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Love some feedback on my latest OSCAR

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stevesnores +0 points · 3 months ago Original Poster

Hello. Thanks for the months of info and browsing (i love reading everyones stories and tips n tricks!) .

So over the past year i have tried all sorts of things. Nose pillows, FF masks, mouth tape, chin strap. The usual. I have recently settled on a Phillps dreamwear full face mask. I think i'm on the right path - i just need some help deciphering OSCAR data. The leakage has always been an issue, so i have been dialling that in recently. Any help or tips would be appreciated.

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Sierra +0 points · 3 months ago Sleep Patron

I don't think your setting are all that bad. Your main component, based on this one night, of AHI is obstructive apnea. It looks like you have Flex turned on. The first change I would try is to turn the flex off. It can make obstructive apnea events appear more often for the same fixed pressure setting. If that does not help, then next you might want to try 10.5 or 11 cm for your set pressure to see if that helps any. More pressure can initiate CA events, but it looks like they are OK for now. As for the leak rate the DreamStation machines display both the total leak rate (upper green trace in the graph) as well as the real leak rate. The top trace includes the intentional purge leak rate for the mask plus unintentional leaks. The bottom curve is the important one as it is the real leak rate where the intentional purge flow is subtracted out. Short story is to ignore the top curve and pay attention to the bottom one. I don't think the leak rate is too bad. If you right click on the Leak Rate vertical scale it should bring up a menu of options. One is to display the Leak Rate Red Line. If you turn that on, it gives you a better idea of where you stand for leakage. I believe it is set for 24 L/min. The Statistics section shows you are over the redline 5.5% of the time. I try to keep that number to 1% or less. You may want to set the scale of this graph to a maximum of 50 so it displays the more useful bottom trace better. Doesn't matter if the total leak rate trace goes off the graph as it is kind of irrelevant.

Hope that helps some. If you have questions, post again...

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stevesnores +0 points · 3 months ago Original Poster

Thankyou so much for replying. I will try turning the flex off first, then post results. Then tackle other issues. I'm in Australia, so I assume in a different timezone, but we'll work it out.

It's been so hot here, any form of sleep is hard at the moment. Thankyou!

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stevesnores +0 points · 3 months ago Original Poster

Hello! Have posted last nights OSCAR reading. I spent last evening reading and doing some adjustments as i'm having some ear issues - not pain or popping, just feeling a bit a deaf. Just feeling like there's too much pressure on the exhale maybe? Not sure. So i left my pressure at 9, i might ramp that up to 10. I added back in the ramp and have changed to c-flex+

It was a pretty good sleep overall. I don't feel 100% , but assume after so many years of untreated apneoa - things are going to take time. Any advice or tips would be appreciated. Thanks!

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Sierra +0 points · 3 months ago Sleep Patron

This daily report is not as good as the previous one. It indicates more of a problem with central apnea (CA events), and minimal obstructive apnea (OA events). You will have to watch if increasing pressure that CA's don't become a problem. Hypopnea (H) is high as well. This graph looks quite a bit like mine where I tend to have issues with CA events and even more with Hypopnea. I have concluded that my hypopnea events are generally central in nature. In other words they are dropping respiratory effort rather than a flow limitation due to obstruction. It is generally assumed that hypopnea events are restrictive in nature, but that is not always true. Here is a night that is a good example of what I am talking about.

This is a close in zoom of the portion of the night where there is a series of 7 events in fairly close succession. Only six are flagged, but the initiating event is an obstructive one which disrupted breathing. It does not last long enough to be flagged, but you can see how it upsets minute ventilation and causes is to start cycling. You can also see the impact on the mask pressure. The short but wide blue band in the mask pressure indicates it is obstructive. The band is the machine cycling flow to see what impact there is on pressure. A CA event paints a more narrow pressure band because the airway is open, not closed. This first obstructive event starts the cycle and results in a clear CA event where breathing stops but the airway is open. This is followed by some less severe cycles in flow that are flagged as hypopnea events. The cycle is almost identical in nature to the one flagged as a CA, but does not go to zero flow so is not flagged as a CA event. The last event is a clear CA one where the flow goes to zero, and the mask pressure paints a narrow band. The cycling continues after this but eventually dies out.

For these reasons I consider most of my hypopnea events as central apnea in nature. I you zoom in and look at your events in detail you may be able to do a similar diagnosis . Those green PB areas are a further indication of this same problem.

So what do you do? If you find this pattern frequently (higher CA and H), then you should do what you can to keep pressure down. One way to do that is as I suggested to turn FLEX off. Flex reduces pressure on exhale. Obstructive events can happen on exhale and a lower exhale pressure can initiate obstructive events. If you turn FLEX off this drop in pressure is avoided, and in your case you get 9 cm on inhale and exhale. With respect to you feeling pressure in your ears I would suspect some congestion issues. I use Otrivin occasionally to reduce congestion. It should not be used on an ongoing basis. In the scheme of things 9 cm is not a high pressure. Some use pressures up to 25 cm. I have mine set at 11 cm with no reduction on exhale (EPR turned off). My thoughts remain the same. Try turning off FLEX to see if this helps. If it does, then you might even want to try a lower pressure than 9 cm. Generally one could reduce the pressure until OA events become the dominant component of the AHI.

On the mask leaks, I think you are doing fine. I would set the Leak Rate red line. Right click on the vertical scale, select Dotted Lines, and then check the Leak Rate Upper Threshold box. I also use the Y-Axis option, and then use Manual Override to set the minimum at 0 and max at 50 L/min.

I hope that helps some. If you have any questions, just ask. Based on this latest Daily Report you do not have a simple basic case of Apnea. It looks like complex apnea. That said a basic CPAP with a fixed pressure may be the best way of addressing it. At least it is the best first try.

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stevesnores +0 points · 3 months ago Original Poster

Hello. Thankyou. A lot of info for a tired human! But I will definitely read through it and try to understand it in detail.

I misinterpreted the flex thing. I reduced it and changed to cflex+ ... How the hell do you turn off flex? I am using a Phillips dreamstation.

And I'll play with my leak line thing later when my brain is a bit clearer.

Thankyou!

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stevesnores +0 points · 3 months ago Original Poster

Ok I think I worked it out. Just went into clinic section and switch flex off. But it also give me an option of flex adjustment in the adjacent box. I assume turning flex off will over ride that?

Will push through work today and give it a go tonight. We have a long weekend here so hope to have a few work free days to experiment.

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Dude +0 points · 3 months ago

Higher pressure did you well but the events came up. However, keep in mind, the higher you go central apnea may creep in... and gas. Your mask leaks are quite a bit high for me and most likely are waking you up. Try and adjust your mask a bit and get rid of the VS2 events, the machine picks up vibrations, hose dragging across you pillow or mattress. If the mask is irritating you nose or anywhere else try some Lansinoh Lanolin cream but very sparingly, especially around your nose, nares. I just ditched my F&P simplus, which had very minimal leaks but I got tired of fighting the hose in my face turning over, and went back to Resmed F30i. I had it before and it had too many leaks, but I learned how to adjust the harness. The dreamwear was worse, but again I didn't adjust well enough, it's basically the same design. Also try and be a side sleeper, as much as you can. How you feel is the main thing. Your flex setting is comfort so adjust accordingly.

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stevesnores +0 points · 3 months ago Original Poster

Hello. Cheers for the response. Appreciate it.

Last night was a shocker sleep. My mask is definitely leaking unless I stay still, I'm going to get another couple to trial. So if I'm understanding correctly (bit of a newbie to Oscar), the mask leaks are disturbing my sleep which are causing me to wake. Hence me sleeping a long time the other night, but not feeling refreshed.

My AHI is pretty low, which is the only thing my doc seems to worry about. But that's not the main thing obviously. But since using a Full face mask for a week (Phillips dreamwear) my data is all going in the right direction. I think getting a mask that fits perfectly is the main thing, then I can start upping pressure and fine tuning. When I get up, I'll post last night's Oscar readout.

Again, thankyou!

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Dude +0 points · 3 months ago

You can get woken up from leaks if they hit your skin or arm hair or blast your pillow and you can hear it... but leaks can cause events yes. Leaks mean less pressure and you are loosing therapy. Raise pressure to 13 and then lightly cinch the top straps to keep the mask in place, pull the bottom straps gradually until the mask stops leaking, not to fast or too tight, gradually.

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