CPAP data from OSCAR, plus OX data, questions about AirCurve 10 ASV pressure settings for pillows vs full face

[MichaelWD64]

Also if it is possible to post a typical day from when you were using the full face mask, that would also be useful.

My FFM (SleepyHead) vs Nasal Pillows (OSCAR) stats, 2 images:
Edit:
https://imgur.com/a/BtiJCGm

Thank you for your patience.
Michael

[palerider]

I hope they're how you need. I had to put them together from 3 shots each, I explained in the post above....Nothing I'm doing (including F12) allows me to take the whole page below the bottom of the screen. I searched for a solution here, and in OSCAR HELP. Nothing.

Nobody has ever *asked* for "the whole page below the bottom of the screen".

Please go back and re-read this:wiki/index.php/Oscar:organize or this: viewtopic/t172378/Sticky--Newbies-PLEAS ... 812ac795b5 or both.

[MichaelWD64]

I hope they're how you need. I had to put them together from 3 shots each, I explained in the post above....Nothing I'm doing (including F12) allows me to take the whole page below the bottom of the screen. I searched for a solution here, and in OSCAR HELP. Nothing.

Nobody has ever *asked* for "the whole page below the bottom of the screen".

Please go back and re-read this:wiki/index.php/Oscar:organize or this: viewtopic/t172378/Sticky--Newbies-PLEAS ... 812ac795b5 or both.

Thank you. No one told me before, and I didn't find it in a lot of searching. That one screenshot of it done right would save a lot of time on here, not just for me and you.

I believe this is in the correct format.
https://imgur.com/a/BtiJCGm

[palerider]

That one screenshot of it done right would save a lot of time on here, not just for me and you.

And that has been why people have repeatedly said "please read the first post on the forum", because both of the links above tell you how to arrange things so you only need to hit 'screenshot' once and post that.

My 'anger' that you decided to remark on was the frustration at you not having read, and followed that post, because that saves time for *everyone*, you included.

[MichaelWD64]

That one screenshot of it done right would save a lot of time on here, not just for me and you.

And that has been why people have repeatedly said "please read the first post on the forum", because both of the links above tell you how to arrange things so you only need to hit 'screenshot' once and post that.

My 'anger' that you decided to remark on was the frustration at you not having read, and followed that post, because that saves time for *everyone*, you included.

Did you tell me that before you started being hysterical at me? Your FIRST post to me this week was screechy. You could post ONE screenshot and save people time.

You're the only person over 14 I've seen on any forum who has an enemies list for a sig line.

I read a bunch of your posts. You don't suffer fools, true.

But you also START conversations with people from a point of anger. You over-screech to the point I bet you're driving noobies off here who go die because you scared them off.

I'm fine, I will continue to do CPAP whether you stamp your feet or not. But people who come in here near death gasping to breathe, I bet you've driven a few off who would still be here if you'd simply ignored them. That's not hyperbole. People starting CPAP can be incredibly frail, and give up easily, because it's such a drastic thing to start, and they're usually in horrible shape when they start.

You're doing more harm than good from what I can see.

I bet dollars to doughnuts you're divorced.

[robysue1]

Also if it is possible to post a typical day from when you were using the full face mask, that would also be useful.

My FFM (SleepyHead) vs Nasal Pillows (OSCAR) stats, 2 images:
Edit:
https://imgur.com/a/BtiJCGm

Thank you for your patience.
Michael

I know that you know immediately which one is the one with the Full Face mask and which isn't. But I don't. And this makes it much harder on me to say what I want to say about things that I see (or don't see) in the two sets of data.

Could you perhaps post two separate links and identify what is in each specific link?

In other words, write something like:

Here's my data using the full face mask: put_the_link_for_the_full_face_data_here.

And here's my data using the pillows mask: put_the_link_for_the_pillows_mask_here.

It would be even better if you used Imgur's BBCode button to copy & paste the link so that it embeds the image as an image instead of just providing the link.

Or you can use the little icon with the picture of a mountain and sun in the cpaptalk edit window to get an image tag and then paste the link inside the image tag.

[palerider]

You're the only person over 14 I've seen on any forum who has an enemies list for a sig line.

Oh, if only you knew.

First, I'm not the person that started that.

Two, they're not *enemies* they're *idiots*. There's a very important distinction that I'm sure escapes you.

You're very much on the way to being an enemy, whether you're an idiot or not remains to be seen, but you're not posting garbage that misleads and may harm new people who don't know any better.

I read a bunch of your posts. You don't suffer fools, true.

But you also START conversations with people from a point of anger.

Only when dealing with fools.

You over-screech to the point I bet you're driving noobies off here who go die because you scared them off.

Those same newbies that *thank* me for helping them? that's a strange way for them to go off and die...

Oh, right, that's just another thing you're wrong about.

I bet dollars to doughnuts you're divorced.

Speaking of *OTHER* things you're wrong about.

Congrats, you'll be happy to know that you're on the foe (idiot) list, so you can be as patronizing and etc as you like, just shout into the void, I'm sure it'll make you happy, hopefully this tells you how little I care about what YOU think.

"Have a nice day", (and those that know me, know what I mean by that).

[MichaelWD64]

....Or you can use the little icon with the picture of a mountain and sun in the cpaptalk edit window to get an image tag and then paste the link inside the image tag.

Sure. Thank you. I appreciate it.
Nasal Pillows (OSCAR) stats from this week:


and
My FFM stats from last time I used SleepyHead:

[robysue1]

I want to remind myself of the issue you are trying to fix. At the start of this thread you wrote:

7 years well treated, obstructive apnea, and central apnea. 58 year old male.

Recently got new machine. Decided to switch over from FFM to pillows. I like them. But my old mask settings feel too high on pillows. Like air-boarding me, blowing me awake over and over.
I lowed them and like the results, and am getting good data.

Use machine with 2 liters oxygen.

So, as I understand things:

1) You have been using an ASV machine for a long time because your diagnostic test showed both OSA and CSA.

2) You do use supplemental O2 at night at 2 L/min when you are using your machine. I assume that the oxygen is fed into the tube either through a special hose with the appropriate port for connecting the O2 cannula or through an oxygen connector port that fits between the machine and the hose. Is that correct?

3) You were not waking up over and over feeling like the machine was air-boarding you when you used a full face mask. Your OSA and CSA were well controlled (in terms of AHI) when using the full face mask and supplemental O2. And you were waking up in the morning feeling pretty good.

4) You switched to a nasal pillows mask, kept the same machine settings, and you started waking up over and over feeling like the machine is air-boarding you. The data still showed the OSA and CSA were well controlled. The problem is you're waking up all night long feeling like the machine is air-boarding you.

5) You have drastically reduced the min EPAP, Max IPAP, and Max PS settings on your machine since starting to use the nasal pillows. Your old settings were:

• OLD WITH MASK
• ASVAuto
• Min EPAP: 14
• Max EPAP: 15
• Min PS: 0
• Max PS: 11

And your new settings are:

• CURRENT WITH PILLOWS:
• ASVAuto
• Min EPAP: 8
• Max EPAP: 11
• Min PS: 0
• Max PS: 7

With the new settings, your AHI has deteriorated a bit, but not enough to worry about if you were getting better quality sleep all around and feeling as good as you were before you started using the pillows.

6) You have an unusual hose set up that lets you wander from your bed all around the bedroom and to the bathroom without turning the machine off and taking your mask off or disconnecting it from the machine:

I was getting ready for bed. I have two hoses put together, I can reach the bathroom and all over my room.

So my questions are:

Q1) When you are moving around in the bedroom or going to the bathroom, do you ever notice the machine increasing the IPAP and PS pressures? Do you ever feel like the machine is air-boarding you when you are moving around the bedroom or going to the bathroom? Or does the air-boarding sensation happen only when you are half-awake coming out of sleep?

Q2) With the new settings, are you still waking up multiple times a night feeling like the machine is air-boarding you? Or has lowering the pressure eliminated the problem?

Q3) When you get up in the morning are you feeling better, worse, or about the same as you felt when you were using the full face mask?


Now here's the FFM data from SleepyHead that you posted:
My FFM stats from last time I used SleepyHead:

Any chance you can find a day where SleepyHead shows you the Flow Rate graph as well as the Pressure Graph, the Leak Graph, and the Flow Limitation graph the way your Oscar data is set up? We kind of need that Flow Rate graph from both the FFM data and the nasal pillows data.

But to plow ahead anyway: From a therapy point of view, there's not actually difference between an AHI = 1.37 (FFM) and AHI = 2.38 provided the patient is getting enough sleep and wakes up feeling rested, refreshed, and has enough energy to get through the day. That's why the answer to my Q3 is so important.

Here's your OSCAR data from the nasal pillows session:
Nasal Pillows (OSCAR) stats from this week:

Were you moving around the room, using the bathroom, ect. while awake between 20:50 and 21:20? If so those apneas are not "real", but the pressure curve is real enough. This is the period during this session when your pressures were at their highest. It's also when your PS was quite high. (Visually PS is the length of the red spikes in the pressure curve.) And so it begs the question: During that time frame, did you feel like the machine was air-boarding you?

And if that's not when you were feeling like you were being air-boarded, can you give us a time frame where you do remember waking up feeling like you were being air-boarded?

Other things that I can tell from your data that might (or might not) be related to your feeling of being airboarded when using the nasal pillows:

On the nasal pillows night, your 95% PS level was about 5.5 cm. (where 95% PS = 95% IPAP - 95% EPAP)
On the full face mask night, your 95% PS level was about 4.1 cm. (where 95% PS = 95% IPAP - 95% EPAP)

So even though you've lowered both max IPAP and max PS, the machine is finding a central-apnea type breathing pattern where it increases the difference between EPAP and IPAP more than it was when you were using a full face mask. And it could be that having IPAP = EPAP + 5.5 is more uncomfortable for you than having IPAP = EPAP + 4.1 regardless of what the EPAP level itself happens to be. And since the 95% PS has increased by 1.5 cm between these two nights, it's just possible that even with the lower EPAP level, what you are noticing when you feel like the machine is waterboarding you is the additional increase in pressure over current EPAP on the inhalations where PS is at its largest.

And on the nasal pillows night, there appears to be a lot more time where the red spikes in IPAP are a lot longer (representing higher PS) than there is on the full face mask night.

And then add to all of this: When the machine increases pressure drastically because of the ASV algorithm, it has to suddenly blow a lot more air into the "semi-closed system" comprising the machine, the hose(s), the mask, and your upper airway. With nasal pillows, all that additional air has to be blown through the two nasal cones, whereas in the full face mask, the additional air is more dispersed through the whole mask. (But note: There's more volume in that full face mask that has to have the pressure increased within it, and that means more air has to be blown into the system.)

And then add in the fact that some people's nostril are more sensitive to the additional air being added to increase the pressure than other people's noses are. My husband cannot tolerate the air blowing directly into his nostrils in a nasal pillows mask, and for years he opted for a nasal mask; he now uses a full face mask because he prefers it---it's "less stuffy" and "doesn't have as powerful of an airstream" to his perception as either the nasal mask or the pillows mask. Me? My nose can't feel the air movement if I have my pillows properly adjusted, but I can't stand the sensation of air blowing on the top of my nose in a nasal mask or a full face mask.

I'll end with these observations:

If lowering the Min EPAP, Max IPAP, and Max PS has eliminated the problem of waking up over and over feeling like the machine is air-boarding you AND if your AHI is still well under 5.0 night after night AND if you are feeling as good (or better) when you wake up in the morning, then I think you can just leave the setting where they are and enjoy the sleep.

But if lowering the Min EPAP, Max IPAP, and Max PS has not eliminated or minimized the problem of waking up over and over feeling like the machine is air-boarding you, then you've got a problem to fix. And one fix would be to go back to the full face mask and its settings. Or you could prudently experiment with further lowering of select settings to see if the air-boarding problem can be minimized without an unacceptable increase in AHI.

If lowering the Min EPAP, Max IPAP, and Max PS leads to too many days where your AHI is higher than you want to see it or the AHI starts creeping up to 5 and you start having more 5+ day than you want, then you've got a problem to fix: You'll need more pressure if you want to use the pillows or you'll need to go back to the full face mask and its settings. Whether you can find set of pressure settings that manages the OSA & CSA while not triggering the air-boarding would require some careful dial-wingin'

And finally, if you are feeling worse when you wake up in the morning when using the pillows at the lower pressure settings, then you've got a problem. Fixing the problem requires figuring out the right compromise between pressure settings, tolerance of the air-boarding sensation, and making a decision about whether the nasal pillows are worth the work or whether returning to the full face mask is the best solution.

[MichaelWD64]

Thank you! Very detailed. I read it all, but I'm sleepy and going to bed soon. I'll read again later and answer more. But, a few points to address some of it:

I've only slept 3 nights with pillows. Once for an hour, once for a few hours, and once for 6. First two I finished out the night with just oxygen. But I think I need more nights with pillows, and full 8 hour nights, to really answer "is it working." But it seems to be. And I did wake up pretty rested the night I did 6 hours and then got up without more sleep (last night.)

I think I can work up to full pressure, or at least close to it, with the pillows, if that's helpful. But I like the "maybe doesn't have to be quite as high" possibility. Really does feel like air-boarding, I guess as you said, because pressure in much smaller hole.

Yes, my oxygen goes into a specialty hose on my CPAP machine. Attaches where the hose attaches to the machine. I made the first one I had, with a drill and silicon sealant, but then found a provider that makes them.

The long hose: I started doing that when my old machine was dying, before I got my new one. It was still working but making a grinding sound. It was loud enough to make it harder to get to sleep, and stay asleep, so I just connected two hoses and moved it further away. It's not super long, my bathroom is right next to where I sleep. I sleep in a recliner chair, not a bed, something I started at a pulmonologist's nurse's suggestion when I first got on CPAP.

It took me 6 months to get a new machine, and the last month my machine started barely working, so I just went on oxygen for a month. I measured oxygen overnight and it was fine. I woke up refreshed. I think I still need CPAP but accidentally discovered in that month that I'm not nearly as dependent on it as I was when I first got on. Also if I have trouble sleeping (sometimes do), sometimes it helps me to move to a different room / chair, and get I use only oxygen when I do that.

I'd also say for anyone having fluid in their lungs, lifting my bed up 4 inches under the pillow with bricks before I got the recliner made immediate difference overnight. Even being at that slight an angle. Note if anyone does that, if you have pets, they will try to get under the new space. I stuffed mine, filled it up with an old blanket so the cats can't get in there and get stuck.

Thank you so much for your thoughtful help and analysis, and taking the time to write it up in a clear way.

What is a good resource to learn to better interpret these CPAP stats? (here or elsewhere).

Have a wonderful rest of the day / week/ etc.

Michael

[Rubicon]

I sleep in a recliner chair, not a bed, something I started at a pulmonologist's nurse's suggestion when I first got on CPAP.

It took me 6 months to get a new machine, and the last month my machine started barely working, so I just went on oxygen for a month. I measured oxygen overnight and it was fine. I woke up refreshed. I think I still need CPAP but accidentally discovered in that month that I'm not nearly as dependent on it as I was when I first got on. Also if I have trouble sleeping (sometimes do), sometimes it helps me to move to a different room / chair, and get I use only oxygen when I do that.

I'd also say for anyone having fluid in their lungs, lifting my bed up 4 inches under the pillow with bricks before I got the recliner made immediate difference overnight. Even being at that slight an angle.

Y'know, IIWM I would rethink the entire process, starting with:

Was your initial sleep study done in a flat bed or a reclining chair?

Do you have a Pulmonary Function Test?

What exactly is the biggest problem? Asthma? COPD? CHF? OSA? CSA?

You might want to look at breath-by-breath to see if events are really being addressed (ASV AHI is otherwise known as "The Big Lie")(OK I made that up) and if there's expiratory flow limitation.

[MichaelWD64]

Y'know, IIWM I would rethink the entire process, starting with:

Was your initial sleep study done in a flat bed or a reclining chair?

Do you have a Pulmonary Function Test?

What exactly is the biggest problem? Asthma? COPD? CHF? OSA? CSA?

You might want to look at breath-by-breath to see if events are really being addressed (ASV AHI is otherwise known as "The Big Lie")(OK I made that up) and if there's expiratory flow limitation.

By "ASV AHI is otherwise known as The Big Lie" do you mean it's too simple of a metric on its own?

What's a good resource, here or elsewhere, to learn to interpret these OSCAR charts?

Thank you.
Michael

[Rubicon]

By "ASV AHI is otherwise known as The Big Lie" do you mean it's too simple of a metric on its own?

No. ASV will send in breaths whenever it sees an apnea so it's pretty much impossible to have scored apneas or hypopneas.

However, that doesn't mean you're not having apneas-- AAMOF, if there's an ASV attack happening you ARE having an apnea.

So is that good for oxygen saturation? Usually.

Does that guarantee sleep continuity? Can't tell w/o EEG, but often not.

[MichaelWD64]

By "ASV AHI is otherwise known as The Big Lie" do you mean it's too simple of a metric on its own?

No. ASV will send in breaths whenever it sees an apnea so it's pretty much impossible to have scored apneas or hypopneas.

However, that doesn't mean you're not having apneas-- AAMOF, if there's an ASV attack happening you ARE having an apnea.

So is that good for oxygen saturation? Usually.

Does that guarantee sleep continuity? Can't tell w/o EEG, but often not.

Ah. Thank you. Well, my wife said I almost never gasp for air like a drowning fish on CPAP the way I did before. And I have a pulse ox, my oxygen is about 92-94 all night.

[Rubicon]

Same patient, AHI = 0.0: