Pulse Oximeter Data, etc.

This is what SleepyHead says about Oximeters. Not sure if OSCAR has added more or not...

What is your breakdown of AHI into the CA, OA, and Hypopnea types? Central apnea can be erratic and harder to deal with. On the times when you have AHI in the 14 range, it would be helpful to know the breakdown to see how much of it is central apnea compared to obstructive. OSCAR will tell you this. All the historic data should be on your SD card, so you can go back and review specific days.

OK. That one set of numbers suggests obstructive apnea is the main issue that drove the AHI up. I suspect you would learn a lot from using OSCAR. It provides much more detailed data. And as long as your SD card was in your machine, it should all be on the card. Have you checked to see that there is a card. Some providers do a nasty trick and pull the card out of the machine.

It would be helpful if you posted a Daily Report screen from OSCAR. There are some things you should do first to clean up the default screen though, assuming OSCAR defaults are the same as SleepyHead. This assumes you are on a PC. Mac should be somewhat similar.

1. Under File, Preferences, Appearance, uncheck the box that says "Show Event Breakdown Chart". It is redundant.
2. Close the Navigation Bar on the right, F10 I believe on a PC.
3. Also click on the black triangle beside the date to hide the month calendar.

All these things use up valuable screen space. Make sure the Event Flags are pinned to the top. Click and drag the graph titles so the Pressure, Flow Rate and Leak Rate show.

Again on a PC the F12 key will save this screen shot as an image file. Just note in the popup where it is saving the file. Then when you navigated in Windows File Explorer and find the file, you can click and drag the file to the body of a post. Just make sure you start with a new post in the thread so you get a full width post.

If you post it here, I can give you my comments. It would be good to post a good day and a bad day.

This is the easier one to comment on and suggest improvements. First I think your minimum pressure is too low and seems to be just set at the default minimum of 4 cm. I would suggest a minimum of about 10 cm. This may prevent a few of the obstructive, hypopnea, and RERA events which are occurring at a pressure of less than 10 cm. CA events are very low, so central apnea does not seem to be an issue. It appears you are using a ramp at the beginning of the night with the Ramp starting at 4 cm also. I would suggest setting the ramp start pressure a bit higher at about 7 cm. For most a little more pressure is more comfortable and less suffocating while going to sleep.

CA events are a little higher, but not much, and not concerning. The OA events are the main problem along with hypopnea. RERA is high too. The large majority of these events are occurring when the machine is maxed out on pressure at 15 cm. The obvious solution is to increase the maximum pressure to 16 or 17 to see what this does. The Machine Settings are not showing, but I'm guessing from the Pressure chart that you have Flex turned on and set at 2 cm? If you turned Flex off, you might gain a little without increasing the maximum pressure. I would try that first, and if you still get bad nights like this, then go to the higher maximum.

Some people seem to have trouble with positional apnea where they get their neck into a cramped position while sleeping which in turn promotes obstructive apnea. When this happens it can result in short periods with very high rate of apnea. Yours does not really look like that, as the rapid apnea events extend over a period of about 4 hours. But, you could keep that in mind. You can buy a soft cervical collar at places like Walmart for about $20 that some wear to keep their neck from getting into a cramped position. I have never tried it, but others report success with it.

That is about all I can think of for now; increase minimum pressure, turn Flex off, and if necessary increase the maximum pressure.

Hope that helps some,

Interesting. There is something strange about the starting pressure and minimum pressure. I am less familiar with DreamStation machines than I am with ResMed. On a ResMed you cannot set the Ramp Start pressure higher than the Minimum Pressure. It appears you can on your machine, as it looks like it start at 10 cm and then goes down to 4 cm when the Ramp is over. ResMed machines would not allow that. I wonder if someone tried to set the minimum at 10 cm, but changed the Ramp Start pressure instead of the Minimum pressure?

My suggestions remain the same. I would get your provider to change the Minimum Pressure from 4 cm to 10 cm. Then the pressure should never go less than 10 cm all night. Also same suggestion with the Flex. Turn it off. It reduces pressure on exhale, and you may be getting more obstructive apnea when exhaling at the lower pressure. When Flex is turned off the red and green pressure lines will be the same, not split. It may allow you to get away with a maximum pressure of 17 cm. It is still maxing out at 17 cm for short periods of time. Once you see how it works with a higher minimum, it may have to go higher still, perhaps as high as 14-15 cm. A Ramp Start pressure at 10 cm seems a little high, and you could set it lower at 7 cm or so, if that feels more comfortable.

DreamStation machines behave a bit differently than ResMed when in Auto. The DreamStations like to ramp pressure down (if you allow it) to see if you get apnea, then it ramps it up again if you do. When your minimum pressure is set low like at 4 cm, it can cause extra OA events as it hunts around with pressure all night long. You can stop that by elevating the minimum pressure. When the pressures are set up well there is often a very narrow range between minimum and maximum pressure. My wife has a ResMed but she still has a narrow range with a minimum of 13 cm and maximum of 14.4 cm. She typically gets under 1 for AHI. Here is what a good night looks like for her. She was diagnosed with an AHI over 80. Note the narrow range between minimum and maximum pressure.