New CPAP User Looking for OSCAR Feedback

BatmanMatt · Post by **BatmanMatt** » Sat Dec 04, 2021 8:23 am

If you have a general sense of what OSCAR data means could you tell me what you see? I tried to follow the sticky post guidelines.

I use Airsense 11 with heated humidifier (its not an option to add to profile here) and just started heated tubing last night.
Resmed F10 full face mask.

I've been using CPAP for 10 days.

Last night I woke up a couple of times but generally it was my best night without a baby waking me up. I feel tired this morning but maybe not as tired. I haven't had the amazing boost of energy others have mentioned.

5'11" 165 Lbs, no other health issues, no sleeping meds or vitamins

Your help is really appreciated.

Pugsy · Post by **Pugsy** » Sat Dec 04, 2021 8:29 am

BatmanMatt wrote: ↑
Sat Dec 04, 2021 8:23 am
I use Airsense 11 with heated humidifier (its not an option to add to profile here) and just started heated tubing last night.

Use your signature line...the equipment profile thing is broken anyway.
https://www.cpaptalk.com/viewtopic/t181 ... ryone.html

Are you comfortable with making changes to your settings yourself?

Overall your report looks quite decent and there's no urgent need to make big changes but maybe a couple of little tweaks to see if it can help with sleep quality or not.

10 days isn't very long to really expect much change in sleep or how we feel...plus if you have a new baby...you have that added sleep disruption as well and the machine settings isn't going to fix bad sleep from the baby.

BatmanMatt · Post by **BatmanMatt** » Sat Dec 04, 2021 8:48 am

Thanks for the feedback. Do you mean making changes to my machine settings? More than comfortable doing that.

BatmanMatt · Post by **BatmanMatt** » Sat Dec 04, 2021 9:19 am

Pugsy wrote: ↑
Sat Dec 04, 2021 8:29 am

BatmanMatt wrote: ↑
Sat Dec 04, 2021 8:23 am
I use Airsense 11 with heated humidifier (its not an option to add to profile here) and just started heated tubing last night.
Use your signature line...the equipment profile thing is broken anyway.
https://www.cpaptalk.com/viewtopic/t181 ... ryone.html

Are you comfortable with making changes to your settings yourself?

Overall your report looks quite decent and there's no urgent need to make big changes but maybe a couple of little tweaks to see if it can help with sleep quality or not.

10 days isn't very long to really expect much change in sleep or how we feel...plus if you have a new baby...you have that added sleep disruption as well and the machine settings isn't going to fix bad sleep from the baby.

See above post

Pugsy · Post by **Pugsy** » Sat Dec 04, 2021 10:25 am

Yes, changes to machine settings...as in minimum pressure and EPR.

If your report was my report I would add in EPR full time to maybe help with the flow limitations which aren't horribly horrible but more than I would want to see...and I would increase the minimum a bit to both offset the addition of EPR full time and maybe stabilize the pressure line a bit.
I don't know for sure if that would impact sleep quality and/or how you feel but it's worth considering IMHO.
Is it something that is urgent that you just have to do right now? No...it's not urgent.
On paper your reports are actually very decent for someone so new to therapy.

This is what I would change if it were my report.
EPR...change to full time and set to 3.
Mode...still auto mode
Minimum from 5 cm to 7 cm.
Maximum...you can leave at 20. The machine won't ever go there anyway so it's kinda a moot point.

Oh...forgot one question that might impact FL graph thoughts....are you experiencing any nasal congestion to speak of?

Bear in mind that most people don't see marked overnight improvement with cpap. I know we read about people having an overnight miracle but those people are the lucky few and most people any improvements noted come on very gradually.

If you have a bad night in terms of sleep quality...wake up often for any reason...baby or whatever...you can expect to feel like crap no matter how good that report looks on paper. You have to get the good sleep first before any of the "numbers" actually mean much. Now it doesn't mean we don't try little tweaks in the settings to see if something seems to help or not...but we have to realize that people have crappy nights and they don't have OSA to deal with or even a new baby.

If you make changes...allow yourself about a week to evaluate any results unless the change caused immediate problems like a ton of central apneas or really bad aerophagia issues.

BatmanMatt · Post by **BatmanMatt** » Sat Dec 04, 2021 11:06 am

Pugsy wrote: ↑
Sat Dec 04, 2021 10:25 am
Yes, changes to machine settings...as in minimum pressure and EPR.

If your report was my report I would add in EPR full time to maybe help with the flow limitations which aren't horribly horrible but more than I would want to see...and I would increase the minimum a bit to both offset the addition of EPR full time and maybe stabilize the pressure line a bit.
I don't know for sure if that would impact sleep quality and/or how you feel but it's worth considering IMHO.
Is it something that is urgent that you just have to do right now? No...it's not urgent.
On paper your reports are actually very decent for someone so new to therapy.

This is what I would change if it were my report.
EPR...change to full time and set to 3.
Mode...still auto mode
Minimum from 5 cm to 7 cm.
Maximum...you can leave at 20. The machine won't ever go there anyway so it's kinda a moot point.

Oh...forgot one question that might impact FL graph thoughts....are you experiencing any nasal congestion to speak of?

Bear in mind that most people don't see marked overnight improvement with cpap. I know we read about people having an overnight miracle but those people are the lucky few and most people any improvements noted come on very gradually.

If you have a bad night in terms of sleep quality...wake up often for any reason...baby or whatever...you can expect to feel like crap no matter how good that report looks on paper. You have to get the good sleep first before any of the "numbers" actually mean much. Now it doesn't mean we don't try little tweaks in the settings to see if something seems to help or not...but we have to realize that people have crappy nights and they don't have OSA to deal with or even a new baby.

If you make changes...allow yourself about a week to evaluate any results unless the change caused immediate problems like a ton of central apneas or really bad aerophagia issues.

Very intrigued by your recommendations. I have woken up a few times because the air coming out of mask wakes me up by the hiss. Would EPR get rid of that?

Pugsy · Post by **Pugsy** » Sat Dec 04, 2021 11:25 am

BatmanMatt wrote: ↑
Sat Dec 04, 2021 11:06 am
I have woken up a few times because the air coming out of mask wakes me up by the hiss. Would EPR get rid of that?

Probably not.
All depends on what is causing the "hiss" that you hear but EPR is just exhale relief and it normally doesn't have anything to do with mask noises of any kind.

Your leak graph isn't alarming as to amount of leak but sometimes it doesn't take much leak to disturb sleep and it's the disturbed sleep part we don't want.

Miss Emerita · Post by **Miss Emerita** » Sat Dec 04, 2021 12:40 pm

You're doing VERY well, and you'll probably feel more rested as time goes by, within the limits set by your baby. I think you will like the settings Pugsy has recommended, and I'd be interested in seeing another chart once you've made the changes.

As you start to sleep better, you may be less disturbed by mask sounds, but in the meantime, you might try watching some videos about fitting your particular type of mask. For what it's worth, sometimes people over-tighten some of their straps, so give some thought to whether that might be an issue for you.

Do you breathe through your nose during the day? If yes, would you be interested in trying a nasal pillow mask?

BatmanMatt · Post by **BatmanMatt** » Sat Dec 04, 2021 12:58 pm

Miss Emerita wrote: ↑
Sat Dec 04, 2021 12:40 pm
You're doing VERY well, and you'll probably feel more rested as time goes by, within the limits set by your baby. I think you will like the settings Pugsy has recommended, and I'd be interested in seeing another chart once you've made the changes.

As you start to sleep better, you may be less disturbed by mask sounds, but in the meantime, you might try watching some videos about fitting your particular type of mask. For what it's worth, sometimes people over-tighten some of their straps, so give some thought to whether that might be an issue for you.

Do you breathe through your nose during the day? If yes, would you be interested in trying a nasal pillow mask?

You know what they say, when two internet strangers agree they’re probably right. Ha, just kidding.

I inputted the settings and will post the data tomorrow. I read that EPR settings might be counter productive. Any reason why I’m starting at max 3 and not 1 and progressively going up? Also, will my doctor or insurance get mad that I’m messing with the settings?

Thanks again!

BatmanMatt · Post by **BatmanMatt** » Sat Dec 04, 2021 12:59 pm

Pugsy wrote: ↑
Sat Dec 04, 2021 11:25 am

BatmanMatt wrote: ↑
Sat Dec 04, 2021 11:06 am
I have woken up a few times because the air coming out of mask wakes me up by the hiss. Would EPR get rid of that?
Probably not.
All depends on what is causing the "hiss" that you hear but EPR is just exhale relief and it normally doesn't have anything to do with mask noises of any kind.

Your leak graph isn't alarming as to amount of leak but sometimes it doesn't take much leak to disturb sleep and it's the disturbed sleep part we don't want.

I should clarify it’s not the mask leak that wakes me up but the exhaust hiss that wakes me up. I have a good seal I think.

Pugsy · Post by **Pugsy** » Sat Dec 04, 2021 1:39 pm

BatmanMatt wrote: ↑
Sat Dec 04, 2021 12:59 pm
I should clarify it’s not the mask leak that wakes me up but the exhaust hiss that wakes me up. I have a good seal I think.

Most likely the vented air is hitting something and creating the noise.
Vented air doesn't actually make much noise when it isn't obstructed...it just goes out into the room air but when the vented air hits something then it bounces back and we tend to hear things that we don't normally hear.
I know sometimes I wake up to vent noise and my mask is essentially silent but I have put my arm up by my face or pulled to covers up next to my face and the vented air is hitting something.
Next time you wake up to the hiss try to be alert enough to play around and see if you can do something to figure out exactly what is causing the hiss.
If it doesn't hiss when you start the night then something changed somewhere to cause the hiss. May take a bit of detective work to figure out what.

BatmanMatt wrote: ↑
Sat Dec 04, 2021 12:58 pm
Also, will my doctor or insurance get mad that I’m messing with the settings?

Your insurance could care less if you change anything or not. They don't even get a report of your settings or results...all they care about is if you use the machine the minimum number of hours each night so they aren't wasting their money paying for something you don't use.

Now the doctors...depends on the doctor but most won't care especially when the patient has a legit reason or thought behind the change and/or the change is relatively small. Now there are a few docs who get on a big power trip and want to act like God and they think that ONLY they are smart enough to change anything...and those docs will likely be unhappy but you don't really want a doc who acts like that anyway.
Think about it...the doc gave a prescription for 5 to 20 cm pressure so the machine can auto adjust all night long anyway.
What if the machine went straight away to 7 cm and never dropped back to 5 for the rest of the night. What real problem would they have with someone just starting with 7 in the first place??? This stuff isn't rocket science and not the national secret yet some docs (and DMEs) treat patients like we are just plain too stupid to know what we feel good with.
If patients can monitor their own blood sugars when they are diabetic with a little bit of education there is zero reason why cpap patients can't do the same with their own therapy.

Any doctor who won't listen to me and value my input about ANYTHING....is going to be my former doctor.

BatmanMatt wrote: ↑
Sat Dec 04, 2021 12:58 pm
I read that EPR settings might be counter productive. Any reason why I’m starting at max 3 and not 1 and progressively going up?

There are some docs and some RTs and some sleep techs who don't like EPR for whatever reason.
It does drop the pressure during exhale and there is the potential for that drop during exhale to get to a low point where the airway is no longer stented/held open. If that should happen it is easily remedied though and it doesn't necessarily happen to everyone anyway. We remedy it with a little more pressure to start with. Easy peasy.
Now there is also a very remote chance that using EPR (or really any sort of exhale relief that creates a bilevel pressure situation) can trigger central apneas where they are numerous to be a problem. It's not all that common though and if it does happen we can make adjustments if needed.
In other words...any problems that EPR or any exhale relief might cause is usually easily fixable.

Now why did I opt for max EPR in your case....I based that thought on what I see on your flow limitation graph and your subjective feelings....in other words my gut feelings based on nearly 13 years of cpap therapy and seeing lots of people have problems and helping them sort through problems.
Using more minimum and adding max EPR might (stress the might part) reduce some of those FLs and FLs can impact sleep quality itself. Meaning the FLs could maybe cause arousals. Now I don't know for sure that your FLs are a problem but there is a chance they might be so we opt to do what we can to improve/reduce them.....just in case.

Also the difference between inhale and exhale is often just plain comforting to people. Often it mimics their own breathing rhythm and people don't feel like they have to work so hard exhaling and they sleep better just from overall comfort.

Now some people simply don't like exhale relief in any form and that's okay too. Everyone is a bit different and preferences, wants and needs are highly individualized. What I might love the next person might just totally hate.
It's pretty much a YMMV sticker that everything regarding cpap therapy comes with.

The settings I suggested...should be very comfortable for you but if they aren't they can be modified and we can go back to taking things a bit slower. Nothing is set in stone and the first primary goal is getting you to sleep and staying asleep as best we can because without sleep none of the rest of this stuff really matters much.

Comfort is critical to getting to sleep and staying asleep IMHO.

Here below is what my really boring FL graph looks like. Compare it to your report which actually isn't all that horrible (I have seen much, much worse) and you can see why I wanted to be a bit aggressive with the setting changes to see if we can improved that FL graph's looks a bit.
All this is assuming your FL graph's activity isn't related to nasal congestion. If you are experiencing much nasal congestion we have a different discussion.

BatmanMatt · Post by **BatmanMatt** » Sat Dec 04, 2021 2:04 pm

Pugsy wrote: ↑
Sat Dec 04, 2021 1:39 pm

BatmanMatt wrote: ↑
Sat Dec 04, 2021 12:59 pm
I should clarify it’s not the mask leak that wakes me up but the exhaust hiss that wakes me up. I have a good seal I think.
Most likely the vented air is hitting something and creating the noise.
Vented air doesn't actually make much noise when it isn't obstructed...it just goes out into the room air but when the vented air hits something then it bounces back and we tend to hear things that we don't normally hear.
I know sometimes I wake up to vent noise and my mask is essentially silent but I have put my arm up by my face or pulled to covers up next to my face and the vented air is hitting something.
Next time you wake up to the hiss try to be alert enough to play around and see if you can do something to figure out exactly what is causing the hiss.
If it doesn't hiss when you start the night then something changed somewhere to cause the hiss. May take a bit of detective work to figure out what.

BatmanMatt wrote: ↑
Sat Dec 04, 2021 12:58 pm
Also, will my doctor or insurance get mad that I’m messing with the settings?
Your insurance could care less if you change anything or not. They don't even get a report of your settings or results...all they care about is if you use the machine the minimum number of hours each night so they aren't wasting their money paying for something you don't use.

Now the doctors...depends on the doctor but most won't care especially when the patient has a legit reason or thought behind the change and/or the change is relatively small. Now there are a few docs who get on a big power trip and want to act like God and they think that ONLY they are smart enough to change anything...and those docs will likely be unhappy but you don't really want a doc who acts like that anyway.
Think about it...the doc gave a prescription for 5 to 20 cm pressure so the machine can auto adjust all night long anyway.
What if the machine went straight away to 7 cm and never dropped back to 5 for the rest of the night. What real problem would they have with someone just starting with 7 in the first place??? This stuff isn't rocket science and not the national secret yet some docs (and DMEs) treat patients like we are just plain too stupid to know what we feel good with.
If patients can monitor their own blood sugars when they are diabetic with a little bit of education there is zero reason why cpap patients can't do the same with their own therapy.

Any doctor who won't listen to me and value my input about ANYTHING....is going to be my former doctor.

BatmanMatt wrote: ↑
Sat Dec 04, 2021 12:58 pm
I read that EPR settings might be counter productive. Any reason why I’m starting at max 3 and not 1 and progressively going up?
There are some docs and some RTs and some sleep techs who don't like EPR for whatever reason.
It does drop the pressure during exhale and there is the potential for that drop during exhale to get to a low point where the airway is no longer stented/held open. If that should happen it is easily remedied though and it doesn't necessarily happen to everyone anyway. We remedy it with a little more pressure to start with. Easy peasy.
Now there is also a very remote chance that using EPR (or really any sort of exhale relief that creates a bilevel pressure situation) can trigger central apneas where they are numerous to be a problem. It's not all that common though and if it does happen we can make adjustments if needed.
In other words...any problems that EPR or any exhale relief might cause is usually easily fixable.

Now why did I opt for max EPR in your case....I based that thought on what I see on your flow limitation graph and your subjective feelings....in other words my gut feelings based on nearly 13 years of cpap therapy and seeing lots of people have problems and helping them sort through problems.
Using more minimum and adding max EPR might (stress the might part) reduce some of those FLs and FLs can impact sleep quality itself. Meaning the FLs could maybe cause arousals. Now I don't know for sure that your FLs are a problem but there is a chance they might be so we opt to do what we can to improve/reduce them.....just in case.

Also the difference between inhale and exhale is often just plain comforting to people. Often it mimics their own breathing rhythm and people don't feel like they have to work so hard exhaling and they sleep better just from overall comfort.

Now some people simply don't like exhale relief in any form and that's okay too. Everyone is a bit different and preferences, wants and needs are highly individualized. What I might love the next person might just totally hate.
It's pretty much a YMMV sticker that everything regarding cpap therapy comes with.

The settings I suggested...should be very comfortable for you but if they aren't they can be modified and we can go back to taking things a bit slower. Nothing is set in stone and the first primary goal is getting you to sleep and staying asleep as best we can because without sleep none of the rest of this stuff really matters much.

Comfort is critical to getting to sleep and staying asleep IMHO.

Here below is what my really boring FL graph looks like. Compare it to your report which actually isn't all that horrible (I have seen much, much worse) and you can see why I wanted to be a bit aggressive with the setting changes to see if we can improved that FL graph's looks a bit.
All this is assuming your FL graph's activity isn't related to nasal congestion. If you are experiencing much nasal congestion we have a different discussion.

Amazing information, thank you. My last question is....

With EPR enabled like this, is there any cause for concern for my health even if central apneas and whatever else might occur? Would it be any worse than not wearing a CPAP at all? I looked all all my flow rate graphs and they're noisy compared to yours. I dont have nasal congestion but my mouth opens at some points. I breathe through my nose during the day.

Pugsy · Post by **Pugsy** » Sat Dec 04, 2021 2:05 pm

My personal experience (and thoughts) about exhale relief.
I found that using exhale relief let me sleep almost an hour longer with no changes in anything else.
The more relief the better...just felt good...no work involved fighting the machine to exhale.
I actually use 4 cm difference between inhale and exhale (different machine that lets me do that) as my preferred setting but I can get by with the 3 cm difference that EPR on the AutoSet offers.
It simply feels better.

I started cpap therapy not using any exhale relief because I couldn't tell it did much and the machine I had at the time didn't offer much anyway. Fast forward through various machines until I finally got a machine where I could actually set exhale relief, like what we can get using EPR, and it was noticeable from day one that I was much more comfortable using 3 or 4 cm difference. Then I actually slept with it and over a period of time I noticed that I was actually sleeping not quite one hour longer on the machine compared to the older machine that didn't offer much exhale relief.

Now you may or may not be like me and actually like the higher difference....but why not give it a go.
Using 4 cm difference...hasn't caused me to have centrals...hasn't caused me to have OAs pop up during exhale...hasn't caused one single problem and has let me sleep a little longer. It's a no brainer for me anyway.
We old time veterans used to communicate privately that once someone got to use real bilevel at a setting that they actually felt good with that nobody would ever go back to not using it.

Using EPR creates a bilevel pressure situation...2 distinct pressures which means inhale is different from exhale.
We often refer to the AutoSet and EPR as the poor man's bilevel because it can function like a bilevel machine but is just limited with how much difference you can get.
It's the difference that offers that comfortable feeling...for most people anyway.
3 cm difference feels good...but for me a 4 cm difference feels even better and I know people say it isn't all that much of a difference...and maybe it isn't but I feel it. Probably another one of those YMMV things.

I use the ResMed AirCurve 10 VAuto....it is essentially your AutoSet on steroids.

I can get more than 3 cm difference and it can go higher than 20 cm if needed. Otherwise it pretty much functions like your AutoSet.

Pugsy · Post by **Pugsy** » Sat Dec 04, 2021 2:19 pm

Pugsy wrote: ↑
Sat Dec 04, 2021 2:05 pm
With EPR enabled like this, is there any cause for concern for my health even if central apneas and whatever else might occur? Would it be any worse than not wearing a CPAP at all? I

First of all people need to quit going into panic mode when they see a few central apneas pop up.
It's normal to have a few central apneas...entirely normal.
Central apneas are only a problem when present in large numbers and causing desats or maybe they keep bouncing a person out of sleep.

Now if you happen to be one of those people that using bilevel triggers centrals...we simply back off and either reduce the difference or turn EPR off.
I have a friend who is using the same machine I use but she has to using starting pressures around 16 cm to keep the airway open. So she really needs some sort of exhale relief. We discovered that with the difference being 4 cm she would have about 15 centrals per hour pop up but with the difference dropped to just 3 cm the centrals essentially went away.
Just a little 1 cm drop in difference was all it took.

Problems that might come up are usually fixable.
The chances of exhale relief triggering centrals.....extremely small but if it does we can fix it.
It's when centrals pop up from other causes that we have more trouble fixing things.

And...most of the time the centrals that might pop up are very short in duration anyway.
Hold your breath for 10 seconds...that's essentially a 10 second central apnea. Easy to do and won't cause desats or any undue stress.
Now do it once a minute for 30 minutes...then we might have a problem.
I once had 17 centrals in 17 minutes and slept right through it. Never did figure out why it happened and it never happened again.

People really need to get past centrals and panic mode...they are fixable if numerous enough to warrant fixing...and a handful of centrals is normal anyway and doesn't warrant doing anything more than a shrug of the shoulders.

Pugsy · Post by **Pugsy** » Sat Dec 04, 2021 2:23 pm

BTW you may see me use the term Pressure Support (PS) sometimes instead of "difference between inhale and exhale" because that's actually the official term.
Using EPR creates pressure support but until newbies learn about what bilevel does and exhale relief causes a bilevel situation...sometimes it's easier to use the "difference" thing.
Essentially the same thing but a bilevel machine and your autoset go about obtaining that difference in a different way.

New CPAP User Looking for OSCAR Feedback

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