
If you were comparing ResMed leak numbers to Respironics leak numbers....don't. Different brands, different ways of reporting leaks, different large leak territories, different leak numbers where large leak territory begins.
Yes, these numbers seem high but that is because of the vent rate being added in. Higher pressures equal higher vent rates...vent rate is intentional leak rate. All masks have to vent.

b) often, when i put on the mask for him, his spo2 drops and snoring will start and then stabilize about half an hour or 1 hr later. is this cos he is adjusting to the high pressure or could be neurological issue?

I can't answer that question. It does look like he often seems to have a lot of events when just starting the sleep session and that would correlate with the drops in O2.
This maybe is related to sleep onset centrals (and a lot of them) but from what we see here it is impossible to know...and once the sleep onset centrals have passed then the centrals settle down once the machine is up and running and doing its job.

c) sometimes i put on the mask on him when he naps in the afternoon, how do i adjust the oscar data so that can only view the data at night (from a certain time onwards)

Impossible to know the cause for sure with the history of the stroke complicating things. Sorry.
Best to ask his doctor this question and see if he is concerned about the drops in O2 at the beginning of the night.

Anytime the machine is started and then stopped a sleep session is recorded.
You can omit short sleep session (like the naps) if you wish.
Look over on the left side of the detailed report and scroll all the way to the bottom below all the statistics and you will see a list of sleep sessions. You can hide the unwanted sleep session by clicking on that session and removing the check mark. Easy.

d) based on the data, is the pressure settings suitable for my hb or too high?

I don't see anything in the settings that would lead me to think that something needs urgently changed.
They seem suitable for someone with both OSA and central apnea which I think you said in past topics was his diagnosis and doesn't surprise me with a history of a serious stroke (which I think you also said this was). Not a minor stroke at all if I remember correctly.

[zonker]

Background: My hb is a stroke patient and his spo2 will move up and down to below 60% at night when he sleeps. Started on a philips asv recently and ahi drop from 53 to current.
I would like to seek your help

would you be so kind as to keep any further questions to just this one thread? it would make it easier for people to help you if they could see everything in one place.

thank you!

[Cranksberry]

Yes I will. Thank you all! Discovering Oscar and this help forum helped us a lot during this journey. I am thankful.

I am hoping with the drop in ahi, to see a increase in energy level. At the moment, my hb is still sleepy in the day.

[Respirator99]

sometimes i put on the mask on him when he naps in the afternoon, how do i adjust the oscar data so that can only view the data at night (from a certain time onwards)

Right at the bottom left of the screen is a bar with blue and yellow sub-bars. Click on these to turn sessions on or off.
.
.

Sub-bar.PNG

[Janknitz]

Cranksberry wrote: ↑Wed Jul 27, 2022 4:32 pm
b) often, when i put on the mask for him, his spo2 drops and snoring will start and then stabilize about half an hour or 1 hr later. is this cos he is adjusting to the high pressure or could be neurological issue?
I can't answer that question. It does look like he often seems to have a lot of events when just starting the sleep session and that would correlate with the drops in O2.
This maybe is related to sleep onset centrals (and a lot of them) but from what we see here it is impossible to know...and once the sleep onset centrals have passed then the centrals settle down once the machine is up and running and doing its job.

Pugsy, I'm not great at reading these, but it looks like there is a ramp setting and he is not getting up to a therapeutic pressure for some time. Could that be why the snoring and O2 drops are happening? Or am I misreading things?

[Pugsy]

Cranksberry wrote: ↑Wed Jul 27, 2022 4:32 pm
b) often, when i put on the mask for him, his spo2 drops and snoring will start and then stabilize about half an hour or 1 hr later. is this cos he is adjusting to the high pressure or could be neurological issue?
I can't answer that question. It does look like he often seems to have a lot of events when just starting the sleep session and that would correlate with the drops in O2.
This maybe is related to sleep onset centrals (and a lot of them) but from what we see here it is impossible to know...and once the sleep onset centrals have passed then the centrals settle down once the machine is up and running and doing its job.

Pugsy, I'm not great at reading these, but it looks like there is a ramp setting and he is not getting up to a therapeutic pressure for some time. Could that be why the snoring and O2 drops are happening? Or am I misreading things?

You aren't misreading things. I meant to mention this and then my mind got side tracked and didn't include it in my thoughts. Thank you for bringing this up.

The very first short segment on the left doesn't appear to be using ramp but the long segment does.
Not sure why. Perhaps he found the higher pressures just too uncomfortable to bear.

So with ramp the EPAP is 5 and with PS of 4 to start with...that means IPAP is 9.
Once the pressure gets up to the minimum EPAP of 12 then that means IPAP is 16.

It does appear that once EPAP/IPAP makes it up to 12/16 that the obstructive apneas are being fairly well prevented and the pressure stabilizes for the most part. We don't even see a lot of PS increases so we would assume not much in the central apnea department.

The short segment on the left with no apparent ramp also shows some clustering of events ...but I do wonder if those are just false positives and he wasn't asleep or at least sound asleep. Appears to be a short nap or attempted nap.

Perhaps the wife could try maybe a shorter ramp period if the hubby can't handle full pressure right off the bat.

I also wonder if maybe a little bit more minimum EPAP might be of benefit but I really hesitate to suggest that change unless I was seeing a lot more OAs/hyponeas than we are seeing due to his grave history. If we remove the short nap from the numbers his AHI would probably be cut in half and that really brings it down to a more acceptable level so I just don't know if there is an urgent of enough need to go down that road.
This is the only real report I have seen from this patient and given the history I am not so quick to start changing much unless there is a critical need and I don't think and AHI of 2 ish is all that worrisome ...and this is the only report we see.

Looks like the ramp might be for maximum or near max time limits...maybe try cutting it in half if turning it off is just too difficult for the patient. The shorter the better....get up to where the prescribed settings can actually do their job in a more timely fashion.

[Cranksberry]

I am trying to understand this. Pls bear with me. Some background:

We started on cpap early June. Then move on to bipap and now asv as my hb needed more than pressure 20 and he had Centrals.

Prior to current settings we have had
1. Backup rate was set at AUTO and that was the worst night ever and my hb couldn't breathe. I thought I was going to lose him that night. The next day, they removed the backup rate but it led to
2. The ahi increasing up to ahi 53 which composed of mostly Centrals. 53 was the ahi in the sleep test. With the Centrals occupying the bulk of the ahi for a couple of days, the vendor put back the backup rate which then reduced the centrals

3. What I do now is that sometimes when I put the mask on, I press the ramp a couple of times if I see my hb fidgeting. Am not sure if it is OK.

The Dr wants him to be on asv at least 8 hours a day and I am trying. Now we are managing about 4 to 5 hrs as he tends to crawl the mask off if he awakes at night. And when I put it on again when he zzz, he awakes again. I hope he adjusts to this soon. If he gets more alert in the day, I can start to bring in the speech therapist.

Thank you all again for yr help

[zonker]

I am trying to understand this.

it would really help us to help you it you could post some oscar charts. that would give is the information we need. the only thing that can be done now is guess. that won't do you any good at all. and forum members hate to guess.