Oscar Help

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
corgan115
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Oscar Help

Post by corgan115 » Sun Jan 29, 2023 3:37 pm

Hey folks,

I am needing some help with my therapy. I have never had a proper titration study (insurance wouldn't cover it) and have been using an APAP. Original settings were 4 - 15 but over time I've been slowly bumping the bottom number up. This has reduced my average AHI from 3.5 - 4.5 to 1.5 - 2.5. Still, I find myself pretty tired during the day and was hoping to get my AHI < 1, as I know a lot of people achieve that regularly.

Last night I decided to try another bump from 11 - 15 to 12 - 15. I woke up significantly more tired and with a higher AHI. Reviewing my Oscar I see last night I had more OA events than usual an even some CA events, which I normally don't have. It's normally all OA.

I have attached my last 3 nights of OSCAR data. Hoping someone might be able to provide some suggestions based on this data.

Thanks!

https://imgur.com/a/xyjar1N
https://imgur.com/a/qpi5HMZ
https://imgur.com/a/FXPQaV1

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Pugsy
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Re: Oscar Help

Post by Pugsy » Sun Jan 29, 2023 3:49 pm

How many hours of real sleep are you getting? Don't count laying awake with mask and machine on.

I see at least 2 breaks in therapy where the machine was turned off and back on....why? Were there other times you were awake and didn't turn the machine off?

Do you take any medications of any kind?

Do you drink alcohol or partake in recreational "medications" before bedtime?

Last night's increase in centrals (CAs on this report) also coincides with what was a very fractured sleep last night.
I would bet my last dollar that those centrals are just awake pauses in breathing or maybe a normal sleep onset central because it is quite obvious that there would have been a lot of transitions from awake to asleep where it is normal to have a sleep onset central.
Crappy sleep last night. It happens. It may or may not have been related to pressure changes.

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corgan115
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Re: Oscar Help

Post by corgan115 » Sun Jan 29, 2023 3:54 pm

Good catch Pugsy. I did have a pretty bad sleep last night. I woke up a few times more than usual and did spend at least some time laying awake. The other two graphs, where my pressure was at 11 - 15 were much more "usual" nights for me. This may not be a good apples to apples comparison because of that.

Based on the other 2 nights of data, where I was at 11 - 15 and had an AHI of ~1.5, do you feel bumping the lower value up is the right move? If so I will try again with the 12 - 15 setting and see how it goes tonight.

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Pugsy
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Re: Oscar Help

Post by Pugsy » Sun Jan 29, 2023 4:18 pm

corgan115 wrote:
Sun Jan 29, 2023 3:54 pm
Based on the other 2 nights of data, where I was at 11 - 15 and had an AHI of ~1.5, do you feel bumping the lower value up is the right move? If so I will try again with the 12 - 15 setting and see how it goes tonight.
I see no need for more minimum pressure....at least based on these couple of reports.

What were you trying to accomplish with more minimum?

It's okay to experiment...I have done LOTS of experiments myself but always with a clear agenda of why and what do I think I might learn from the experiment.

I do think you probably would benefit from being able to identify real asleep flagged events from awake/arousal flagged events.
Separate them out. More pressure isn't going to do a damn thing for awake/arousal flagged events. So make sure what you are wanting to kill with more pressure is killable with more pressure. False positive arousal/awake flagged events need to be fixed by improving on overall sleep quality and more pressure isn't going to help.

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corgan115
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Re: Oscar Help

Post by corgan115 » Sun Jan 29, 2023 4:35 pm

Trying to get my AHI below 1. Last night was a bad example but the other two nights I slept pretty normally and woke up tired. I mean, nothing compared to pre-treatment when my AHI was 31. But still, kind of tired. I'm assuming it's because my AHI was around 1.5. Granted that isn't very high but reviewing my OA flags it seems like I'm still having pretty regular OA events and I assume I'm waking up slightly every time this happens.

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Pugsy
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Re: Oscar Help

Post by Pugsy » Sun Jan 29, 2023 4:47 pm

corgan115 wrote:
Sun Jan 29, 2023 4:35 pm
reviewing my OA flags it seems like I'm still having pretty regular OA events and I assume I'm waking up slightly every time this happens.
It's always possible that OAs cause arousals but it can also be that the arousal ends up causing the OA flag.

Asleep breathing is circled in red.
Image

Same time frame as above but zoomed out a bit more and you can see arousal breathing with a hyponea and OA flag. More pressure won't do a thing for those events or the crappy sleep. It's not related to airway issues.

Asleep again circled in red.

Image

A couple of for real asleep flagged OAs here.

Image

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palerider
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Re: Oscar Help

Post by palerider » Sun Jan 29, 2023 5:04 pm

corgan115 wrote:
Sun Jan 29, 2023 4:35 pm
Trying to get my AHI below 1. Last night was a bad example but the other two nights I slept pretty normally and woke up tired. I mean, nothing compared to pre-treatment when my AHI was 31. But still, kind of tired. I'm assuming it's because my AHI was around 1.5. Granted that isn't very high but reviewing my OA flags it seems like I'm still having pretty regular OA events and I assume I'm waking up slightly every time this happens.
An AHI of 1.5 is good, with diminishing returns as you get lower and lower than that.

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corgan115
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Re: Oscar Help

Post by corgan115 » Sun Jan 29, 2023 5:20 pm

Thank you Pugsy and palerider!

Reviewing some of my past nights data (excluding last night as it was just a bad night) it does appear that most of my OA flags are true OA's... but I also noticed that in some cases the OA flag is when the pressure is already over 12. So bumping the min pressure to 12 is likely not going to fix all of the OA's. Is it possible that there really is no magical pressure that will always prevent the airway from collapsing?

If you feel my graphs and AHI look good on the original 11 - 15 range I will revert to that. I do still feel tired some days but I also recently found out that I have an iron deficiency. A side-effect of that is also fatigue. So perhaps I'm chasing the wrong thing.

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Pugsy
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Re: Oscar Help

Post by Pugsy » Sun Jan 29, 2023 5:31 pm

corgan115 wrote:
Sun Jan 29, 2023 5:20 pm
Is it possible that there really is no magical pressure that will always prevent the airway from collapsing?

Bingo...not only is it possible...it is actually probable and to be expected.
We simply don't sleep the same each night and there's no way to anticipate what will happen tonight.

There is no magic bullet pressure that fixes everything every time. Too many variables at play.

I don't even bother looking at the AHI breakdown unless I see over 3 AHI and usually for more than just one night.

You are going to have bad nights....you are going to have some nights with a higher AHI for any number of reasons.
Until we have working crystal balls the best we can do is do whatever works "most of the time" and just accept it.
Trying to always get AHI below 1.0 with more and more pressure....unrealistic goal and unlikely to be obtained.

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Additional Comments: Mask Bleep Eclipse https://bleepsleep.com/the-eclipse/
I may have to RISE but I refuse to SHINE.

If you want to try the Eclipse mask and want a special promo code to get a little off the price...send me a private message.