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Moe_Howard
Unread post  Post subject: Help With OSCAR Please  |  Posted: Wed Jun 10, 2020 12:23 pm
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Joined: Thu May 07, 2020 1:03 pm
Posts: 61
PAP Mask: Philips Respironics DreamWear nasel headgear with arms
PAP Machine: Res Med 10 auto set.
Humidifier: Yes
Pressure Setting: Minimum pressure is 11.2 and Maximum pressure is 13.8 ---E.P.R. is on off

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I've just tried to download my SD card onto OSCAR to read how I'm doing so far for the month of June. ( I have all data from Feb. to May already on OSCAR) Now when I download my data I get a message that no data available and please remember to select the root folder or drive letter. Any help would be appreciated .


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Pugsy
Unread post  Post subject: Re: Help With OSCAR Please  |  Posted: Wed Jun 10, 2020 1:24 pm
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Joined: Wed Aug 02, 2017 8:01 pm
Posts: 1982
PAP Mask: Bleep/DreamPort nasal mask
PAP Machine: ResMed AirCurve 10 VAuto

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Try creating a new profile after getting the most recent version of OSCAR just released a few days ago.

_________________
I may have to rise but I refuse to shine.


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Moe_Howard
Unread post  Post subject: Re: Help With OSCAR Please  |  Posted: Wed Jun 10, 2020 3:58 pm
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Joined: Thu May 07, 2020 1:03 pm
Posts: 61
PAP Mask: Philips Respironics DreamWear nasel headgear with arms
PAP Machine: Res Med 10 auto set.
Humidifier: Yes
Pressure Setting: Minimum pressure is 11.2 and Maximum pressure is 13.8 ---E.P.R. is on off

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Thank you!


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Moe_Howard
Unread post  Post subject: 2 Questions  |  Posted: Sat Jun 13, 2020 3:52 pm
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Joined: Thu May 07, 2020 1:03 pm
Posts: 61
PAP Mask: Philips Respironics DreamWear nasel headgear with arms
PAP Machine: Res Med 10 auto set.
Humidifier: Yes
Pressure Setting: Minimum pressure is 11.2 and Maximum pressure is 13.8 ---E.P.R. is on off

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Hi everybody!

Firstly I want to thank everyone as the advise I'm getting is greatly appreciated!

My 2 questions are

1- If my average EPAP is 8.92 should I have my Min. pressure set at 8 or does it not matter?

2- If my average Max. pressure is 15, should I have my Res. Med set to 15 or is it O.K. to keep my Max. pressure set at 19?


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Respirator99
Unread post  Post subject: Re: Help With OSCAR Please  |  Posted: Sat Jun 13, 2020 7:17 pm
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Joined: Mon Apr 27, 2020 1:06 am
Posts: 141
Location: Australia
PAP Mask: Resmed Airtouch F20
PAP Machine: Resmed S9 VPAP Adapt
Humidifier: Resmed H5i
Pressure Setting: Min EPAP: 8.0 Max EPAP: 11.0 PS Min: 3.0 PS Max: 8.0

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Answering Q2 first - in general, your maximum set pressure doesn't matter, as the machine will only go as high as it needs to. So a max of 20 is OK in most cases. Sometimes, however, the machine experiences a runaway situation where the pressure goes to the max in a non-therapeutic manner. In that case, you could reduce the maximum.

Question 1 - as a general rule, you should set your minimum pressure somewhere near the median that the machine settles on. This is so there is a sufficient pressure (EPAP) at all times to allow the machine to respond quickly to events. This is probably more important for Philips machines, which tend to be slower to react. If your median is 8.9 and your minimum is set at 8, that sounds reasonable. Unless there are other factors at play, I wouldn't change the minimum.

At this stage, we really do need to see some data from you in order to provide any more detailed advice. How are you getting on with Oscar? If you could share a daily page or two with us, we'd be able to understand in detail how things are going and give you some targeted recommendations rather than working by rule of thumb.

Best wishes

_________________
Regards from Australia

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Moe_Howard
Unread post  Post subject: Re: Help With OSCAR Please  |  Posted: Sat Jun 13, 2020 7:59 pm
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Joined: Thu May 07, 2020 1:03 pm
Posts: 61
PAP Mask: Philips Respironics DreamWear nasel headgear with arms
PAP Machine: Res Med 10 auto set.
Humidifier: Yes
Pressure Setting: Minimum pressure is 11.2 and Maximum pressure is 13.8 ---E.P.R. is on off

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Thank you for getting back to me. I will only use this tread for my posts. Please find enclosed 3 pictures from today. At you convenience , let me know what you think.


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Moe_Howard
Unread post  Post subject: Re: Help With OSCAR Please  |  Posted: Sat Jun 13, 2020 8:05 pm
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Joined: Thu May 07, 2020 1:03 pm
Posts: 61
PAP Mask: Philips Respironics DreamWear nasel headgear with arms
PAP Machine: Res Med 10 auto set.
Humidifier: Yes
Pressure Setting: Minimum pressure is 11.2 and Maximum pressure is 13.8 ---E.P.R. is on off

Offline
Thank you for getting back to me. I will only use this tread for my posts. Please find enclosed 3 pictures from today. At you convenience , let me know what you think.


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Respirator99
Unread post  Post subject: Re: Help With OSCAR Please  |  Posted: Sat Jun 13, 2020 10:00 pm
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Joined: Mon Apr 27, 2020 1:06 am
Posts: 141
Location: Australia
PAP Mask: Resmed Airtouch F20
PAP Machine: Resmed S9 VPAP Adapt
Humidifier: Resmed H5i
Pressure Setting: Min EPAP: 8.0 Max EPAP: 11.0 PS Min: 3.0 PS Max: 8.0

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Hi Moe, thanks for posting these. A couple of things stand out on the daily chart:

1. Turn the calendar off.
2. Leaks are fairly large and persistent.
3. You have a cluster of central apneas starting at 10:20
4. There are visible flow limitations throughout.

Taking these in turn:

1. The calendar isn't necessary for us to view your results, but it does cover up the machine settings, which it would be useful to review. You can easily turn it on or off by clicking on the little triangle just left of the date.

2. Leaks are important. When the leak goes over the "red line" (24 L/min for Resmed) the machine has difficulty maintaining the appropriate airflow and can't properly diagnose and treat events. This is the area shaded grey on the charts - you are experiencing these large leaks nearly 20% of the night. Even if the leaks aren't that high, they can still disturb your sleep. I see you're using a nasal mask and I believe your leaks are mainly because your mouth is falling open. There are a number of ways to address this, including:

a) learn to place your tongue to seal the mouth,
b) use a chin strap to stabilise your jaw and keep the mouth shut,
c) tape your lips shut using a suitable surgical tape such as Micropore,
d) use a soft collar to support your neck and prevent your jaw from dropping,
e) change to a full-face mask.

3. There is a big cluster of central apneas starting at 10:20 am. It would be helpful if you could zoom in on that cluster so that about 3 minutes of the graph fills the screen. That way we can see if they're genuine centrals or something else. It's not uncommon to get centrals during the sleep - wake transition period ("sleep wake junk") but you've got a lot of events over a fairly extended period. Looking at your stats, the central apnea index is generally low, so this might have been a one-off situation.

4. The flow limitations are a partial closure of the airway, almost an hypopnea waiting to happen. Resmed machines detect these and increase pressure to fend them off. Generally the advice is to increase the EPR setting to increase air flow, but in your case I suspect it would lead to increased central apneas. Perhaps we should leave aside the flow limits for now, and revisit them once we've got other things sorted out.

So, at this stage I'd leave all your settings as they are. Work on getting the leaks under control, and let us have a close-up view of that big central cluster. After that we'll think further about the flow limitations.

_________________
Regards from Australia

* Download Oscar
* Oscar help
* Organise your Oscar charts


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Moe_Howard
Unread post  Post subject: Re: Help With OSCAR Please  |  Posted: Sat Jun 13, 2020 11:39 pm
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Joined: Thu May 07, 2020 1:03 pm
Posts: 61
PAP Mask: Philips Respironics DreamWear nasel headgear with arms
PAP Machine: Res Med 10 auto set.
Humidifier: Yes
Pressure Setting: Minimum pressure is 11.2 and Maximum pressure is 13.8 ---E.P.R. is on off

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here are 2 more screen shots. Please let me know what you think.


Attachments:
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Moe_Howard
Unread post  Post subject: Re: Help With OSCAR Please  |  Posted: Sat Jun 13, 2020 11:53 pm
User avatar

Joined: Thu May 07, 2020 1:03 pm
Posts: 61
PAP Mask: Philips Respironics DreamWear nasel headgear with arms
PAP Machine: Res Med 10 auto set.
Humidifier: Yes
Pressure Setting: Minimum pressure is 11.2 and Maximum pressure is 13.8 ---E.P.R. is on off

Offline
Again, I want to thank you for your input and help. I do appreciate it.


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Respirator99
Unread post  Post subject: Re: Help With OSCAR Please  |  Posted: Mon Jun 15, 2020 12:29 am
User avatar

Joined: Mon Apr 27, 2020 1:06 am
Posts: 141
Location: Australia
PAP Mask: Resmed Airtouch F20
PAP Machine: Resmed S9 VPAP Adapt
Humidifier: Resmed H5i
Pressure Setting: Min EPAP: 8.0 Max EPAP: 11.0 PS Min: 3.0 PS Max: 8.0

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Hi again Moe. Obviously the 11th was a better night than the 12th in terms of AHI, mainly because that big cluster of centrals didn't occur. I wonder if you might have moved in your sleep around 10:20am and caused your chin to tuck down to your chest. This can cause a series of obstructive apneas which are often reported as centrals. It would be good to get a close-up of that episode just to be sure.

Again, the leaks were excessive on both nights. It looks like they are nearly all occurring at times of high pressure, so we can experiment a bit - try increasing your EPR to 3. This should reduce the flow limitations and stop the pressure going so high. It might have the effect of increasing central apneas so that's a balance we need to strike.

But I think if we can get your leaks under control the overall results will be very good and you should have much more restful and refreshing sleep.

_________________
Regards from Australia

* Download Oscar
* Oscar help
* Organise your Oscar charts


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Moe_Howard
Unread post  Post subject: Re: Help With OSCAR Please  |  Posted: Mon Jun 15, 2020 10:55 am
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Joined: Thu May 07, 2020 1:03 pm
Posts: 61
PAP Mask: Philips Respironics DreamWear nasel headgear with arms
PAP Machine: Res Med 10 auto set.
Humidifier: Yes
Pressure Setting: Minimum pressure is 11.2 and Maximum pressure is 13.8 ---E.P.R. is on off

Offline
Thank you for your advice. I'm going to try a chin strap, maybe that will help with my leaks.
As for the morning of the 12th at 10:20 a.m. I was not sleeping but still in bed rolling around wearing the mask, I think that's why a series of obstructive apneas occurred.


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Moe_Howard
Unread post  Post subject: Re: Help With OSCAR Please  |  Posted: Sun Aug 02, 2020 12:26 pm
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Joined: Thu May 07, 2020 1:03 pm
Posts: 61
PAP Mask: Philips Respironics DreamWear nasel headgear with arms
PAP Machine: Res Med 10 auto set.
Humidifier: Yes
Pressure Setting: Minimum pressure is 11.2 and Maximum pressure is 13.8 ---E.P.R. is on off

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Enclosed are current screenshots. Any advise on pressure settings would be appreciated.


Attachments:
File comment: Enclosed are current screenshots. Any advise on pressure settings would be appreciated.
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File comment: Enclosed are current screenshots. Any advise on pressure settings would be appreciated.
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DeltaBravo3.8
Unread post  Post subject: Re: Help With OSCAR Please  |  Posted: Sun Aug 02, 2020 4:55 pm
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Joined: Sat Jul 04, 2020 8:38 am
Posts: 295
Location: Greencastle, Pennsylvania, USA
PAP Mask: ResMed F20 N30i P30i, a F&P Simplus & soon to have Vitera
PAP Machine: I will likely tell the doc it's going to be ResMed Astral 150
Humidifier: Accessory Humidifier will be requested
Pressure Setting: 0 setting for now, soon to be using AVAPS settings

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The event counts are down into a reasonable area and are almost split 50/50 between OA and CA. It's good not to see the CA cluster from earlier in the thread. Leaks are still rather high at around 25% for Large Leaks for July 31.

I think the priority is on control of leaks. There's a chin strap called Knightsbridge Dual Band that you may want to research to see if it might be of use.

_________________
Dave K9DWB 73s

https://www.sleepfiles.com/OSCAR
http://www.apneaboard.com/wiki/index.php/OSCAR_Help
http://www.apneaboard.com/wiki/index.php/OSCAR_Chart_Organization


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Moe_Howard
Unread post  Post subject: Re: Help With OSCAR Please  |  Posted: Mon Aug 03, 2020 12:03 pm
User avatar

Joined: Thu May 07, 2020 1:03 pm
Posts: 61
PAP Mask: Philips Respironics DreamWear nasel headgear with arms
PAP Machine: Res Med 10 auto set.
Humidifier: Yes
Pressure Setting: Minimum pressure is 11.2 and Maximum pressure is 13.8 ---E.P.R. is on off

Offline
Thank you , I'll definitely check out the Knightsbridge Dual Band chin strap.


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Moe_Howard
Unread post  Post subject: Re: Help With OSCAR Please  |  Posted: Thu Sep 03, 2020 10:57 am
User avatar

Joined: Thu May 07, 2020 1:03 pm
Posts: 61
PAP Mask: Philips Respironics DreamWear nasel headgear with arms
PAP Machine: Res Med 10 auto set.
Humidifier: Yes
Pressure Setting: Minimum pressure is 11.2 and Maximum pressure is 13.8 ---E.P.R. is on off

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Hi , I just bought a res med f30 full face mask and have been using it for a few days. I find my leak rate went down, but my AHI went up (to 6.71). Enclosed are 5 screen shots from last night. Any suggestions would be greatly appreciated .


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DeltaBravo3.8
Unread post  Post subject: Re: Help With OSCAR Please  |  Posted: Thu Sep 03, 2020 2:26 pm
User avatar

Joined: Sat Jul 04, 2020 8:38 am
Posts: 295
Location: Greencastle, Pennsylvania, USA
PAP Mask: ResMed F20 N30i P30i, a F&P Simplus & soon to have Vitera
PAP Machine: I will likely tell the doc it's going to be ResMed Astral 150
Humidifier: Accessory Humidifier will be requested
Pressure Setting: 0 setting for now, soon to be using AVAPS settings

Offline
What I'm seeing especially in screenshot 39 where you have the thick black Flow Rate graph:

segment/session 1 at 5:40 - 6:10 ish, look at 5:40 the FL and darker blue Hypopnea flag right at the beginning for this cluster at the hashmark for 5:40. You had an Hypopnea and FL very close to the same time, maybe/likely a FL that strengthened into an H. I say as a guess from this view, this started that mess of clustered events with leaks as a result of higher pressure. Progression possibility is FL>H>cluster mess, with pressures jumping in an attempt to address and leaks came along for the ride.

I don't recall if you're using a soft collar to combat cluster apnea events, if not maybe consider it. Look at this article from Apnea Board if you want to learn about the soft cervical collar wiki info. In case you want the info, here's the links to CorFlex...

http://www.apneaboard.com/wiki/index.php/Soft_Cervical_Collar

It involves a simple free test...sit in a chair and drop your chin to your chest, was it more difficult to breathe? This chin drop action can happen while sleeping and may cause clusters of apnea events, something very much like your clusters at 5:40 and the later 8:10-30 one. Include the little cluster at 9:40 too.

If you have a collar now, it's not preventing these 3 segments of clusters. If you don't have one, it may be good ammo to combat these clustering events. I've heard others get about a $20 or so collar from Walgreens. Also look up CorFlex collars. The product is an Ultra Cervical Collar.

Here's the product page https://www.corflex.com/products/cervical-spine/neck/cervical-supports/ultra-cervical-collar/

Order form direct from CorFlex http://corflex.com/ProductPDF/15-5000.pdf

If you want, put up a zoomed in redo of shot 39 and look at the progression.

_________________
Dave K9DWB 73s

https://www.sleepfiles.com/OSCAR
http://www.apneaboard.com/wiki/index.php/OSCAR_Help
http://www.apneaboard.com/wiki/index.php/OSCAR_Chart_Organization


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Pugsy
Unread post  Post subject: Re: Help With OSCAR Please  |  Posted: Thu Sep 03, 2020 2:36 pm
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Joined: Wed Aug 02, 2017 8:01 pm
Posts: 1982
PAP Mask: Bleep/DreamPort nasal mask
PAP Machine: ResMed AirCurve 10 VAuto

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Sometimes some people need a little more pressure when going to a full face mask from a nasal mask. That lower strap on most full face masks pulls the jaw back ever so slightly and alters the airway a bit. So it can take more pressure to hold it open and prevent the airway collapse.

Sometimes adding a cervical collar will help keep the airway from changing and needing more pressure.
Sometimes it's positional and sometimes it's REM stage sleep related.

I have known people to see a 2 or 3 cm different in pressure needs between a full face mask and a nasal mask. Not everyone of course...but enough to know it happens fairly often.

If adding a cervical collar doesn't work for you or you don't like that idea then you might try a 1 cm increase in your minimum pressure and see how much it helps or not.

_________________
I may have to rise but I refuse to shine.


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Moe_Howard
Unread post  Post subject: Re: Help With OSCAR Please  |  Posted: Thu Sep 03, 2020 2:53 pm
User avatar

Joined: Thu May 07, 2020 1:03 pm
Posts: 61
PAP Mask: Philips Respironics DreamWear nasel headgear with arms
PAP Machine: Res Med 10 auto set.
Humidifier: Yes
Pressure Setting: Minimum pressure is 11.2 and Maximum pressure is 13.8 ---E.P.R. is on off

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Thank you Pugsy and DeltaBravo3.8 for the info. I really don't want to sleep with the cervical collar unless I need to. I'll raise my minimum pressure by 1cm and see if that helps.

Again, thank you so much for your help.


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DeltaBravo3.8
Unread post  Post subject: Re: Help With OSCAR Please  |  Posted: Thu Sep 03, 2020 3:13 pm
User avatar

Joined: Sat Jul 04, 2020 8:38 am
Posts: 295
Location: Greencastle, Pennsylvania, USA
PAP Mask: ResMed F20 N30i P30i, a F&P Simplus & soon to have Vitera
PAP Machine: I will likely tell the doc it's going to be ResMed Astral 150
Humidifier: Accessory Humidifier will be requested
Pressure Setting: 0 setting for now, soon to be using AVAPS settings

Offline
Welcome, yes I'd go that way if I were you. It's free to adjust the PAP and see how it responds. One less thing to strap on after you buy it. The mask change seems promising though. Keep at it and best to your success.

_________________
Dave K9DWB 73s

https://www.sleepfiles.com/OSCAR
http://www.apneaboard.com/wiki/index.php/OSCAR_Help
http://www.apneaboard.com/wiki/index.php/OSCAR_Chart_Organization


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