Newbie Oscar results insight

[Nevergiveup13]

MPER!?,
Thank you for all of this new insight. I am going to have to look at it closer and try to decifer what it all means. Hahahaha. As I am still learning the lingo.

The good news is that I have upped my minimum number to 6 and it is not waking me up as badly. I am thinking about inching that up a little bit more. The other good news is since I have increased the minimum pressure, I have slept much better and am not waking up with the big blast of air. I am also down to 1/2 pill of benadryl. I am trying not to get too excited but its the best I have slept ever in I don't know how long. My aches are also improving and I am beginning to try and do more earlier in the day; my doctor has told me she thinks I have chronic fatigue and fibromyalgia and my pulmonologist said that sleep apnea causes both so I am hoping to get back to normal.

Palerider, I think I figured out the screenshot!

Somebody asked what kind of mask. I thought I had it on my signature but it is a dreamwear nasal pillow mask/headgear. Its pretty comfortable. I finally figured out that I hate having the tube out the front of my face but that it is much better off the top of my head where I can move around freely at night.

Do you all think I have a good seal? It seems like I do after reading my charts. I did notice last night waking up with a leak out of one of my nasal pillows.

Attached is my oscar charts from last night if you all have any other words of wisdom. Thank you all so much for your help!

[Julie]

Glad you're feeling a little better, but I strongly urge you to get new doctors... the ones you have are either so overworked they should quit for now, or else go back to school!

Your pulmonologist thinks apnea causes chronic fatigue and fibromyalgia? Seriously?

Run, don't walk to the nearest new doctors... maybe yours have been exposed to the brain eating amoeba!

[mper!?]

"the good news is that I have upped my minimum number to 6 and it is not waking me up as badly...."

Hi, Nevergiveup13

_ that is great! It looks like you are doing well, and, very important, paying close attention to your data/information. However, there would be plenty of room for improvements on your sleep quality, if you want in the future;

_leaks are doing pretty much OK (could be better, though); they are provoked by increases in pressures due to flagged FL, which your APAP try to correct;
_then, should you be able to decrease flagged FL, pressure would drop and maybe leak would follow;

_ flagged FL usually can not be corrected with APAP machines up to EPR 3.0, whatever are your Pmin, Pmax. Ultimate corrections for flagged Fl need Bilevel machines (VAUTO, for instance) and more Pressure Support, and, eventually, additional adjustments;

_your flagged FL are widespread night long. If were me, I would never live with this! Solution would be right on the corner with Bilevel, once you want, maybe;

_widespread flagged FL mean your respiration is flow-limited during the night. I would bet if you zoom in you would find out flatted-top inspiration all the way through. Fow-limited respiration means jeopardized TV/MV, as appears to be your case (very likely, an UARS person);

_ another thing, which, if were me, I also would not live with: an exertioned respiration. That means, Expiratory time/Inspiration time of 1.05 (that is, you are respiring as if you were running rather than just sleeping). This ratio should be about 1.8 to 2.1, somewhere;

PS: I am still not suggesting you should move as soon as you can to a Aircurve 10, VAUTO. Each case is each case. You may want to learn some more by yourself and keep experiencing on own therapy; this is good! Who knows?!
However, based on my personal experience (you might find something I posted on my case, somewhere above), that would be what I would do.

If I may, I would like to suggest you take a look on Steven Park’s book, Sleep Interrupted.



all the best

[Nevergiveup13]

Julie,
You are right about doctors! Because my sleep apnea is considered mild, these doctors think I am making some of this crap up! My PCP does not. She knows it’s not me because she has known me for years. I had to leave my town to go to a sleep neurologist and will discuss it with her on my follow up.

MPER?!,
Thanks again for the information and the book recommdation. I will take a look at that and digest all the information you mentioned. My insurance covers my machine I believe every 5 years so this is the one they have given me for now. I can’t afford another one at this time because lost my job and haven’t even gotten any disability money because it took them 8 months to figure out I had sleep apnea. I am working on that too!

I couldn’t fall asleep until really late last night after waking up with high level of pressure after 10 minutes and feel exhausted today. I always wake up after 10 minutes of falling asleep. In fact, I always have. I think it must be related to sleep apnea events right away. Thanks again for all of the suggestions.

[Okie bipap]

Over all, your leaks look good. You had one or two very short periods that show as large leaks. Total time in large leaks was less than 1% of the night. Even though your machine identified them as large leaks, they were well within the range where they do not affect how well your machine operates and treats your apnea.

[mper!?]

....... after waking up with high level of pressure after 10 minutes and feel exhausted today. I always wake up after 10 minutes of falling asleep. In fact, I always have. I think it must be related to sleep apnea events right away......

_ no sure whether or not sleep apnea, or just flow limitation/minor suffocation is enough to awkake us up (my case), very sensitive UARS people, maybe like you, I think;

_ I would like you to know these my thoughts on UARS, just for you think about:

As per literature, my own case, and some other cases I used to follow closely, strategies to treat UARS could be, maybe in this order:

(1) adequate sleep position, not on the backs, avoiding the so-called tongue collapse, in particular during REM (While dealing with thousands of cases, Drs. Guilleminaut, in particular his videos; Steven Park, his book Sleep Interrupted; Barry Krakow, his book Sound Sleep Sound Mind; and many others, made and have been making points on this positional drawbacks on UARS treatment);
(2) cervical collar (I used it, and help better-quality non-mouth breathing respiration), avoiding the so-called chin tucking, as per other Forum’s suggestions;
(3) BPAP, with properly balanced EPAPmin x PS;
(4) dental appliance, and
(5) surgery.

good luck

[Nevergiveup13]

Mper?!
Thanks for all of the information. I contacted my sleep doctor and provided her with all of this information and response below. Do you think I should give it a try with changed settings or go in for a titration study? I don't know if she had changed it prior to yesterday but last night going to sleep about 3-4 times the pressure was so suffocating for about an hour and then 5 hours later. When I woke up I had to take my cpap off to catch my breath for about 15 minutes and went back to sleep. Also could the I/E ratio not show up on an overnight sleep test if you don't really sleep well? And now that I am sleeping longer and better-more than 2 hours at a time-do apnea episodes increase? I didn't really sleep so great during my overnight study. Thanks!

...We can try to increase the room on apap but you do not have a whole lot of anything, obstructive or central. Most of what you have are centrals- which is normal and appear to cluster around awake / sleep transition. Raising the pressure with often increase the centrals. Not sure why the I/E times are off but honestly it appears that a few things do not make sense- like huge tidal volumes. There is no way you are moving that much air. You would have to grown significant since the last I saw you And there is certainly no concern that the upper airway resistance is jeopardizing the volumes. I will ask that they pull the original data / waveforms from your study to verify however. They usually would have noted something in the study reports if they had felt there was something off with the respiratory patterns. Unfortunately, sometimes equipment such as this can give more data or data that is not reliable enough to be clinically relevant. As far as bpap, you have very little hypopnea that would suggest significant ongoing airway collapse. I have sort of built in a bpap by putting in the epr of 3. From an insurance standpoint, bpap machines ( the mentioned aircurve etc) are only covered if the cpap cannot control the apneas ( meaning keeping less than 5 per hour) or if you cannot tolerate the cpap pressure. If you feel a generalized sensation of smothering from pressure , then a titration using bpap may be helpful. I would be happy send you for in lab titration. As well, as pointed out, oral appliance to keep the tongue positioned forward is also a very reasonable suggestion.

[mper!?]

I contacted my sleep doctor and provided her with all of this information and response below.....This is good! more people to analyse your case brings us comfort!.... Do you think I should give it a try with changed settings or go in for a titration study? ....well, as I said, you could try further with changing settings in APAP to learn more about your therapy. However, I am afraid I have never seen yet a single case in which, after already on EPR 3.0 and facing discomphort with pressures, person succeeded on taming his FL and arousals/awakenings by changing APAP pressures. Therefore, If were me, based on my own experience and observations of others struggling with APAP machines, that is what I would do: go for a BIPAP titration if you can. It could be a good re-start point...

I don't know if she had changed it prior to yesterday but last night going to sleep about 3-4 times the pressure was so suffocating for about an hour and then 5 hours later. When I woke up I had to take my cpap off to catch my breath for about 15 minutes and went back to sleep.......yes, bumps in pressures, while trying to correct FL, which APAP can not do usually, can be a very detrimental sleep problem from my own experience, so much so, I keep my BIPAP pressures fixed since long ago....., Also could the I/E ratio not show up on an overnight sleep test if you don't really sleep well?.....I don't think so...... And now that I am sleeping longer and better-more than 2 hours at a time-do apnea episodes increase?....it could be case, especially during REM stages, which likely you would have more of these..... I didn't really sleep so great during my overnight study..... this would not be important. What would count more in my modest opinion, would be you getting the BIPAP and go for your own titration (guided by Resmed guide, for instance).... Thanks!

...We can try to increase the room on apap but you do not have a whole lot of anything, obstructive or central. Most of what you have are centrals- which is normal and appear to cluster around awake / sleep transition......yes, I agree..... Raising the pressure with often increase the centrals..... well, maybe not necessariry, it would depend on machine and so forth..... Not sure why the I/E times are off but honestly it appears that a few things do not make sense- like huge tidal volumes........not so familiar with this, however your TV, 340/360 would be huge?...what is your height and weight?...what I would be missing here? There is no way you are moving that much air. You would have to grown significant since the last I saw you And there is certainly no concern that the upper airway resistance is jeopardizing the volumes. I will ask that they pull the original data / waveforms from your study to verify however......good!.... They usually would have noted something in the study reports if they had felt there was something off with the respiratory patterns......not sure, from my experience with Labs; today, I would always like to count on OSCAR outcomes to summ up, I am afraid.... Unfortunately, sometimes equipment such as this can give more data or data that is not reliable enough to be clinically relevant.....well, what can I say?... As far as bpap, you have very little hypopnea that would suggest significant ongoing airway collapse.......yes, but your respiration is flow-limited all night long, which keep arousal/awakening you.... I have sort of built in a bpap by putting in the epr of 3. From an insurance standpoint, bpap machines ( the mentioned aircurve etc) are only covered if the cpap cannot control the apneas ( meaning keeping less than 5 per hour).....well, this a pit insurances keep thinking this way, and not adressing such a deleterious ilment such UARS (used to bring me close to suicide, I am afraid), in which AHI is useless parameter in my modest opinion, and so many more well-based ones elsewhere.... or if you cannot tolerate the cpap pressure. If you feel a generalized sensation of smothering from pressure .....does not look to be the case?, then a titration using bpap may be helpful..... I would do this if were me ....I would be happy send you for in lab titration.....great! It would be a good start point . As well, as pointed out, oral appliance to keep the tongue positioned forward is also a very reasonable suggestion.....I don't have experience with MAD, and no nobody who had close, unfortunately. I have heard it would work more as a torture.... I would much prefer keep on trying with CPAP for a long while

Nevergiveup13, just to reinforce, I am not a Doctor, I have just letting you know my own three-year experience with brick CPAP, pretty much waisted time, I see today; APAP, the same, and BPAP (looks the straighforward solution for Fl/arousals/awakenings), as well as close observations/analyses on other people's cases.

Maybe some others could pop in and let us learn more on all this.

all the best and good luck

[Nevergiveup13]

Thank you and yes I understand. Last night was a better night with no suffocating. My dr increased my max pressure to 12 and the highest I got was 11.98 so that seemed to possibly help. My I/E ratio was 1.55 so that was better too. I think I may give the new settings some time and hopefully it will stay better. I also had only 1 hypopnea but a bunch of CAs toward waking up times. She mentioned those increase when increase pressure. I don’t really get that but it sounds as if they aren’t a big deal. Thanks again.

[mper!?]

Hi, Nevergiveup

_ I am feeling your case coult turn out to be very educational, maybe, as it has this parallel opinion of a real Doctor.

_ Just for us keep learning some more with your case, would you mind keep posting (once and while as you are stepping further) your full night charts, and some 10-min duration windows?

all the best

[Pugsy]

Central apneas flagged during known wake times don't count.
Hold your breath for 10 seconds. That's essentially a 10 second central apnea. The airway is open but no air is moving because you aren't making any effort to breath. We pause our breathing all the time while awake and simply don't realize it. So while awake or during the waking up process on the machine we still have those pauses. The machine only measures air flow....it has zero way to discount awake breathing air flow irregularities.

As for increases in pressure causing centrals...yes, sometimes that happens but it only matters if we see an increase in centrals when we know for sure we were asleep. Awake flagged anything simply doesn't matter.
When pressure (can be higher but can be as low as 5 cm) do cause central apneas they typically happen all night long...not just in a random grouping. It's a small percentage of people who are put on cpap that develop too many centrals.
A few real asleep centrals aren't a big deal so seeing a handful of even real asleep centrals isn't a reason to panic over a central flag. In fact it's normal to have a handful of centrals.

Central apneas are only a problem if they are so numerous they keep bouncing a person out of sleep or they cause desats.
Occasional 10 to 30 second central apneas (even if real) won't cause desats or bounce a person out of sleep.

Higher pressures don't always cause central apneas in all people. There are people using pressures starting out at a minimum in the high teens all night long and they don't have centrals pop up. Now there are a few people who might have essentially no centrals at say 10 cm and a truckload of centrals if they hit say 12 cm...but those people are in a really small minority. It's not nearly as common as people believe. I myself will see my pressure sometimes hit 15 to 18 cm during the night but I don't get centrals pop up with the higher pressure. Most of the time when we see people develop centrals with cpap pressures...it's any pressure and not just higher pressures.
Heck, I have seen people develop central sleep apnea with as little as 5 cm pressure.

People need to quit freaking out over a few centrals.
Number 1....most will be false positive awake flagging or SWJ sleep/wake/junk and they mean absolutely nothing except we weren't asleep.
Number 2....it's normal to have a few centrals that are real asleep centrals...it doesn't mean anything and a few short lived pauses in breathing won't hurt a person.
Number 3...even if someone does develop central sleep apnea and they have enough centrals to be a problem...there ware ways to deal with it. It's fixable and no reason to panic.

[Miss Emerita]

Nevergiveup, I see that your doctor didn't mention flow limitations as a potential problem to be addressed by greater EPR (pressure support). For some people, a lot of FL during the night can make for shallower sleep and more frequent wake-ups. In addition, the night-long additional effort to inhale can be tiring.

If it isn't too late to ask her about this, I'd suggest that you do that. If a titration with greater bi-level pressure support could pay attention to FLs, it would be well worth doing it.

However, as your doctor notes, your insurance may decline to pay for a bi-level machine, even if she believes it would improve your sleep. With a prescription from her, however, you could buy a bi-level machine yourself, if you can afford one. And sometimes forum member LSAT has lightly used bi-level machines for sale. That's how I got mine.

[Nevergiveup13]

All,
I have attached my last night oscar results with increase in pressure by my doctor to 12. I told her to wait for now on titration test to see how things go with new settings. I felt like I slept the longest I have ever slept last night though had a little difficulty falling asleep but not as much as before. I am less tired but still not energetic feeling, a little achey. Does that take a while once getting everything adjusted? I take it that my flow limitiation graph should be flat whereas mine is spiking all night. It looks as if my CA were closer to morning. I am taking benadryl to sleep maybe it has worn off later and I am having arousals, I don't know? Here is what my doctor said to my response...Glad you felt better. Interestingly, the pressure profile was identical to the 27th, 28th and 29th. Continue to monitor and let me know.



Mper?1, absolutely I will let you all know what is going on. It may not be right away but I will do my best.

Pugsy,
Thank you for the explanation about CA. I will continue to read that and digest it all. I am a work in progress!

Miss Emirita,
Thank you for addressing the flow limitations. I do not think my doctor can see flow limitations on her detailed report. Mine seem to be abnormal and something that may be helped with BIPAP is sounds (I guess my graph should be flat?). If I eventually have to go that route, I could purchase a machine. My insurance pays for all of my supplies with my machine so if I don't use the one they have purchased, I wonder if they still would- Insurance companies!!!

Thanks to everyone for your guidance!

[Pugsy]

Your flow limitations aren't that bad. See below for a really bad FL graph.
If you are having any nasal congestion at all that might account for your FL activity. If no nasal congestion to blame it on...a little more minimum might help reduce it but I would concentrate on just getting the sleep first and see how you feel.
That's really all that is available to help with the FLs at this point with your machine and it might just help but they aren't so bad that you urgently need to do something about them right at this moment. Before I would start worrying about a bilevel machine I would try making the current machine work and you still have options available with it.

[Nevergiveup13]

Pugsy,
Thanks and good point. I do have a deviated septum which makes it hard to breath easily even when awake out of my left nostril so maybe that’s the problem.