PRESSURE SETTINGS AND AHI

samir · Post by **samir** » Sat Jul 02, 2022 7:28 am

Dear All,

I was diagnosed with sleep apnea in 2018 and have been struggling since then. By struggling, I mean I have been feeling good some days and not so well in many of the other days. I have reached a point I briefly stopped even using the CPAP machine. However, after much thought and support, I believe it is best bet to continue with the CPAP therapy. I have attached below a screen grab of my OSCAR report for last night and as you will see, the events graph is quite 'overloaded'. Regarding my feeling, I can say its fair and would rate it at 5.5 on a scale of 10. What advise will you give so that my events can be reduced? what is your interpretaion from the report as I am not familiar with OSCAR interpretation? I have seen a few colleagues talk of the use of meds? what are these meds? are they specific for sleep apnea? Note: I do not use any meds and I hope my attachments are line with the advise given by pugsy.

Regards
Samir.

LSAT · Post by **LSAT** » Sat Jul 02, 2022 7:33 am

Your report looks pretty good. Increasing your minimum pressure to 5.5 or 6 should reduce your AHI a little.

Pugsy · Post by **Pugsy** » Sat Jul 02, 2022 7:35 am

The meds question we ask is most often asked to rule out medication side effects as a potential cause for daytime symptoms that someone might be complaining of. Example is fatigue or trouble sleeping which both can be caused to worsen simply from medication side effects.

For your issues....and your report.
Do you remember waking often during the night last night?

I would suggest changing the minimum from 4.5 to 7 cm and see what happens. If you can't comfortably do that in one step then I suggest going up gradually with 0.5 cm increments.

samir · Post by **samir** » Sat Jul 02, 2022 7:41 am

Thanks Pugsy and LSAT for your responses. For last night, I remember waking up a few times though not very often like the previous nights. I think I can comfortably ramp up the pressure to 7 and see what happens. Thanks

samir · Post by **samir** » Tue Jul 05, 2022 9:15 am

In my last OSCAR report, I notice two episodes of periodic breathing, one lasted for 2 mins and 45 seconds while the other lasted for 2 mins and 36 seconds. Does this imply I have some form of central apnea?

Pugsy · Post by **Pugsy** » Tue Jul 05, 2022 9:22 am

samir wrote: ↑
Tue Jul 05, 2022 9:15 am
In my last OSCAR report, I notice two episodes of periodic breathing, one lasted for 2 mins and 45 seconds while the other lasted for 2 mins and 36 seconds. Does this imply I have some form of central apnea?

Doubtful.

Did you have a truckload of central apneas during those flagged periodic breathing episodes?
Do you see LOTS of flagged periodic breathing episodes chocked full of central flagged events?

Periodic breathing is just a general waxing and waning of the flow rate (breathing) that lasts for at least 2 minutes.
Cheyne Stokes Respiration is a form of periodic breathing but it isn't the only kind of periodic breathing that people can have.
It is of course a type that could point to a problem which is why we sit up and take notice.

But not all periodic breathing is CSR and thus not all PB points to any problem or potential problem.

What is the central index of your AHI per the machine?

Pugsy · Post by **Pugsy** » Tue Jul 05, 2022 9:25 am

Normal and not alarming flagged PB

CSR periodic breathing has a very specific pattern

samir · Post by **samir** » Tue Jul 05, 2022 9:31 am

Thanks Pugsy for the information. It is very useful and appreciated.

I have attached my report. I would be happy if you reviewed it. the two episodes are shown clearly at the top of the first graph.

Regards

Pugsy · Post by **Pugsy** » Tue Jul 05, 2022 9:41 am

Those 2 flagged episodes obviously aren't chocked full of central apneas and they are very brief...I suspect if you zoomed in on them they would look like my first image above ...the normal and not alarming flagged PB.

But overall your detailed report just screams sub optimal therapy in general.
Your minimum pressure is simply to low to do a good job holding the airway open well enough to prevent the collapse.
I am not sure what the minimum needs to be but something in the neighborhood of 7 or 8 cm would likely clean up the report a lot.

samir · Post by **samir** » Tue Jul 05, 2022 9:53 am

Thanks once again.

I have zoomed in on one of the episodes and definitely looks like the one you posted earlier on. Does that mean this is normal? i was somehow worried about the 2 mins periodic breathing, I mean I just cant imagine not breathing properly for over 2 mins.

Regarding the low Min pressure setting. I did try ramping up the pressure to 7cm as you advised the last time but was not feeling somehow comfortable. I will try adjusting to an incremental 0.5cm over the next few nights.

Pugsy · Post by **Pugsy** » Tue Jul 05, 2022 10:01 am

Your zoomed in on PB episode looks more like arousal breathing than it does asleep breathing to me.
And yes...an occasional flagged PB episode is actually "normal" and doesn't mean much one way or the other.
The large number of flagged events seen...could actually be making the chance of arousal/awake breathing PB episodes greater. Meaning the real flagged stuff could be causing arousals when in turn can cause irregular breathing which in turn might get flagged as PB by mistake.

Even if your PB was real CSR and chocked full of centrals....2 random and very brief episodes aren't necessarily indicative of a serious problem anyway. We we need to see a LOT of such episodes often before we worry.
And obviously yours aren't chocked full of anyhing....shrug your shoulders and move on with that worry.

Do try to increase the minimum if you can. Try 0.5 cm incremental increases over several weeks to get your body adjusted to the new pressure if you have to. Give yourself a week at each increase if you have to in an effort to get used to the new slightly higher pressure.

samir · Post by **samir** » Sun Jul 17, 2022 4:48 am

Hi,

I have been ramping up my pressure for some time now and ended up with a 9.5 from 4.5.

Last night I woke up gasping for breath with some chest pains on the left side and immediately look at my OSCAR report. I have only slept for 23 mins at the time.
I didn't see much from the report but there was a "pressure pulse" reading I do not understand what that means.

I wanted to know what is PP and why does my graph look that weird at the end (Attached).

Samir

Dog Slobber · Post by **Dog Slobber** » Sun Jul 17, 2022 6:23 am

samir wrote: ↑
Sun Jul 17, 2022 4:48 am
I didn't see much from the report but there was a "pressure pulse" reading I do not understand what that means.

I wanted to know what is PP and why does my graph look that weird at the end (Attached).

There is no attached graph.

When using the boards attachment feature make sure that it uploaded correctly, (thee is no exclamation mark), or use an external site such as imgur.

And check your content by looking at it.

samir · Post by **samir** » Sun Jul 17, 2022 6:55 am

Sorry about.

I think I have issues with using the board's attachment feature but please see the link below.

https://imgur.com/a/vjMkSBI

samir · Post by **samir** » Thu Jul 28, 2022 5:51 pm

Hi All,

I had my Min pressure at 4.5cm at the start of my therapy however after advice from members whose contributions and advice I sincerely appreciate, I ramped up my pressure each night to 11.5cm which I find it OK for me with regards to my feeling. However, with the increased pressure I can see that CAs have also dominated my charts for now. Additionally, After looking at my Oscar report for last night, my average pressure was under 12.8cm 95% of the time. I have attached the OSCAR report.
My questions 1. Now that my average pressure was 12.8cm for 95% of the time last night, does that mean I will benefit more if let say I increased the pressure to 13cm.
2. My thinking is that since am still experiencing obstructive apnea with a min pressure of 11.5cm, a further pressure increase may eliminate the OAs.
3. Does this also mean that my body needs higher pressures and therefore better handled by a BIPAP rather than a CPAP.
4. What steps can I take to reduce the CAs.
5. I also experienced periodic breathing episodes. I have honestly not very well understood what this is all about.
6. Finally, If you look at my flow rate, it seems like the first part on the left is smooth and looks pretty normal with the second part been inconsistent and this
pattern is shown throughout the night. Is there any explanation for this.

Additional Info. Min 11.5cm Humidity level 3 A flex 3

OSCAR report link https://imgur.com/a/PWS4d4c

I will appreciate your advice and many thanks in advance.

PRESSURE SETTINGS AND AHI

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