Help with statistics from OSCAR

G'day everyone, posting on behalf of my mother in law in hopes we can get some help. I have collected her CPAP data on OSCAR and to me it doesn't look good hoping for some more expert opinions.

Bit of background information - Mother in law is 52 years of age, diagnosed with sleep ap in 2013, Diagnosed as SEVERE. She has been using a nasal mask up until the 2nd of September this year when she switched over to the f20 full face mask to see if it made any difference, She has noted she feels a lot better and isn't having as many/as long of a day nap anymore.

Which is strange as OSCAR is still showing that she is spending at least a few minutes per night in sleep ap and that she has a high leak rate but she hasn't complained of any leaks or has woken up from big leaks.

Any information would be great, I think Iv'e attached/said everything that is required before posting. If not I do apologize in advance!

Thankyou everyone.

photos of OSCAR data -

https://ibb.co/f1RXV4L
https://ibb.co/JpK5Hyk
https://ibb.co/B3BbMPN
https://ibb.co/4W03MFg
https://ibb.co/LdZZjY2
https://ibb.co/X8j9ggf
https://ibb.co/51Wyjrs

Is she experiencing any nasal congestion during the night?

She really, really needs to get some better leak management because a good chunk of the time the leaks are large enough and prolonged enough to impact the machine's ability to sense, respond and record.

Please review the formatting of the graphs here.
http://www.cpaptalk.com/viewtopic/t1585 ... eview.html

One screenshot will get all that is needed.

As Pugsy said, you need to clean up thos leaks.

You say that on September 2 she changed from Nasal to Full-face and she feels a little better.

But, that's not the only change that was made at about that time. A machine configuration change was also made. Specifically EPR was also changed at about that same time. You therefore don't know if she's feeling better because of the change from a nasal mask, or now using EPR.

This is why we don't like to change more than one thing at a time.

Although there may be a machine/data accuracy problem because of the excessively high leaks. I do think we can conclude her minimum pressure is *way* to low. The minimum needs to be increased.

Increasing her minimum can also help he manage her leaks. She's falling asleep at a pressure of 5 and there's no leaking. Then the pressure moves up. Had her minimum be set higher, while she was awake, she could attend to her mask and perhaps address the mask fit.

You state, that the leaks aren't waking her up. Her sleep is *very* fragmented. The leaks may very well be waking her up.

She’s stated she doesn’t feel as stuffy or have her usual croky voice since using the full face mask pugsy.

So first point of contact should be to get her leaks under control yes? How could we go about doing that? We ran the mask fit setting and everything seemed good we ran it for 10minutes with her laying down and rolling around in bed and all was good. Upping her start pressure maybe like you suggested?

As for the fragmented sleep I know the machine resets it’s day at mid day and since she’s having naps of an afternoon could this be why it’s very fragmented? She also gets up for the occasional toilet through the night aswell.

I appreciate the responses and help so does the mother in law!

Does she use the machine for naps (many don't depending on location, i.e. office)?

Good Cpap should lessen bathroom breaks - have they improved at all?

magicmoon wrote: ↑

Sun Sep 11, 2022 7:29 am

As for the fragmented sleep I know the machine resets it’s day at mid day and since she’s having naps of an afternoon could this be why it’s very fragmented?

No.

The naps are visible and easily differentiated from the *multiple* times a night she's waking up.

She also gets up for the occasional toilet through the night aswell.

Waking up to go pee, can often be a symptom of disturbed sleep and not necessarily the cause of wakeups.

A familiar story with many of us here is:

• Prior to CPAP, waking up to pee a few time a night.
• Early CPAP treatment, fewer times
• After adjusting to CPAP, nightly awakenings stop entirely

I can't remember the last time I woke up to go pee.

magicmoon wrote: ↑

Sun Sep 11, 2022 7:29 am

As for the fragmented sleep I know the machine resets it’s day at mid day and since she’s having naps of an afternoon could this be why it’s very fragmented? She also gets up for the occasional toilet through the night aswell.

The naps are easily seen as to what they are...How old is she? I am wondering why so many naps are even being needed????

Does she have to go pee very often during the day? While nocturia is a common symptom of untreated apnea and once the apnea is dealt with effectively it will go away for the most part, it isn't the only cause of nocturia.
In the guys we can sometimes blame the prostate and with both guys and gals we can sometimes blame over active bladder.

magicmoon wrote: ↑

Sun Sep 11, 2022 7:29 am

So first point of contact should be to get her leaks under control yes? How could we go about doing that? We ran the mask fit setting and everything seemed good we ran it for 10minutes with her laying down and rolling around in bed and all was good. Upping her start pressure maybe like you suggested?

This would be the first thing I would do if it were my family member. If she's not having a lot of nasal congestion then we can't really blame the flow limitations for driving the pressure upwards and leaks managed well at 5 cm won't hold up when a person goes over 10 cm and she seems to do that fairly often.
I would increase the minimum...how much will depend on several things but I suspect 8 or 9 cm would be a good choice.
She may or may not be comfortable with a jump that big though and if she isn't then I would start small and work my way upwards with the minimum as she can tolerate it.

We can't really evaluate the overall effectiveness of the settings and/or how much leaks are impacting sleep or therapy when faced with this level of large leak. Once you go over 30 L/min things start getting iffy and the further you go the iffier it gets.

Not to mention that leaks can affect sleep quality even if we don't necessarily remember them.

Get the leaks under better control would be my first suggestion and using a higher minimum is the first step especially since she apparently needs higher pressures anyway.
Also, might get lucky and with a better more optimal minimum pressure the machine just might not need to go as high.
I have seen it happen.

DS said:
I can't remember the last time I woke up to go pee.


I say: ahh one day maybe -whistful sigh-

Also, isn’t it true the “for her” algorithm stinks badly?

(wonky images may have caused me to misread that it is set that way?)

lynninnj wrote: ↑

Sun Sep 11, 2022 6:35 pm

Also, isn’t it true the “for her” algorithm stinks badly?

Not at all. It's actually a very decent algorithm. I used to use it myself and it worked great.

What it doesn't do well is do a good job auto adjusting on SOME people when pressures above 12/14 or higher is needed but when we have seen that happen the AHI is awfully high and the machine just can't bring it down.
We then suggest trying the regular auto adjusting mode.

With the amount of leaks on those reports it's really an unknown at this time if the algorithm might not be a good fit for this person. The leaks have to be fixed first....then we see if the algorithm maybe isn't a good way to go.