Oscar Charts Input

[mper!?]

How do I add a median line to the graphs? I looked and couldn't find an option that I could identify.


Hi,
sorry...just go on the left of each chart, right click, and, on dotted lines, mark the median.

all the best and good luck

[Mchezaji]

Adding 2 days worth of screenshots, I have zoomed in near both pressure increase and a central as well.

I tried a setting of EPR for a few days and it seems to have increased my obstructive apneas slightly-so I backed off on that beginning 10/13 and turned the EPR off completely.

Additionally, I have ordered a soft cervical collar and plan on using it as soon as I receive it at the end of this week(I am a mouth breather and my jaw muscles relax significantly as I am falling asleep). Hopefully this will help? The chin strap that I am currently using doesn't seem to be doing that great of a job.

I greatly appreciate everyone's input and thoughts on my case. I know that my AHI is pretty low compared to many out there but continue to feel extremely tired and fatigued.

Thank you for the input BlueDragon. I am trying to get a good sleep doctor, so that I can even try an get on a VAuto. Recently I lost most of the data on myn SD card and although I was able to retrieve it using software, it's the folder/structure that it's in is not understood by OSCAR. I have another post that I have requested assistance from OSCAR developers on how I can get the data integrated into OSCAR. I am hoping that extensive data, can enable the MD to write me a VAuto that will be covered by my insurance company.

I am most definitely not an expert on CPAP treatment but have looked at my own charts in detail. Here is what I see in your charts.

Overall the numbers look good, as you know. But quality of sleep is more important than the numbers. I recently went through an extensive process of trying to figure out why I was still so fatigued despite "good" numbers (average AHI about 1.7). The result for me was switching from an AutoSet to a VAuto and using EERS (Enhanced Expiratory Rebreathing Space). My AHI now averages under .5, sometimes I even see 0.0, and I feel more rested.

You have a sporadic increase in flow limits that drives the increase in pressure (as it is supposed to). And during those periods of pressure increase your tidal volume drops and your respiration rate increases -- suggesting shallower, faster, but irregular breathing. I would think that might disturb your sleep in itself.

Might the pressure increase itself be disturbing your sleep? You could try fixed pressure and see if that makes any difference.

I will try and shift to a CPAP mode for a week or two to see what it does?

Looking at the flow chart itself, I see that it sometimes looks like a solid bar, while at other times it looks "fuzzy." If you are breathing regularly, with minimal variation in breath-to-breath volume, the flow graph will look like a solid bar. The fuzzier the bar, the more varied the breaths. I suggest zooming in so only 10 minutes is shown. Do that both where the bar looks solid and where it is fuzzy. Maybe one around a CA too.

I'll work on some screenshots and add them shortly.

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[Mchezaji]

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[Mchezaji]

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[Mchezaji]

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[Mchezaji]

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[Mchezaji]

Thanks-posted a few screenshots.

How do I add a median line to the graphs? I looked and couldn't find an option that I could identify.


Hi,
sorry...just go on the left of each chart, right click, and, on dotted lines, mark the median.

all the best and good luck

[mper!?]

Hi, thanks Michezaji (male or female? I am afraid, I may have missed..)

_ I am afraid your case comes with some complexity, indeed. I would have to count on other opinions, trying to narrow down something.

Let us refresh and see if we could conclude something up to here:

_ Pugsy, with all her experience, initially said: "It wouldn't be impossible for there to be some poor sleep quality happening here that is unrelated to apnea or airway issues";

_ your latest charts appear confirming you indeed would not have problems with OSA, or even typical UARS (you do not arousal/awakening as I would expect);

_ you said you “sleep well”, with only exceptions. You are 5-11 height and 195 pounds; sleep on your backs, and is a mouth breather (for some ENT’s, mouth-breathing already implies in poor quality, some 25% downgraded respiration);

_ your OSCAR charts show a widespread FL all night long, however not enough to arousal/awakening/wake up you during the night. You appears going with a shallow respirarion throughout the night (low MV, on account of a rather low TV, 380/400, instead some expected 500/600, as just per a quick look on Google nomograms. You could talk with your Doctor on this). And, as usual with APAP machines, you appear fighting against the machine with very short expiration time;

_ would this all-night-long flow-limited, mouth, shallow respiration be enough to cause your ultimate poor sleep quality?
………Maybe.

_ could this it be improved going to FFM, using the sof collar, and moving to BIPAP?
…....... I think so. FFM could help you non-mouth breathing, eventually. Collar, as well, could add on non-mouth breathing and avoid chin from tucking. Moving to a BIPAP would implies elimination of all FL, maybe lower flow constrictions at quasi-hypopneas, better ventilation (higher MV, how much? not sure), and less/no intolerance on expiration;

_Would this be enough to feel much better?
……….I don’t know how much better, but sure enough, something better. I think it would be well worth trying all those steps, if you can. Insurance wise, don’ know much about this, unfortunately.

hope others pop in and add.

all the best and good luck

[Dog Slobber]

You have a sporadic increase in flow limits that drives the increase in pressure (as it is supposed to). And during those periods of pressure increase your tidal volume drops and your respiration rate increases -- suggesting shallower, faster, but irregular breathing. I would think that might disturb your sleep in itself.

Might the pressure increase itself be disturbing your sleep? You could try fixed pressure and see if that makes any difference.

The timing of the flow limits, pressure increases, as well as the related respiration rate looks exactly like REM sleep. I would definitely not move back to fixed pressure, APAP is doing exactly what it's supposed to do.

[Mchezaji]

Thanks mper!? for your detailed input. I greatly appreciate the feedback from folks on the forum who combined have a wealth of knowledge.

Btw, the mask I am using is considered a FFM(the F30i). Currently, I tape my mouth so its channeling most of the flow via my nostrils.

Yesterday was my first night using a soft collar and I will post the charts below.

Hi, thanks Michezaji (male or female? I am afraid, I may have missed..)

_ I am afraid your case comes with some complexity, indeed. I would have to count on other opinions, trying to narrow down something.

Let us refresh and see if we could conclude something up to here:

_ Pugsy, with all her experience, initially said: "It wouldn't be impossible for there to be some poor sleep quality happening here that is unrelated to apnea or airway issues";

_ your latest charts appear confirming you indeed would not have problems with OSA, or even typical UARS (you do not arousal/awakening as I would expect);

_ you said you “sleep well”, with only exceptions. You are 5-11 height and 195 pounds; sleep on your backs, and is a mouth breather (for some ENT’s, mouth-breathing already implies in poor quality, some 25% downgraded respiration);

_ your OSCAR charts show a widespread FL all night long, however not enough to arousal/awakening/wake up you during the night. You appears going with a shallow respirarion throughout the night (low MV, on account of a rather low TV, 380/400, instead some expected 500/600, as just per a quick look on Google nomograms. You could talk with your Doctor on this). And, as usual with APAP machines, you appear fighting against the machine with very short expiration time;

_ would this all-night-long flow-limited, mouth, shallow respiration be enough to cause your ultimate poor sleep quality?
………Maybe.

_ could this it be improved going to FFM, using the sof collar, and moving to BIPAP?
…....... I think so. FFM could help you non-mouth breathing, eventually. Collar, as well, could add on non-mouth breathing and avoid chin from tucking. Moving to a BIPAP would implies elimination of all FL, maybe lower flow constrictions at quasi-hypopneas, better ventilation (higher MV, how much? not sure), and less/no intolerance on expiration;

_Would this be enough to feel much better?
……….I don’t know how much better, but sure enough, something better. I think it would be well worth trying all those steps, if you can. Insurance wise, don’ know much about this, unfortunately.

hope others pop in and add.

all the best and good luck

[Mchezaji]

Thank you for the input Dog Slobber.

You have a sporadic increase in flow limits that drives the increase in pressure (as it is supposed to). And during those periods of pressure increase your tidal volume drops and your respiration rate increases -- suggesting shallower, faster, but irregular breathing. I would think that might disturb your sleep in itself.

Might the pressure increase itself be disturbing your sleep? You could try fixed pressure and see if that makes any difference.

The timing of the flow limits, pressure increases, as well as the related respiration rate looks exactly like REM sleep. I would definitely not move back to fixed pressure, APAP is doing exactly what it's supposed to do.

[Mchezaji]

Yesterday was the first night that I used the soft collar, in addition to taping my mouth which I have been doing for about 3 weeks now.

It's interesting that my AHI dropped down to almost a zero. I had one central and one obstructive-however the obstructive happened as I was awake, so I am discounting it, so technically my AHI was a 0.1. What is interesting is that in the past most of what I had was centrals and using the soft collar seems to have reduced the centrals as well? However, this is just one night and I will report back over the next several days on the progress-especially on how I feel in relation to the numbers.

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[mper!?]

Yesterday was the first night that I used the soft collar, in addition to taping my mouth which I have been doing for about 3 weeks now.

It's interesting that my AHI dropped down to almost a zero. I had one central and one obstructive-however the obstructive happened as I was awake, so I am discounting it, so technically my AHI was a 0.1. What is interesting is that in the past most of what I had was centrals and using the soft collar seems to have reduced the centrals as well? However, this is just one night and I will report back over the next several days on the progress-especially on how I feel in relation to the numbers.
OSCAR 1015-1.pngOSCAR 1015-2.pngOSCAR 1015-3.png

Hi,
_ good you are trying non-mouth breathing;

_ AHI: actually, it would not be a thing for you to care about in my modest opinion. It looks essentially associated with false positive centrals (in turn associated with arousal/awakening-back to sleep);

_ collar reducing centrals (false positive)? yes, it could be the case; once with the collar you would moving smoother throughout REM, with less arousals/awakenings;

_ it appears to me your main drawback keep going the same, maybe: shallow breathing, low TV/MV throughout the night. Let us see whether this will improve with your current Autoset, as you progress.

all the best and good luck