Help with OSCAR Report from Loewenstein Prisma Smart

Hi all,

I've been using a Loewenstein Prisma Smart APAP for 4 years now with a nasal mask and pressure settings @ 7-10 cmH2O. So far I've had slight improvement of some of the more severe symptoms - like waking up with frequent headaches and my brain feeling completely "fried" / foggy after waking up (and mostly the whole day after). But I still wake up tired every day like I barely slept a few hours and I'm fatigued and unfocussed all day. I've brought this up to my treating physician multiple times and he always waves it off by telling me to just stick to the therapy. So now i'd finally like to tackle this issue and started looking into evaluating the data myself with OSCAR.

I'm still very new to this so I'm gonna need some help here, but from what I can see my AHI seems to be fine, but the flow limitations might be an issue. I also see some RERAs here and there but nothing to crazy I guess. Can anyone give me a bit more insight into what might be going on here?

I'll let more experienced members comment on the results, but just wanted to let you know everything from ES down to critical leak is not needed on the reports here.

Some thoughts and questions.

You may not be getting enough sleep. Most people need 7 to 8 hours of actual sleep, which may mean more like 7.5 to 8.5 hours in bed. You might try making more time for sleep.

Do you take any medications? If yes, what are they?

I don't know what the metric for flow limitations means, but the best tool for treating them is to have a higher pressure for inhalation than for exhalation. If you haven't maximized that capacity on your machine, you might give it a try.

There is some clustering in your FLs and snores. Do you sleep on your sides, back, or stomach, or a mixture? And do you have a low pillow or a high pillow? Do you tend to tuck your chin toward your chest?

p.s. Do you have nasal congestion?

Miss Emerita wrote: ↑

Fri Aug 23, 2024 12:13 pm

Some thoughts and questions.

You may not be getting enough sleep. Most people need 7 to 8 hours of actual sleep, which may mean more like 7.5 to 8.5 hours in bed. You might try making more time for sleep.

Do you take any medications? If yes, what are they?

Quite a few:

• bisoprolol (beta blocker), candesartan, hygroton (diuretic) - hypertension
• Metformin - prediabetes
• Testosterone replacement therapy
• Vyvanse - prescribed for ADHD, though I suspect large parts of those symptoms are due to the years of unrestful sleep

Miss Emerita wrote: ↑

Fri Aug 23, 2024 12:13 pm

I don't know what the metric for flow limitations means, but the best tool for treating them is to have a higher pressure for inhalation than for exhalation. If you haven't maximized that capacity on your machine, you might give it a try.

Yeah I think on my machine it's called softPAP and it's set to "Slight", i'll see if I can turn that up.

Miss Emerita wrote: ↑

Fri Aug 23, 2024 12:13 pm

There is some clustering in your FLs and snores. Do you sleep on your sides, back, or stomach, or a mixture? And do you have a low pillow or a high pillow? Do you tend to tuck your chin toward your chest?

I sleep mainly on my side. Low pillow. Its possible with the chin, I do sometimes wake up with the pillow bunched up between the headret and my head pushing my chin towards my chest.

Miss Emerita wrote: ↑

Fri Aug 23, 2024 12:13 pm

p.s. Do you have nasal congestion?

Yes I do have nasal congestions sometimes, although it seems to be pretty random. Some days completely stuffed, sometimes not at all. Not sure what is causing it though. My ENT seems to think it's a long term complication from covid. Though I've felt tired on APAP therapy ever since I started, long before the congestion issue.

Thanks a lot for the suggestions so far!

Bisoprolol can cause problems falling asleep or staying asleep. Vyvanse can cause trouble sleeping, although that's not a common side effect. You might discuss those meds with your doctor. Also, if you haven't recently had a check of your T levels, that might be worth doing, in case your dosage needs a tweak.

Any chance you have long Covid?

When people tuck their chins down toward their chests, their airways can get a little bit compressed, which can be just enough to make flow limitations, hypopneas, and obstructive apneas more likely to happen. You could try using a soft cervical collar to see whether that helps you sleep better. There some good information here:
https://www.apneaboard.com/wiki/index.p ... cal_Collar

Many people get some relief from stuffiness by using a nasal spray like Ayr, a nasal rinse like NeilMed, and Flonase nasal spray. Be aware that Flonase takes a week or two to kick in.

Judging from your medication list, you've had a good workup from your physician. But just to check you been tested for problems with iron, vitamin D, B vitamins, Lyme disease, thryroid, or autoimmune disease, especially in the connective tissue disease family?

Honestly, the very first thing for you to do is to try to get a sleep schedule going that allows you to sleep for 8 hours.

Miss Emerita wrote: ↑

Sat Aug 24, 2024 11:25 am

Any chance you have long Covid?

Its possible that I have long covid, after my last covid infection (February 2023) i developed long term intermittent congestion and my sense of smell and taste have been permanently affected - not completely gone but very weak.

Miss Emerita wrote: ↑

Sat Aug 24, 2024 11:25 am

When people tuck their chins down toward their chests, their airways can get a little bit compressed, which can be just enough to make flow limitations, hypopneas, and obstructive apneas more likely to happen. You could try using a soft cervical collar to see whether that helps you sleep better. There some good information here:
https://www.apneaboard.com/wiki/index.p ... cal_Collar

Good tip with the collar, i can give that a shot.

Miss Emerita wrote: ↑

Sat Aug 24, 2024 11:25 am

Many people get some relief from stuffiness by using a nasal spray like Ayr, a nasal rinse like NeilMed, and Flonase nasal spray. Be aware that Flonase takes a week or two to kick in.

I do occasionally use decongestants if it gets too bad before bed. We don't have flonase here but I use one of those that are not supposed to be used for more than 3 days, as I use it only on occasion and it works very fast.

Miss Emerita wrote: ↑

Sat Aug 24, 2024 11:25 am

Judging from your medication list, you've had a good workup from your physician. But just to check you been tested for problems with iron, vitamin D, B vitamins, Lyme disease, thryroid, or autoimmune disease, especially in the connective tissue disease family?

Iron and vitamin D are fine (i take 5000IU per day). Thyroid is fine too. Never been checked for lyme, been checked for autoimmune hypothyroidism and I believe i had an AMA test a while ago which was negative. Haven't been specifically tested for any connective tissue disorders - is that something that can cause sleep apnea?

My sleep apnea started once I started getting really overweight and went into overdrive after starting TRT, which was actually a blessing in disguise - when I started having sleep apnea due to being overweight, my AHI was very borderline (slightly above 5) though I was already feeling as tired as I do now. Then after being on TRT for a year or so, I got retested and hit an AHI of 28 so I finally got treated. Interestingly enough, the APAP treatment only improved the severe symptoms I got after starting TRT, the tiredness I had at an AHI of 5 is still there.

Miss Emerita wrote: ↑

Sat Aug 24, 2024 11:25 am

Honestly, the very first thing for you to do is to try to get a sleep schedule going that allows you to sleep for 8 hours.

You are right, I'm definitely working on that. I do have an issue with going to bed too late but its getting a bit better now. I used to go to sleep around 2, now its more like 12am. I think if I hit somewhere around 10-11pm, that should be good enough.

Thanks again for all the great input!

Connective tissue diseases don't cause apnea, but they do cause tiredness and often cause sleep disturbances. In this article, the top bulleted list includes good screening for CTD:

https://emedicine.medscape.com/article/334482-workup

The second bulleted list is for additional testing based on symptoms.

If your AMA test used immunofluorescence assay, then your negative result probably means you don't have a CTD.

About long Covid: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10028338/