Helping interpreting Oscar

I have been on CPAP for 30+ years. My 2008 original AHI was 95. My original DR said it was severe and used my study to teach from at the University of Miami. So everyone got a good laugh. I lost 75 lbs or more 3 time over that 30 years and gained back. Now I have lost 140lbs and weight 145 for a 5'7" male and have kept it off for 18 months. As a result became a mouth breather and terrible cotton mouth. I decided my pressure of 13-15 was too high..Went to Dr and he wanted a new study done to get the exact pressure rather than just lowering a bit at a time. Last study was like 1999, so I agreed. Bottom line is now that I know what good sleep is, I could not tolerate all the wires and being fully hooked up, combined with worst bed I have ever slept on. After 4.5 hours I actually only slept 34 min. So I stopped the study and went home. I had already found out how to lower the pressure on my Airsense 11 and had been taking it down with good success. The limited study did showed a AHI of 45 untreated and they got me up to 5 on the pressure which did not arrest all the events. I went home and set it down to 6-7 where I have been for the past 20 days. The myair score on my app is always 98-100 sleeping 6.5-7.75 hr per with and events/hr is 0 - .7 per hour with .4 typical. Is there someone with good knowledge I could send my Oscar data to to give an opinion on the pressure to see if it could be less?

BTW started this journey because I got COOVID in February and did not use CPAP for about 10 days straight. I have always been very compliant. My wife said 1) you don't snore any 2) you do not wake up gasping and my dry mouth went away. But the sleep fatigue was coming back and when I went back on cpap that corrected but the dry mouth came back. Therefore thought it was the pressure blowing my head off. Which seems to be correct. Just trying to get pressure spot on without enduring a study. Sorry for the long post.

carlmims wrote: ↑

Sun Jun 16, 2024 3:31 pm

Is there someone with good knowledge I could send my Oscar data to to give an opinion on the pressure to see if it could be less?

The standard protocol is to post the appropriate OSCAR chart in this thread. Please read the first thread in the Announcements and the first page of the second thread.

My applogies for not reading the instructions. I think I have done this correctly, Using Resmed Autosense S11 with heated tube and humidity on, nasal pillow P10. I have lowered the pressure for the past month to 6-7. That has stopped the dry mouth issue and the MyAir app score is alway 99-100 with usage of 6.5 - 7.75 hr, Events per hr is almost always below 0.5 and typically 0.1 - 0.3. Only once had a 1.1 never to the rate of lowering score. Lowest score always comes from Mask off the get up during the night. Still having some issues with sinus drainage and not coughing up. Better when I first lowered pressure and has increased over time. Trying to determine if I can go even lower on pressure. Last night had best Fitbit score ever. Typically 75-80

You are reporting a lot of good things - very low AHI, virtually zero mask leak, no dry mouth, and a good quantity of sleep. How are you feeling?

Your flow limitation (FL) is high at times because you have limited the max pressure. I understand you might not want to raise the max pressure. You could say you don't want to make any changes because you are feeling well. You could change the EPR to 2 and see if the FLs clear up. If not, the next step would be to change it to 3 and monitor the results. If you get poorer results, you can always change the EPR back to 1. (EPR has been known to help with FLs.)

carlmims wrote: ↑

Sat Jun 29, 2024 12:07 pm

Trying to determine if I can go even lower on pressure.

Your goal should be to work up your pressure... you are under-treated. See the flat-topped Pressure graph? See the jagged forest of FL's? Hold at least where you are and strive to increase the Max pressure slowly.

vandownbytheriver wrote: ↑

Sat Jun 29, 2024 4:07 pm

carlmims wrote: ↑

Sat Jun 29, 2024 12:07 pm

Trying to determine if I can go even lower on pressure.

Your goal should be to work up your pressure... you are under-treated. See the flat-topped Pressure graph? See the jagged forest of FL's? Hold at least where you are and strive to increase the Max pressure slowly.

I disagree that this should be the first step. Instead I think CG's advice is best at this point. See how you do with EPR of 2, and then try 3. (For 3, you will need to put your minimum up to 7 to get the benefits of EPR all night, since the machine can't drop down below 4.)

So give that experiment a try and let's see what happens.

(Something to keep in mind. Neither EPR nor a higher minimum or maximum will help your FLs if they originate in your nose. If they originate further down in your airway, though, your machine settings can help, and that might help you sleep better.)

Rest wise I feel great. The sinus drainage down the throat has been worst the past week but running similar #s for a month. Decreasing max pressure to 7 stopped the dry mouth and greatly helped the drainage for a while. The past week the drainage and throat issue has come back. It is so bad that by the end of the day I am loosing my voice. I am hoping I can further reduce pressure and that it will help with the throat issues. On of the comments was that I was under treated... I thought the goal was to have as little pressure as required and since my events are so low that I could likely reduce pressure. I will start increasing the EPR to see if that helps. Keep in mind the prescription for 13 was from 2008 when I was 140 lbs heavier. I had been 99.9% compliant for 30 years until I went 10 days without any CPAP for 10 days and my throat totally cleared up the the loss of sleep caught up with me and went on the journey of trying to find the lowest possible pressure. That was my 2nd study with the original in 1990 and it was for 15. In those days the machines were not automatic. My 2nd machine in 2008 was a S8 and had auto.

carlmims wrote: ↑

Sat Jun 29, 2024 8:42 pm

On[e] of the comments was that I was under treated... I thought the goal was to have as little pressure as required and since my events are so low that I could likely reduce pressure. I will start increasing the EPR to see if that helps. Keep in mind the prescription for 13 was from 2008 when I was 140 lbs heavier. I had been 99.9% compliant for 30 years until I went 10 days without any CPAP for 10 days and my throat totally cleared up the the loss of sleep caught up with me and went on the journey of trying to find the lowest possible pressure.

In those days, the machines knew nothing of flow limitations. However, if flow limitation are the result of semi-collapsing airways, then clearly your pressure it too low to keep your airway fully open. On the image you posted you breathing is not very stable, look at the way your flow drops in the first session after 01:00. The machine would have gone to higher pressures in the attempt to handle the flow limitations - had you let it do that.

My mouth blows open and dries up terribly no matter what the pressure. I had to start mouth taping when my pressure was 6.6.
When I use a well fitting FFM, my mouth doesn't get dry. I get dry mouth on an FFM only if it has a bad leak.
And, of course, my mouth will dry if the tape springs a leak.

carlmims wrote: ↑

Sat Jun 29, 2024 8:42 pm

I thought the goal was to have as little pressure as required

Normally, the minimum pressure should be set as low as that which will treat the condition properly. And the maximum pressure will be set at 20.0. (The machine will not go any higher than needed.) Since you had problems at higher pressure, I would try upping the EPR first.

carlmims wrote: ↑

Sat Jun 29, 2024 8:42 pm

since my events are so low that I could likely reduce pressure

Yes, your Events are very low. But your FLs could use some improvement.

On the other hand, you say

carlmims wrote: ↑

Sat Jun 29, 2024 8:42 pm

Rest wise I feel great.

If you are energetic during the day, you could say, "F$*%k the charts. I'm good."