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cmaustin
Unread post  Post subject: OSCAR Results  |  Posted: Wed Aug 26, 2020 11:03 am

Joined: Wed Aug 26, 2020 11:00 am
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Hello, I've been getting good at using my CPAP machine for the last 5 months. I just got OSCAR and wanted to know your thoughts on my results. Thanks.


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DeltaBravo3.8
Unread post  Post subject: Re: OSCAR Results  |  Posted: Wed Aug 26, 2020 11:50 am
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Joined: Sat Jul 04, 2020 8:38 am
Posts: 293
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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Hi and welcome to the forum. A few comments and a return question: one big area is controlling leaks. The data points out leaks of some form to be an area needing attention. I'm not sure what mask you're using, but it may a good idea to research on proper adjustment and fit. These are two separate but linked aspects. Adjustment addresses how tight or loose the straps are set. And being too tight is a trap quite a few PAP users fall into. Being too tight can increase pain and discomfort. It can increase leaks by distortion of the cushion seal. Fit is the cushion size chosen. Sometimes the wrong size is used, and especially if using Pillows, you may try larger than you think and get improvements.

Otherwise, we can look at therapy settings. I think on looking at this chart, the biggest area of improvement after leaks is in the flow limit chart. Are you using EPR now? If not, it might be good to add it. It will require two things, move your low of 4, which is really too low for most adults anyway. Let's consider bumping 4 to 7 and adding in EPR of 3. This adds two things, better comfort due to EPR exhale relief and a bit more air to breathe better and to treat the FL. I also think you may need a bit more on top than 11. The pressure flat topped around 01:00. I think it wanted to go higher to address some event but with your setting it couldn't go up any further.

Try these edits: EPR 3 Pressure 7-13 and actively work on mask adjustment and fit. The leaks are going to throw your therapy off the rails if not reigned in.

_________________
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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cmaustin
Unread post  Post subject: Re: OSCAR Results  |  Posted: Wed Aug 26, 2020 1:48 pm

Joined: Wed Aug 26, 2020 11:00 am
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Thanks for your advice. I set my unit, AirSense 10 Autoset, to your recommended settings. I have a weak chin and that is where my problem is regarding leaking. At first I tried the AirTouch F20 L mask but the leaking was real bad. Now I'm using the FP Vitera L mask. Its not as comfortable, but leaks less.


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DeltaBravo3.8
Unread post  Post subject: Re: OSCAR Results  |  Posted: Wed Aug 26, 2020 6:32 pm
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Joined: Sat Jul 04, 2020 8:38 am
Posts: 293
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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OK good info regarding the Vitera. That's going to be my next mask to go with a new pulmonary team, new nebulizer, inhalers, and NIV vent soon. And you're welcome, hope it helps.

OK we're back after the commercial break above...I have an item in mind for you to consider. You do what you want with the info. Look up a company called Knightsbridge Dual Band. They have a cap you wear that has 2 sets of velcro to hold your mouth closed. It may help you with that weak chin thing.

https://dualbandchinstrap.com/

Here's one of their images from their site.

Image

_________________
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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cmaustin
Unread post  Post subject: Re: OSCAR Results  |  Posted: Fri Aug 28, 2020 10:17 am

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Yes, I figured my next step is a chin strap. Didn't want to because they look so uncomfortable. I'll give this one a try since it appears it might not completely suck and see how it goes.


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DeltaBravo3.8
Unread post  Post subject: Re: OSCAR Results  |  Posted: Fri Aug 28, 2020 1:43 pm
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Joined: Sat Jul 04, 2020 8:38 am
Posts: 293
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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FWIW several have tried it on Apnea Board and seem to like it, but just like all other products it isn't for everyone. The positive effect of supporting the jaw while sleeping tends to be very good according to feedback.

_________________
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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cmaustin
Unread post  Post subject: Re: OSCAR Results  |  Posted: Fri Sep 18, 2020 5:34 am

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Hello, I tired the head strap but it didn't seem to help. I have gotten my leak better. See attached. General thoughts? I think the CPAP is helping my health.

Also, on OSCAR, there are three types on events: CA, OA, UA, H, and RE. I know what they stand for but what I would like to know is if one type of event worse than the other? Are they are equally bad?


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Lewbie
Unread post  Post subject: Re: OSCAR Results  |  Posted: Fri Sep 18, 2020 10:20 am

Joined: Fri Sep 18, 2020 7:47 am
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I have been using a cpap since March 2020. I have a ResMed Airsense10. I haven't used an SD card until yesterday. My questions:
1. If I load the card to OSCAR will it only have the data since I installed the SD card or will the history be on the card?
2. How frequently should I upload the SD card to OSCAR?
Thanks.


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DeltaBravo3.8
Unread post  Post subject: Re: OSCAR Results  |  Posted: Fri Sep 18, 2020 11:37 am
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Joined: Sat Jul 04, 2020 8:38 am
Posts: 293
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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@cmaustin It looks better than before but I would consider bumping 7 up just a bit more if you're wanting to bring down the events any further, especially the Flow Limit shaggy grass part. It may be disrupting somewhat. So a question, do you seem to be benefiting as is? How is comfort on using the PAP? ResMed PAPs can choose pressures of "fractions" such as 7.2 instead of 7.0. Maybe try small low pressure fraction bump up to see if comfort improves any, FL grass gets mowed down some. However, if you think it feels good, run it as is and you should benefit from better restful sleep.

I consider Obstructive Apnea as the worst, CA or Central Apnea second, Hypopnea, then FL. Obstructive events are most to full blockage of the air passage, and I think the highest impact to oxygen flow. CA can be very disruptive to sleep, and can cause arousals. Hypopnea are lesser strength obstructive or central apnea events. FL are the weakest, but can still cause lots of interruptions to sleep.

@Lewbie the SD card must be mounted/inserted in the PAP machine for detailed data to be obtained and saved. You cannot get it after the fact. You can see some summary data on the machine without an SD card present, but it's not as helpful as the detailed data if saved on the SD card. As for how often to look at the data: if you've just started PAP therapy, I would do so daily until therapy is nearly dialed in. Then weekly data viewing should be fine until/unless therapy starts feeling less effective.

_________________
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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cmaustin
Unread post  Post subject: Re: OSCAR Results  |  Posted: Fri Sep 18, 2020 1:07 pm

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@deltabravo3.8 I feel I am getting a better sleep. I have no problems increasing the low 7 settings. What do you think?

Can you explain "Flow Limit shaggy grass?" I see the chart but what does it mean?
Thanks!


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DeltaBravo3.8
Unread post  Post subject: Re: OSCAR Results  |  Posted: Fri Sep 18, 2020 2:22 pm
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Joined: Sat Jul 04, 2020 8:38 am
Posts: 293
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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Look at your Flow Limit or FL section on OSCAR. It has a shaggy grass look, or an unmowed lawn look to it. I realize it registers from 0-1 with 0.x in between. I have typically gotten feedback from other users that typically with the shaggy look with events registering above .3 it can indicate sleep disturbances. Visualize how I described it. Yep non-medical terms but you should see it.

As for changes, you decide if you want to, but maybe try 7.2 and see if it feels better and if FL shrinks. If it makes it worse in any way, go back to 7. If it's doing OK there, try it for 2 or so days.

BTW we're adjusting for results, increasing how you feel, etc. not to get perfect zero AHI and other scores. We can adjust to lower FL as in your case.

_________________
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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cmaustin
Unread post  Post subject: Re: OSCAR Results  |  Posted: Fri Sep 18, 2020 3:10 pm

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Thanks @deltabravo3.8, why not just set the lower limit to 8? Is 7.2 really that much of a difference? The max is much higher at 13.


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DeltaBravo3.8
Unread post  Post subject: Re: OSCAR Results  |  Posted: Fri Sep 18, 2020 10:05 pm
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Joined: Sat Jul 04, 2020 8:38 am
Posts: 293
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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No 7.2 isn't a big step from 7.0. You can change to 8 if you're so inclined. You can try it and see what happens, then if it's a bit much, back it down some. If it works out, great. Keep it where it shows improvement. The .2 bump up was a very conservative step is all it was. FWIW 8 was where my ASV started at, with it Maxing at 25.

_________________
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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cmaustin
Unread post  Post subject: Re: OSCAR Results  |  Posted: Mon Sep 21, 2020 4:40 am

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@deltabravo3.8 Went to 8 min and the good news, I slept the whole night for the first time in a long time. Didn't do a good job "mowing the grass." Thoughts?


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Pugsy
Unread post  Post subject: Re: OSCAR Results  |  Posted: Mon Sep 21, 2020 7:27 am
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PAP Mask: Bleep/DreamPort nasal mask
PAP Machine: ResMed AirCurve 10 VAuto

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Work on leak management. If you notice your FLs are worse in times of large leak. When not in large leak the FLs aren't that bad.
You can't mow the grass well when in large leak.

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I may have to rise but I refuse to shine.


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cmaustin
Unread post  Post subject: Re: OSCAR Results  |  Posted: Fri Sep 25, 2020 5:35 am

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Thank you for everyone's advice. I think I'm starting to get to a good place. Before CPAP, my AHI score was 42 which included 34.5 OAs per hour. Here our my latest sleep graphs. I can always improve my leak, etc., but would the pros here consider this "good enough?"


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DeltaBravo3.8
Unread post  Post subject: Re: OSCAR Results  |  Posted: Fri Sep 25, 2020 7:54 am
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Joined: Sat Jul 04, 2020 8:38 am
Posts: 293
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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Except for leak rate, it is looking much improved. FL grass has been mowed. I know it's somewhat hard to tell if this a true representation of data due to leaking. Even so, let's do this, consider the question "how do you feel after therapy?" Think on things like do you sleep better, feel more refreshed, better or more comfort.

I'm going to put it back on you in this way, if you feel better for the therapy, run with it as is. If me, I would relax, take a few days off any adjusting if you're feeling better for the therapy. So to speak, take a breather, then after a few days, say next week, renew efforts to lower leaking rates. No other area needs addressed other than that leak issue. Even if it never gets better, you're still better now than earlier. Give leak management a try next week, and if you still can't get it better, so be it. Just let it go as is then. This therapy is disrupting on its own, so don't beat yourself up if this is the best it gets.

Hope the above makes sense. Best wishes it continues well. Don't obsess over data BTW. At this stage, for anything other than leak adjust attempts next week, maybe look at this data weekly or not at all until/unless you start feeling badly after sleeping. Just trying to minimize the therapy drag.

_________________
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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cmaustin
Unread post  Post subject: Re: OSCAR Results  |  Posted: Fri Sep 25, 2020 8:06 am

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Is there any data that shows that with leak levels like I'm having, is the machine unable to actually prevent apnea events?


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DeltaBravo3.8
Unread post  Post subject: Re: OSCAR Results  |  Posted: Fri Sep 25, 2020 9:49 am
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Joined: Sat Jul 04, 2020 8:38 am
Posts: 293
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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I don't think there's specifics I can point you to, it is under the common knowledge folder of user experience and feedback of others. I have seen people have high leaks and then they either get them under control or have a night with low leak rates and they mention how better it was or we see OSCAR showing low leaks and better control over events in individuals.

It just comes down to the lower the leak level the better and more accurate therapy gets and machine control is maintained. Your leaks aren't as bad as some I've seen. You can choose with it as is to not worry about the leak rate and just run with it, with an occasional checking the stats on it. If yours go any worse though, then you must deal with it.

I place your leak rate chart at the high end of the good range (with higher meaning less good), meaning if it were any more leaks than it is, it is then in the bad range, an area that most likely means uncontrolled and does definitely impact therapy accuracy. You are in the right field, just getting close to the bad sides fence.

_________________
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: OSCAR Results  |  Posted: Fri Sep 25, 2020 10:39 am
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Usually the first sign the machine is maybe having problems when faced with big leaks is we see UAs being flagged. Unknown apneas....something is happening but in the face of a big leak the machine can't put a name to whatever is happening.

We aren't seeing that in your case so I would lean toward nothing is happening. From my own past experience with large leaks and UAs...I started seeing them flagged when I hit 35 L/min or higher on a ResMed machine.

ResMed will give you Mr Smiley face for leak management up to 30% of the night being over 24 L/min. I always looked at how far over 24 L/min I went and how long I was up there when I evaluated my leaks.

IMHO you are pushing the boundaries but if you are sleeping good and those leaks aren't waking you up and you are feeling great...then you are probably okay.

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