YEA My First Oscar submission

[palerider]

For what it's worth, I agree with Pugsy's interpretation of the charts she posted.

[scf]

Palerider, your opinion is worth a lot, never doubt it. I will reduce the EPR to 1. I have never had a problem with any pressures anyway as far as them bothering me one way or another. And I know I need to raise the min from 7 to 8 or 9. I will do that after we see what the lowering of EPR does. Thank you so much.

Pugsy, for the last 3 nights I have slept better than I have since I started APAP in September.

[palerider]

Palerider, your opinion is worth a lot, never doubt it. I will reduce the EPR to 1. I have never had a problem with any pressures anyway as far as them bothering me one way or another. And I know I need to raise the min from 7 to 8 or 9. I will do that after we see what the lowering of EPR does. Thank you so much.

Pugsy, for the last 3 nights I have slept better than I have since I started APAP in September.

Lowering the EPR will have the effect of raising your minimum pressure, since EPR is a pressure drop from what's set.

[Pugsy]

So...I reviewed last night's report in detail.
84% of the AHI are false positives....arousal/awake related breathing flagged events. and pretty much all were centrals.
8% of the AHI were real asleep flagged events...one OA and 4 centrals which look like sleep onset centrals to me.
8% of the AHI were what I call "maybe" events because they weren't real easy to decide asleep vs arousal. couple of hyponeas and 4 centrals which may also have been sleep onset centrals.
So roughly 9.3 of that AHI of 11.47 from last night was arousal related or false positives.

Tons of episodes of arousal breathing...some brief and some prolonged.
On paper....crappy sleep quality but OP reports actually sleeping decently last 3 nights.
Upon further discussion OP does take some meds that are known to mess with sleep quality or cause insomnia. Definitely could be a factor in the arousals.

The flow limitation graph is fairly active and the flow rate breaths confirm the FL looking "chair like appearance" quite often.
I am unsure of the FLs themselves are a factor in the arousals or not. Need to have the usual nasal congestion question first.
The arousals seem to happen out of the blue and not related to any reduction in airflow itself. Nice normal breathing is seen and then wham...big arousal. Not necessarily preceded with a lot of flow limited breaths either.

So medication side effects can be a factor and FLs could potentially be a factor....impossible to know for sure how much either might be but the meds are needed for sure...so can't be altered at least at this time. They are critical meds.
The FLs....an unknown but a maybe factor (assuming not nasal related) and we can try increasing the pressure a bit (via reducing EPR at this time just to see if it affects centrals or not as well as the FLs) and see what happens with the arousals.

About all we can do is try some pressure tweaks and see what happens... Experiment...but at no point to we want to sacrifice her perception of her sleep (says last 3 nights have been the best so far) just to get prettier reports.
She's not complaining of crappy sleep quality now....so we sure don't want to make her sleep worse just to get nice low numbers. Remember we may be dealing with medication side effects here as well.
So any experiments...small changes for sure. Nothing drastic for sure.

All this assuming we aren't dealing with nasal congestion FLs here.....if we are we have a totally different discussion.

Some more screen shots below that show obvious asleep vs arousal breathing...

Here's one where I think the leak caused the arousal.

scfleak.PNG

Here's on where she went back to sleep after the leak caused arousal.

scfpostleak.PNG

just a general arousal followed by a central but I think it is arousal related and not a real asleep central

scfarousal1.PNG

[scf]

Palerider, your opinion is worth a lot, never doubt it. I will reduce the EPR to 1. I have never had a problem with any pressures anyway as far as them bothering me one way or another. And I know I need to raise the min from 7 to 8 or 9. I will do that after we see what the lowering of EPR does. Thank you so much.

Pugsy, for the last 3 nights I have slept better than I have since I started APAP in September.

Lowering the EPR will have the effect of raising your minimum pressure, since EPR is a pressure drop from what's set.

Great!

[scf]

Wow Pugsy. Your taking the time to evaluate my data is above and beyond…I don’t know how to thank you enough. I watched all of the videos you recommended and read your article on interpreting Sleepyhead/Oscar, so this is becoming more understandable to me.

My perception that the last three nights were good sleep nights more than likely are biased by their being better than I have experienced in a year. Hopefully this will continue to improve. If not I can live with it.

If I have nasal congestion I am unaware of it? It feels like I am breathing fine.

Hugs and many thanks.

[Pugsy]

Update. Had a nice chat with OP this morning and we covered potential options as to what to do or try and see if we can improve on the sleep quality.

Short trial with EPR at 1 last night was a disaster....pretty much invited the aerophagia monster to move in and we all know that we don't sleep so great with him in residence.

We don't know for sure if the FLs are disturbing sleep or not but do know for sure that the presence of the aerophagia monster definitely disturbs sleep.

Several potential experiments were discussed and for now we are going to back way up and not worry about the FLs at this time. I know the machine wants to kill them but allowing the machine to kill something that we don't know for sure is impacting sleep quality will most likely create a problem with aerophagia.

Her OSA itself is well treated with fairly low pressures so we are going to try limiting the max to 8 to see if a tighter range keeps the aerophagia monster away....on the off chance that the numerous arousals we see are related to belly issues.
So lowering the minimum a bit and the max as well...and see what happens.
We fully understand that the machine will likely max out at 8 because it wants to kill those FLs (and there is no real nasal congestion to blame the FLs on) but right now the FLs are on the back burner and we are just trying to improve overall sleep quality and reduce the arousals.

Surprisingly even with the ugly reports...sleeping better than without cpap here lately and the bulk of the arousals she doesn't remember. Other health issues as well as medications known to mess with sleep are also a factor in overall sleep quality. Most likely a combination of things going on and not one clear cut culprit.
She does sound a lot like myself in terms of other health issues messing with sleep quality and we are going to do like I have done...try various little tweaks to see if we get lucky and sleep quality improves....or not.
Main difference is I never really had the aerophagia complication.

We aren't going to worry about the AHI numbers themselves unless we see a marked increase in OAs and hyponeas that are for sure asleep flagged events. We already know that probably 80 to 90 % of the AHI is arousal/awake related anyway.
Hopefully we get lucky and can reduce the number of arousals and with that reduction the false positive flags will also reduce.
FLs are on the back burner for now because to kill them we know that will invite the aerophagia monster to move in and right now he's a known for sure problem and the FLs aren't a for sure problem.

[zonker]

Main difference is I never really had the aerophagia complication.

We aren't going to worry about the AHI numbers themselves unless we see a marked increase in OAs and hyponeas that are for sure asleep flagged events.

pretty much my attitude when i fought the aerophagia monster. i mean, what good is therapy if you can't sleep with a rock hard extended belly waking you up?

i took a different route. i just said screw it and started at the lowest minimum (left the max at 20) where aerophagia didn't trouble me. then slowly increased pressure until i could get accustomed to it.

interested to see how you and scf's approach works.

[scf]

pretty much my attitude when i fought the aerophagia monster. i mean, what good is therapy if you can't sleep with a rock hard extended belly waking you up?

i took a different route. i just said screw it and started at the lowest minimum (left the max at 20) where aerophagia didn't trouble me. then slowly increased pressure until i could get accustomed to it.

interested to see how you and scf's approach works.
[/quote]

Same here, especially since I have called the sleep clinic RN's, who gave me a card with contact numbers, three times over six weeks and have yet to receive one response.

[Pugsy]

Quick update.
Decided to address the aerophagia monster first with a reduction in minimum pressure and see if that doesn't allow too many OAs or hyponeas.
So minimum reduced to 5...last couple of nights no aerophagia and AHI has been 2 ish and all centrals.
Last night some leaks may have caused some arousals so some of the AHI could be false positive.

More importantly...no aerophagia issues and I think the reduction/elimination of the aerophagia issues has decreased the arousals...which then of course will decrease the arousal related false positive flagging.
She reports sleeping MUCH better overall and feeling decent. It's only been a couple of nights so we want to see how it goes but seem to be on the right track.

Remember we are still dealing with a 78 yr old with all the normal stuff that comes with aging and arthritis and some pain issues...so sleep may never be totally perfect...but the OSA is well treated...aerophagia seems to be gone...and with time the sleeping better overall should help a bit with how she feels during the day.
It may not be "perfect" but it is better than it was.

Sleep quality....extremely important because without it the numbers don't mean much.

[zonker]

Sleep quality....extremely important because without it the numbers don't mean much.

just to tag along on this. two + years ago, when i lived in flagstaff az, wife and i stayed overnight with her niece in mesa az. it was a horrible night of "sleep"! it was hotter than i'm comfortable with. i couldn't find a spot or position that felt right to me. i ended up just laying there in some sort of stupor. i honestly don't think i slept at all that night.

when we got back home, oscar reported my ahi for that night at zero.

go figure.

[scf]

[/quote]
Lowering the EPR will have the effect of raising your minimum pressure, since EPR is a pressure drop from what's set.
[/quote]

I am still doing homework and slowly beginning to catch on. I have a question that I cannot seem to find the answer for. If a minimum pressure is set on 5 and the EPR is on 3, I know that this does not work because it won't let the pressure go below 4. But does EPR reduce it to 4 anyway or do nothing. Might as well set it on 1 right?

[Pugsy]

If a minimum pressure is set on 5 and the EPR is on 3, I know that this does not work because it won't let the pressure go below 4. But does EPR reduce it to 4 anyway or do nothing. Might as well set it on 1 right?

Correct for the period of time that the pressure is at 5 cm but remember when using auto adjusting pressures that as the machine wants to go higher it can get to a point where there is more than a 1 cm reduction when EPR is set higher than 1.
If EPR is set to 3 and the machine goes to 6 cm for whatever reason then EPR can result in a reduction to 4 cm from the 6 cm...or if the machine wants to go to 8 cm...then EPR of 3 will end up with a drop to 5 cm during exhale.
If you set EPR to 1 cm...and the machine wants to go to 8 cm...then you only get a 1 cm drop during exhale down to 7 cm.
This is how reducing EPR effectively increases the overall average pressure during exhale.

[scf]

Sleep quality....extremely important because without it the numbers don't mean much.

just to tag along on this. two + years ago, when i lived in flagstaff az, wife and i stayed overnight with her niece in mesa az. it was a horrible night of "sleep"! it was hotter than i'm comfortable with. i couldn't find a spot or position that felt right to me. i ended up just laying there in some sort of stupor. i honestly don't think i slept at all that night.

when we got back home, oscar reported my ahi for that night at zero.

go figure.

Oscar is FABULOUS tool, but sometimes I think we have to take what it reports with a grain of salt considering the false events that pop up on mine. Knowledge is power. What I really mean is that one has to learn how to interpret it or it does not help in being knowledgeable about your own therapy.

[zonker]

Oscar is FABULOUS tool, but sometimes I think we have to take what it reports with a grain of salt considering the false events that pop up on mine. Knowledge is power. What I really mean is that one has to learn how to interpret it or it does not help in being knowledgeable about your own therapy.

yup. and one has to keep in mind that it's just recording events that happen while you sleep. it means that that one hypopnea or central or whatever happened because your machine wasn't able to respond to that event. but there is SO much more that impacts sleep in addition to apnea.

btw, did you know that oscar will allow you to "edit" the session so that you get rid of those clusters? this happened to me a LOT as a newbie; the transitions that crop up going into or out of sleep. by doing some fancy mouse work, you can highlight the period in between and see what your ahi was without the transitional events.

i believe it was pugsy who showed me that.