Oscar chart

jumblegirl wrote: ↑

Wed Jun 15, 2022 12:14 pm

Is this how I embed the image I don't think so

[img]https://imgur.com/Nrb20Ry[/image]

No, you have to embed the link to the image, not to the page the image is on:

Instructions: wiki/index.php/Oscar:organize

Here are my graphs from last night, I kept mask on all night (used new nasal N20 airfit) and cervical brace. AHI is better but mostly central? Do not feel rested waking up. Any input appreciated, thanks.

https://imgur.com/a/yqPmfZK

Did you have very many wake ups during the night last night....or do you feel that you slept solidly for most of the night?

Do you remember waking and noticing a leak?

The second and third graphs aren't of much value. I would narrow the traces and include the flow limitation trace

You *probably* don't feel rested, because you still aren't sleeping well. This is understandable because you are still not used to wearing CPAP.

The priority is to get you accustomed to sleeping with the device. If your chart was from someone who was accustomed to CPAP, I would increase the minimum pressure a bit to flatten the pressure trace, and decrease EPR by one.

But, doing both may increase your discomfort. At this stage, you are treating your apnea OK, trying to fine tune your therapy is of little value because we simly don't know if the Centrals are caused because of pressure or being novice. They aren't a huge issue.

Pugsy wrote: ↑

Thu Jun 16, 2022 7:25 am

Did you have very many wake ups during the night last night....or do you feel that you slept solidly for most of the night?

Do you remember waking and noticing a leak?

I did not wake up at all or remember waking up once I fell asleep. I wore the mask earlier in the day to get accustomed but didn’t include those times (I think) in the shots. I tried a new nasal mask airfit n20 I did notice it was getting wet so I don’t know if that means the hose is wet too. I turned down the humidifier.

I did not notice a leak. Does it show a problem?

Dog Slobber wrote: ↑

Thu Jun 16, 2022 7:41 am

The second and third graphs aren't of much value. I would narrow the traces and include the flow limitation trace

I don’t know what narrowing the traces means? Sorry. I am lucky I can figure out the Imgur stuff at all !

Dog Slobber wrote: ↑

Thu Jun 16, 2022 7:41 am

The priority is to get you accustomed to sleeping with the device. If your chart was from someone who was accustomed to CPAP, I would increase the minimum pressure a bit to flatten the pressure trace, and decrease EPR by one.

What does ‘pressure trace’ mean?
I can increase the min pressure to 10 I think someone else had recommended that. It was originally 7. I can reduce EPR. I do have to tape my mouth shut with the nasal mask or I can’t exhale right like my nose sort of plugs up. But then I keep pulling the tape off randomly in the middle of the night. Maybe that’s the leak problem. I can use a chin strap instead.

Pugsy wrote: ↑

Thu Jun 16, 2022 7:25 am

Did you have very many wake ups during the night last night....or do you feel that you slept solidly for most of the night?

Do you remember waking and noticing a leak?

Would intermittently untaping my mouth during the night, and breathing through it maybe cause the leaks? The machine claims my mask had a good seal

ChicagoGranny wrote: ↑

Wed Jun 15, 2022 3:10 pm

jumblegirl wrote: ↑

Wed Jun 15, 2022 1:15 pm

no idea what eg flow limitation means

(tidal volume was another one)

IMO, you are trying to run before you can walk. Priorities at this point should be using the CPAP all night, keeping the mask leak level within a good range, achieving an acceptable AHI, and getting sufficient restful sleep. (What little data you have doesn't show a problem with flow limitations.)

How do you eat an elephant?

One bite at a time.

Yeah I agree I’m trying to do too much at once but I really want to understand this stuff even though I can’t really concentrate because I’m not sleeping well. Kind of a catch 22.

Also the flow limitations are in the 3rd chart at top - theyare cut off at the top but they didn’t go higher than any of those lines…
But next time I will do the ones below if they will all fit. I tried to change the size of the graphs using the file menu but I couldn’t figure it out.

So flow rate isn’t one of the important ones?

“The real important traces (Daily Page) are:
Event Flags
Pressure
Flow Limits
Leak Rate”

No...the leak doesn't show a problem. I was just wondering if small leaks were waking you up because in a couple of places the centrals flagged also happen around the time the leaks increased a bit. Just wondering if those small leaks were disturbing sleep quality which would increase the chance that the centrals flagged might be false positives.

I think you need to take a crash course in figuring out if those centrals are real asleep centrals or arousal/awake related centrals or false positives.
Go here and watch the videos and learn how to zoom in and evaluate the flow rate (breaths) for asleep vs arousal flow rate.
If awake/arousal related flagging then we worry more about sleep quality itself as in why the poor sleep.
If asleep related we wonder what we can do (if anything) to reduce the centrals. While not a huge number of centrals are present they are appearing in clusters and could potentially mess with sleep quality and thus how you feel during the day.

Sometimes when people start cpap they will get central apneas pop up when they didn't necessarily have a problem with centrals before. It just happens and sometimes the centrals will fade away with a bit of time.
Also called treatment emergent centrals. These have to be asleep central apneas though....different from awake/arousal centrals which is why you need to learn how to figure out the difference.

Sometimes using exhale relief actually can cause central apneas because it creates a bilevel pressure situation.
So when that's a possibility we advise people to reduce or totally eliminate any exhale relief just to see if the centrals we are seeing are related to the exhale relief bilevel pressure situation.

If you had told me that you remembered waking often last night then I would tend to think there is a high chance that those centrals were arousal/awake related but since you can't say that then I would tend to lean towards those centrals being asleep related. It's not a horribly high number of centrals but it is borderline for where doctors would maybe keep one eye on them.

If this were my report and I couldn't blame those centrals on arousals/awakenings from something then I would at least keep one eye on them and maybe try a couple of little tweaks to see if I could reduce the number of centrals.
The only real thing that we might try that might help is reducing or eliminating EPR exhale relief and there is no guarantee that will help. It will help ONLY if exhale relief bilevel pressures are causing/triggering the centrals.
At this point we don't know what it is that is triggering the centrals or heck we don't even know for sure that they are asleep centrals. They could still be arousal related centrals because we don't always remember arousals.

So....assuming real asleep centrals...these options/thoughts.
1...we can try reducing or eliminating EPR and see what happens
2...if no change with tweaking EPR it is possible that the centrals are just plain old treatment emergent centrals that could very well fade with time. This is why doctors will tell people to "give it time" because sometimes giving it time works.
3...one last option to try...going to a fixed pressure because in some cases the auto adjusting pressures can trigger centrals and when someone goes to fixed pressures the centrals will reduce.

I always say to fix a problem we have to first identify the problem which is why we first need to figure out if those centrals are real asleep centrals or if they are arousal/awake related centrals.
The machine doesn't/can't tell if you are asleep or not because it only measures air flow and when a person is awake the breathing is much more irregular than asleep breathing and the machine thinks the irregularity is some sort of apnea event.
False positives for lack of better term.

If it were my report...I would try eliminating EPR first. Easy to try and it might work. If you can't fall asleep without EPR you can set EPR for "ramp only" and that way have EPR at the beginning of the night and it will go away once you are asleep (or the machine thinks you are asleep since you are using auto ramp)

jumblegirl wrote: ↑

Thu Jun 16, 2022 8:30 am

Also the flow limitations are in the 3rd chart at top - theyare cut off at the top but they didn’t go higher than any of those lines…
But next time I will do the ones below if they will all fit. I tried to change the size of the graphs using the file menu but I couldn’t figure it out.

So flow rate isn’t one of the important ones?

“The real important traces (Daily Page) are:
Event Flags
Pressure
Flow Limits
Leak Rate”

Flow rate is your breathing and yes it is important. Watch the videos I sent you a link for and you will understand what is meant by "narrowing the flow rate".

I wasn't to worried about the flow limitations from last night because the max it went to was 0.10 and that's not horribly high. They probably are fluctuating a bit which is causing the pressures to fluctuate a bit. Flow limitations are one of the primary things the machine looks for and will try to kill. If you are having any nasal congestion that can also show up as an increase in FLs but more pressure can't really deal with nasal congestion FLs. We have to treat nasal congestion FLs in the usual way we treat nasal congestion which might be meds, nasal rinses, etc.

Your leaks were well within what the machine can compensate for. I don't think they are a problem unless they were waking you up and you say you slept solidly last night so I assume they didn't wake you.

jumblegirl wrote: ↑

Thu Jun 16, 2022 8:14 am

Dog Slobber wrote: ↑

Thu Jun 16, 2022 7:41 am

The second and third graphs aren't of much value. I would narrow the traces and include the flow limitation trace

I don’t know what narrowing the traces means? Sorry. I am lucky I can figure out the Imgur stuff at all !

In OSCAR, hover your your mouse on the border-line of two graphic trace boxes. Then click to drag the box to make it more narrow. Now you fit more stuff onto a single screen print.

jumblegirl wrote: ↑

Thu Jun 16, 2022 8:18 am

What does ‘pressure trace’ mean?

The "trace" is the graph line. The pressure graph.

jumblegirl wrote: ↑

Thu Jun 16, 2022 8:18 am

I can increase the min pressure to 10 I think someone else had recommended that. It was originally 7. I can reduce EPR. I do have to tape my mouth shut with the nasal mask or I can’t exhale right like my nose sort of plugs up. But then I keep pulling the tape off randomly in the middle of the night. Maybe that’s the leak problem. I can use a chin strap instead.

Increasing your minimum pressure, and decreasing you're EPR will be more uncomfortable to breathe against. This isn't an issue for those accustomed to CPAP, but you aren't sleeping well.

You aren't going to hit on perfect numbers in the next couple days. There is no magic combination that is going to give you a perfect AHI and a restful sleep. That comes with acclimation to the device.

Work on getting used to it, and leaks.

jumblegirl wrote: ↑

Thu Jun 16, 2022 8:30 am

So flow rate isn’t one of the important ones?

“The real important traces (Daily Page) are:
Event Flags
Pressure
Flow Limits
Leak Rate”

My mistake, I neglected to mention flow-rate.

jumblegirl wrote: ↑

Thu Jun 16, 2022 8:30 am

Also the flow limitations are in the 3rd chart at top - theyare cut off at the top but they didn’t go higher than any of those lines…

The preference is the important ones on the same graph.

So one other thing that kind of worries me is that I have a ring that gives me AHI number which was much higher (19) and while it may not be accurate, it does match the times when the machine says I had events. So I’m wondering if the machine catches all of them? I’ll put it in Imgur and post.

jumblegirl wrote: ↑

Thu Jun 16, 2022 8:58 am

So one other thing that kind of worries me is that I have a ring that gives me AHI number which was much higher (19) and while it may not be accurate, it does match the times when the machine says I had events. So I’m wondering if the machine catches all of them? I’ll put it in Imgur and post.

No, the ring is not accurate.

And if the ring said you had an AHI of 19, and the CPAP (which *actually* measures flow) says your AHI is 4.37, than they can't match.

Your CPAP is the gold standard of treatment, studied scrutinized and peer reviewed. Your ring is a toy.

When they hand out rings to diagnose sleep apnea, then you can wonder about the accuracy of your CPAP.

I think you need to put away your ring and stop looking at the numbers for a while.