How is my wife doing based upon these two screenshots from OSCAR

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
Jeffj318
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Re: How is my wife doing based upon these two screenshots from OSCAR

Post by Jeffj318 » Sun Jul 18, 2021 9:18 pm

Thank you so much, Pugsy, for taking the time to read OSCAR.
I informed my wife and we are good to go.
She is sleeping well and feels much better with CPAP plus stopping maintenance chemo as per Johns Hopkins.
She received a second opinion and that was a Godsend. Kind regards to you!
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Jeffj318
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Re: How is my wife doing based upon these two screenshots from OSCAR

Post by Jeffj318 » Thu Jul 22, 2021 7:03 pm

Here is last night's OSCAR screenshot. MyAir said 20/20 for leaks knowing MyAir is very basic. Looks like from OSCAR it is scattered although Michele is sleeping well.
Should a leak rate be scattered or more flat line? She might try the gel nasal pillows for the same Dreamwear mask that she is now using the nasal cushion.
The last time she tried pillows were with a different mask and she did not like them.
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Pugsy
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Re: How is my wife doing based upon these two screenshots from OSCAR

Post by Pugsy » Thu Jul 22, 2021 8:49 pm

Leak lines don't have to be real pretty. We all know mine sure aren't.
So they don't have to be flat or 0.0 or real pretty as long as they aren't waking us up or going really deep into large leak territory for prolonged periods of time.

While it's nice to have bragging rights for a nice perfect 0.0 flat line so we can pat ourselves on the back, it's not really necessary in terms of effective therapy. The machine can compensate for substantial leak before it runs into trouble in terms of affecting therapy itself.
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Re: How is my wife doing based upon these two screenshots from OSCAR

Post by BlueDragon » Fri Jul 23, 2021 12:08 am

It sounds like the therapy is working for your wife. That's great!

The chart shows a very large number of flow imitations. If you wanted, you could try setting EPR to 2. In addition to making exhalation easier, introducing some EPR usually reduces the number of flow limitations. Since the CPAP machine responds to flow limitations with pressure increases, the average pressure might be lower. At a lower pressure, you might see fewer leaks.

EPR sometimes results in an increase in central apneas and AHI, which can be worse than when you started. The only way to tell is to try it and see.
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Jeffj318
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Re: How is my wife doing based upon these two screenshots from OSCAR

Post by Jeffj318 » Fri Jul 23, 2021 10:00 am

BlueDragon wrote:
Fri Jul 23, 2021 12:08 am
It sounds like the therapy is working for your wife. That's great!

The chart shows a very large number of flow imitations. If you wanted, you could try setting EPR to 2. In addition to making exhalation easier, introducing some EPR usually reduces the number of flow limitations. Since the CPAP machine responds to flow limitations with pressure increases, the average pressure might be lower. At lower pressure, you might see fewer leaks.

EPR sometimes results in an increase in central apneas and AHI, which can be worse than when you started. The only way to tell is to try it and see.
Since her AHI numbers are good maybe skip trying the EPR?
I have the machine set on Auto For Her mode. Would it possibly make a difference if she used just the Auto mode?
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Re: How is my wife doing based upon these two screenshots from OSCAR

Post by Pugsy » Fri Jul 23, 2021 10:40 am

The for Her auto mode seems to make for more active FL graphs.
That mode looks for FLs it seems. I know I have used both modes and the for her mode always looked worse.

I forget...any nasal congestion going on? If so, that might account for some of the ugly in the FL graph and you really can't fix ugly FL graphs from nasal congestion with setting tweaking. Have to instead fix the nasal congestion the usual ways.

Given your wife's history and she's now sleeping good and feeling better I don't know that I would be in any rush to go messing with settings.
Sometimes we just have to sort of shrug our shoulders with a not so pretty FL graph...and while it isn't pretty....I have seen much worse.

If you were to change to the other auto mode the FL graph would likely be a bit less ugly but the machine might increase the pressure more and that might cause some sleep problems.
My thought is if there aren't any problems now...don't go screwing with things and maybe create problems.
Now if she was complaining of poor sleep quality and feeling sleep deprived....then maybe play with the settings a bit.
But with her history and she is so fragile as it is....I don't know if I would be in any hurry to try to tweak things to maybe make things better because it might make things worse.

Though EPR is quite nice and you might offer it to her and have her try it while awake and see if she likes it or not.
Let her decide.
I love it myself but other people don't and that's okay.
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Jeffj318
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Re: How is my wife doing based upon these two screenshots from OSCAR

Post by Jeffj318 » Fri Jul 23, 2021 11:23 am

OMG! I can count on you, Pugsy, for the complete answers in detail.
Yes, she has been congested and starting taking Allegra-D for the last three days.

Lo and behold, she said she fiddled with her nasal cushion and pushed it closer to her nose, and voila! She got what you see last night.
She said she did not sleep that well, however, the CPAP was used for the entire duration of the night.
The leak rate looks incredible. How is everything else based upon one night?
Would you suggest raising the beginning pressure from 7 to maybe 8 or 9 as that seems to be where she heads very quickly? She does not use ramp anymore and this seems okay with her.
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Re: How is my wife doing based upon these two screenshots from OSCAR

Post by Pugsy » Fri Jul 23, 2021 11:50 am

The machine is increasing the pressure in response to the increased flow limitations but if that is nasal congestion....doesn't matter how high it will go because it can't fix nasal congestion issues with more pressure.

So yes, the machine is essentially setting a new minimum pressure going up and staying up but it really won't do much to reduce the FLs if you did increase the minimum because it is trying to fix something with more pressure that can't be fixed with more pressure.
The machine only measures air flow and it is sensing a reduction but the reduction is in the nasal cavity and not down the airway where OSA happens. It doesn't know that the reduction in air flow is in the nose but it will for sure try to fix it.

I suspect even if we used 20 cm all night long the FL graph would still be ugly and her sleep would be like crap just because of the pressure.

Now you could go ahead and increase that minimum if you wish but if you do I would for sure add in EPR because she might have trouble exhaling at the higher minimum.

You can do experiments if she is willing and comfortable but there is no urgent need to do them.
She might like EPR....I found it helped me actually be more comfortable and sleep a little better. Gotta be comfortable first to have any chance of decent sleep.

I think minimum of 10 with EPR of 3...would be a good experiment to try.
She might hate it...or she might love it.
When it comes to experiments I always say that we always learn something....now it might be that all we learn is what a bad idea that was but we still learned. You never know till you try.

Always, always ask her if she is comfortable though. If she isn't comfortable and doesn't like the way it feels then she's not going to sleep good and the primary reason we do all this cpap stuff....sleep good because without sleep nothing of this other stuff matters does it?
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Jeffj318
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Re: How is my wife doing based upon these two screenshots from OSCAR

Post by Jeffj318 » Sat Jul 24, 2021 11:52 am

Thanks, Pugsy, for all the info.

I think we shall leave well enough alone for now. She seems fine with her sleep, does not wake at night usually, and has not had a need for a long afternoon nap in quite some time.
She says she is fine with the air coming in and does not have a problem. Would changing the EPR from 0 to 1 do anything different for her?

She is in remission or what they call NED (no evidence of disease) for now although Stage 4 can return at any time anywhere. She needs scans and bloodwork every three months.
She changed oncology centers and is going with Johns Hopkins who gave the second opinion and recommended stopping maintenance chemo for now.
All she wants to be able to do is put on her mask, adjust her nasal cushion and go to sleep. I do all the rest for her such as cleaning, water chamber, etc.
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Jeffj318
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Re: How is my wife doing based upon these two screenshots from OSCAR

Post by Jeffj318 » Tue Sep 14, 2021 11:19 am

"I think a minimum of 10 with EPR of 3...would be a good experiment to try.
She might hate it...or she might love it.
When it comes to experiments I always say that we always learn something....now it might be that all we learn is what a bad idea that was but we still learned. You never know till you try."

She sleeps through the night and seems refreshed for the day upon waking and some coffee LOL.
Do I dare try the EPR of 3 with a minimum of 10?

Currently, she starts out at 7 which I increased from her generic ramp up of 4. No ramp now. Starts at 7 and then falls asleep quickly and goes up to her "normal" 11 or around that range.
She said she does not feel any problems as she sleeps with exhaling.
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Okie bipap
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Re: How is my wife doing based upon these two screenshots from OSCAR

Post by Okie bipap » Tue Sep 14, 2021 2:59 pm

The only way to know for sure is to try it. I have made numerous changes to my wife's machine and she has never noticed. Start off with EPR of 2 rather than 3.
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Re: How is my wife doing based upon these two screenshots from OSCAR

Post by zonker » Tue Sep 14, 2021 4:41 pm

Okie bipap wrote:
Tue Sep 14, 2021 2:59 pm
The only way to know for sure is to try it. I have made numerous changes to my wife's machine and she has never noticed. Start off with EPR of 2 rather than 3.
you know, i think that's the key. don't tell 'em. don't make a production out of it. and see how it goes.
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1.
2.
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