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JB1975
Unread post  Post subject: Newbie needs Help with Oscar Charts  |  Posted: Mon Oct 12, 2020 7:57 pm

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Hi all, Long time Listener, first time caller... :)

I've been using my APAP for about 3 weeks now and I've gotta say I love the thing, but I'd like to have a deeper understanding of the different types of events. If any of you are willing would you please look at my charts and let me know what you think? I wish I had better more specific questions, but I don't quite have a grasp of all of this yet. Thank you in advance for your time and knowledge.


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Pugsy
Unread post  Post subject: Re: Newbie needs Help with Oscar Charts  |  Posted: Mon Oct 12, 2020 8:54 pm
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http://www.apneaboard.com/wiki/index.ph ... rpretation


Overall....pretty boring zoomed in segments.
Would be nice to see the overall not zoomed in version.

And it's hard to answer questions or explain things when there isn't a specific question as to what needs to be expanded upon.


Based on what is shown though...if you are sleeping decently and feeling decent during the day then I think you can run with it like it is.
I see nothing that points to an urgent need to be changing anything.
So continue as is and keep reading up on what you are seeing and when you run across something that isn't clear to you....just ask and someone will try to explain it more clearly for you.

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Respirator99
Unread post  Post subject: Re: Newbie needs Help with Oscar Charts  |  Posted: Mon Oct 12, 2020 9:41 pm
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I agree with Pugsy - your numbers are fine and there's nothing in the charts you've shown us to suggest any changes.

Once you've got your AHI down to this level, the question becomes - how do you feel? Are you getting rested or do you wake up fatigued? Any particular discomforts or other issues?

Quote:
... I'd like to have a deeper understanding of the different types of events.


There are three types you'll likely see most of the time: Obstructive apnea, central apnea and hypopnea.

Obstructive apnea is the most common and is caused by the tissues in your airway collapsing in your sleep and/or your tongue falling back to obstruct the airway. Can also be caused by letting your head drop forward so that your chin touches your chest, thus putting strain on the windpipe.

Central sleep apnea occurs when your brain fails to send the "breathe now" signal to your lungs / diaphragm. This can have a wide range of causes including some form of neurological problem, congestive heart failure, certain medications (especially CNS depressants or pain relief). But in the great majority of cases they are idiopathic, which is doctor-speak for "I haven't got a clue what's causing them". They can also be false positives, where you stop breathing for a little while after some disturbance such as rolling over in your sleep. Your central apnea index is so low that it can be safely ignored, based on the charts provided.

Hypopnea is a partial obstruction of the airway lasting 10 seconds or more. Think of it as an obstructive apnea that hasn't fully developed.

Hope this explanation helps.

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JB1975
Unread post  Post subject: Re: Newbie needs Help with Oscar Charts  |  Posted: Tue Oct 13, 2020 4:17 am

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Thank You for replying so quickly. Here I thought I'd be providing greater detail by zooming in. Guess I was wrong. Here's a whole night.

I guess what I'm wondering is there anything in this chart that would indicate what would cause a bloated feeling? I feel like my abdomen area is full of air sense I started using the APAP? I've also hear that running in Auto mode can be potentially worse than running in Constant mode, is this true?

At around 02:25 the flow rate seems to be totally different than the rest of the night. Is this caused by the leak that runs concurrently?

I appreciate all of your insight and willingness to help.


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Pugsy
Unread post  Post subject: Re: Newbie needs Help with Oscar Charts  |  Posted: Tue Oct 13, 2020 7:55 am
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aerophagia...that bloated feeling
unfortunately it doesn't really show up as anything on the software reports except maybe potential awake breathing if it causes enough discomfort to wake a person up.

Usual first remedy to try...add in some exhale relief in the form of EPR so that there isn't so much constant pressure against the LES Lower Esophageal Sphincter letting air get into the stomach.

Turn on EPR and set it to 3 full time and see what happens.

Your question about the flow rate at 2:25...now that I would need to see zoomed in on but I doubt it is related to the leak. Most likely just a change in breathing for some reason. My best guess...leak disturbed sleep and woke you up a little and the flow rate which is just a breath by breath graph and the breathing changed a bit. Awake vs asleep breathing maybe.

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JB1975
Unread post  Post subject: Re: Newbie needs Help with Oscar Charts  |  Posted: Tue Oct 13, 2020 8:31 pm

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For some reason, the last chart I posted had errors. Apparently OSCAR combined Sunday and Monday into 1 day and reported many false details. I created a new profile in OSCAR and re-imported the data. Now I have the correct data for both Sunday and Monday. Has anyone had that happen before?

I will turn on EPR tonight. Are there any side effects I need to be worried about with EPR? I've read differing opinions so I'd like to know which is better EPR or no EPR.

I'm going to post a zoomed out image from last nights corrected chart and what I'd really like to know is, are there any obvious changes that could be made that would help to further drive down the AHI? I notice there are events taking place after the pressure drops below about 7, but my min is 5.2. Should I raise the minimum or would this just be exposing myself to higher pressures unnecessarily? Is there anything concerning on this chart at first glance?

I'm just trying to understand the charts, and have the treatment be as affective as possible. Again, thank you in advance for all your help.


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Respirator99
Unread post  Post subject: Re: Newbie needs Help with Oscar Charts  |  Posted: Tue Oct 13, 2020 10:39 pm
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When your AHI is down around 1 or 2 you're probably doing as well as can be expected. Slightly lower AHI may come naturally as your body gets more accustomed to using CPAP, but you've achieved a pretty good result already.

Turning on EPR can sometimes cause more central apneas. This is because it improves breathing efficiency, thus reducing the proportion of CO2 in the blood, and tricking the brain into thinking it doesn't need to breathe just now. If you do see a sudden increase in centrals, then turn the EPR down.

You should also raise your minimum pressure, for a number of reasons:

1. EPR effectively reduces your exhale pressure, and you don't want to let it get too low. As a rule of thumb, I would add 1 cm H2O for every cm of EPR.

2. Your chart does show some flow limitations and snores which should respond to a slightly higher pressure.

3. Having a low starting pressure means that the machine has to respond more aggressively when an event occurs, causing fairly abrupt pressure changes. These can be disturbing, and also aggravate your aerophagia. It's sometimes the case that starting a little higher effectively suppresses apneas and their precursors, so the machine doesn't reach maximum pressure as long or as high.

The downside of raising the pressure for you might be an increase in aerophagia. So make your changes gradually and progressively, giving your body time to make the necessary adjustments.

Having said all that, your numbers are looking really good and your apnea is being well treated. Now it's a matter of maximising comfort and sleep quality.

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DeltaBravo3.8
Unread post  Post subject: Re: Newbie needs Help with Oscar Charts  |  Posted: Wed Oct 14, 2020 12:33 pm
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Just note that if you want to enable EPR 3 as Pugsy suggests, your pressure must be at a minimum of 7 or EPR of 3 is not attainable. Pressure of 7 minus EPR 3 equals 4, and that 4 is as low as your machine drops.

You could do both these edits. Bump pressure from 5.2 I think is what was showing, so bump that to 7. EPR Full time 3 cmH2O.Use that and give us an OSCAR chart no zoom, and include how you felt.

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JB1975
Unread post  Post subject: Re: Newbie needs Help with Oscar Charts  |  Posted: Thu Oct 15, 2020 4:09 am

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Good Morning! So...I did as suggested. I bumped up my minimum pressure to 7 and turned EPR on full time at 3.

The good: I feel rested, in fact for this whole week I've been waking up naturally 15-30 minutes before my alarm goes off. I feel rested this morning. The aerophagia doesn't feel any worse.

The Bad: The aerophagia doesn't feel any better, but of course this was quite a jump on the Min Pressure so it may take a bit to get used to. I had a little trouble at the beginning of the night due to the higher starting pressure, but still managed to fall asleep within 30 minutes or so.

As far as sleep quality, I feel like when I was asleep, it was great, but our dog had a rough night and he woke me up a couple times last night. In fact after 4:00am I was awake, partly because he woke me, but partly because it was 7 hours after I went to sleep. Nonetheless, those events probably shouldn't be counted.

I've attached my chart from last night and welcome any insight, explanations, advice, etc.

Thank you again for all your help!


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Pugsy
Unread post  Post subject: Re: Newbie needs Help with Oscar Charts  |  Posted: Thu Oct 15, 2020 7:06 am
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If the aerophagia is still bad and annoying.
You can set EPR to 3 and your minimum back to 5.2 or where it wasn't so bad....and while it won't give you 3 cm difference at the beginning of the night once the pressure goes up during the night it will kick in to the max of 3.

We might end up need to limit the max a bit if that doesn't resolve the problem.

So you can still start out at lower pressures if you wish and it might help with the aerophagia....then the 3 cm exhale drop with EPR won't fully kick in until you reach 7 cm minimum...you will still have some drop and it might be enough to help with the belly issues.

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JB1975
Unread post  Post subject: Re: Newbie needs Help with Oscar Charts  |  Posted: Thu Oct 15, 2020 7:28 am

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Thank You Pugsy,

Don't misunderstand, I don't think the aerophagia is all that bad, it's just a little discomfort and bloating. I think the benefits are awesome and probably worth it to at least ride it out for a bit and see. I really feel quite rested even though the sleep was broken up by our doggie :)


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Pugsy
Unread post  Post subject: Re: Newbie needs Help with Oscar Charts  |  Posted: Thu Oct 15, 2020 8:00 am
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Okay. You are the best judge of how bad or annoying the aerophagia issues are. I have had both...slightly annoying and massively making me ill (had that happen twice). I can deal with a little belching or farting but I won't deal with bad pain or nausea from it.

Just wanted to let you know that you could use the lower minimum starting point and still use 3 EPR if you wanted to. The full benefit wouldn't kick in until your pressure reached 7 cm but you don't have to use 7 minimum to get at least some benefit at the lower pressures.

Example....if you wanted to use a minimum pressure of 5 and EPR of 3.
Yes..when you start out the night you would have inhale of 5 and exhale of 4 since that is as low as the machine will go but once the machine works its way up to 7 then you would have the full EPR of 3 cm drop available to help you out. You don't always have to use 7 cm starting minimum to have 3 EPR help you out later. Now if you needed it immediate for comfort reasons and falling asleep reasons...different story but just because you can't get a 3 cm drop at 5 minimum doesn't mean it won't happen once the machine gets up to 7.

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JB1975
Unread post  Post subject: Re: Newbie needs Help with Oscar Charts  |  Posted: Thu Oct 15, 2020 8:03 pm

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thank you for the explanation, Lots of great information.

It's nowhere near severe in any way. It's mostly just a bit of discomfort. This afternoon I took a nap, for which I've included the chart. I felt much better after my nap.

I'm going to leave it for a bit to see how I feel.


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DeltaBravo3.8
Unread post  Post subject: Re: Newbie needs Help with Oscar Charts  |  Posted: Thu Oct 15, 2020 11:22 pm
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Charts look good from here. I'd just run with it a bit and see if you can keep building good charts like these. Congrats.

_________________
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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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JB1975
Unread post  Post subject: Re: Newbie needs Help with Oscar Charts  |  Posted: Fri Oct 16, 2020 1:54 pm

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Thanks DeltaBravo3.8

My chart from last night seems to be really good for the first couple hours, but then seems to take a jump in pressure and many other parameters, just before 0215. It stays that way the rest of the night. What could have caused this?


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Pugsy
Unread post  Post subject: Re: Newbie needs Help with Oscar Charts  |  Posted: Fri Oct 16, 2020 4:36 pm
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My best guess when I see changes like this.
Started out sleeping on one's side and rolled over onto one's back and stayed there.

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