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LaPorte429
Unread post  Post subject: Seeking OSCAR Report Feedback  |  Posted: Wed Mar 31, 2021 4:46 pm

Joined: Mon Mar 08, 2021 9:37 am
Posts: 5
PAP Mask: Philips Respironics DreamWear Nasal
PAP Machine: Philips Respironics DreamStation Auto CPAP Machine (DSX500S11)
Humidifier: None
Pressure Setting: 10 cmH2O

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Hi all,

I am looking to optimize my CPAP therapy.

I am using a Philips Respironics DreamStation with the DreamWear nasal mask.

I am open to any and all feedback, both in terms of my treatment settings and also in the layout/formatting of my OSCAR report to render it most useful for review.

Thank you kindly,
Jason


Attachments:
OSCAR.JPG
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Respirator99
Unread post  Post subject: Re: Seeking OSCAR Report Feedback  |  Posted: Thu Apr 01, 2021 3:46 am
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Joined: Mon Apr 27, 2020 1:06 am
Posts: 339
Location: Australia
PAP Mask: Resmed Airtouch F20
PAP Machine: Resmed AirCurve 10 CS Pacewave ASV
Pressure Setting: Min EPAP: 8.0 Max EPAP: 11.0 PS Min: 3.0 PS Max: 8.0

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G'day Jason, welcome to the forum.

It looks like your therapy is well dialled in, with excellent results. The real question now is "how do you feel?" If you are sleeping well and feeling well rested, then don't change anything. On the other hand, if you are not getting refreshing sleep you could try bumping the pressure up a little to control the RERAs*, and maybe consider going to automatic rather than fixed pressure. Tell us how you feel and any specific problems you're having.

* RERA = Respiratory Efforted Related Arousal. https://www.sleepdr.com/the-sleep-blog/ ... -rdi-mean/

As far as your Oscar chart is concerned, have a look at the links in my signature below.

_________________
Regards from Australia

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LaPorte429
Unread post  Post subject: Re: Seeking OSCAR Report Feedback  |  Posted: Thu Apr 01, 2021 5:20 am

Joined: Mon Mar 08, 2021 9:37 am
Posts: 5
PAP Mask: Philips Respironics DreamWear Nasal
PAP Machine: Philips Respironics DreamStation Auto CPAP Machine (DSX500S11)
Humidifier: None
Pressure Setting: 10 cmH2O

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Respirator99 wrote:
G'day Jason, welcome to the forum.

It looks like your therapy is well dialled in, with excellent results. The real question now is "how do you feel?" If you are sleeping well and feeling well rested, then don't change anything. On the other hand, if you are not getting refreshing sleep you could try bumping the pressure up a little to control the RERAs*, and maybe consider going to automatic rather than fixed pressure. Tell us how you feel and any specific problems you're having.

* RERA = Respiratory Efforted Related Arousal. https://www.sleepdr.com/the-sleep-blog/ ... -rdi-mean/

As far as your Oscar chart is concerned, have a look at the links in my signature below.


Awesome thank you very, very much.

I feel very well rested and feel that CPAP therapy has been completely life-transforming for me, it's incredible!

Great advice, I will bump up to 10.5 tonight and go from there. If I could decrease my obstructive events without appreciably increasing central events, then wonderful and worth the try!

I don't have any specific problems, just trying to optimize therapy. But I suppose, as they say, treat the person, not that number.

That said, the RERA events do concern me. Sometimes my DreamStation will display a periodic breathing % of 1 or 2%, is this RERA-related?

Also, since the machine is not measuring my O2 sat or brainwave patterns, is it possible that these RERA events are not actually causing harmful oxygen desaturations and micro awakenings?

Thank you kindly,
Jason


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Pugsy
Unread post  Post subject: Re: Seeking OSCAR Report Feedback  |  Posted: Thu Apr 01, 2021 6:30 am
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Joined: Wed Aug 02, 2017 8:01 pm
Posts: 2461
PAP Mask: Bleep/DreamPort nasal mask
PAP Machine: ResMed AirCurve 10 VAuto

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RERAs are a symptom of something and not necessarily the cause of something.
A flagged RERA just means that a person's breathing LOOKS LIKE the breathing that is commonly seen when someone has some sort of airway/apnea related arousal.
So it's a potential symptom of poor sleep or arousals.

RERAs themselves won't cause drops in O2 or anything like that.
Now whatever airway related event that caused the arousal breathing might but the RERA is just a symptom and not the cause.

Periodic Breathing itself is just a waxing and waning of the air flow that last at least 2 minutes. Not a big deal most of the time especially when someone sees a very small percentage of time spent in PB.
PB is only a problem when it is chocked full of central apneas and lasts a lot longer than just a few minutes here or there.

A lot of time awake breathing irregularities will get flagged as PB...awake breathing is simply a lot more irregular than asleep breathing....easy for false positives to happen and if we aren't sleep then whatever is flagged simply has to be disregarded.

It is entirely possible that someone might see some flagged PB time around the time they also see RERA flagging but all it means most likely is there was some sort of arousal/awakening (may or may not remember it) but this is a symptom of potential awakening and not the cause of the problem or awakening.

Side note....flow limitations are NOT flagged at all when in cpap mode...doesn't mean they didn't happen but in fixed mode the machine doesn't flag them and they are kinda important to know if they are happening or not. You know FLs are one of the driving forces for the auto adjusting algorithm to increase the pressures in an effort to prevent them. FLs are early warning signs that the airway is trying to collapse.

If you prefer a fixed pressure for whatever reason I strongly suggest that you at least turn auto mode on so you will get to see if you are having in FLs or not....you can still do a fixed pressure if that is what you want in auto mode.....just set the minimum to equal the maximum and the machine will deliver a fixed pressure but FL flagging is turned on.

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


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LaPorte429
Unread post  Post subject: Re: Seeking OSCAR Report Feedback  |  Posted: Thu Apr 01, 2021 9:02 am

Joined: Mon Mar 08, 2021 9:37 am
Posts: 5
PAP Mask: Philips Respironics DreamWear Nasal
PAP Machine: Philips Respironics DreamStation Auto CPAP Machine (DSX500S11)
Humidifier: None
Pressure Setting: 10 cmH2O

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Pugsy wrote:
RERAs are a symptom of something and not necessarily the cause of something.
A flagged RERA just means that a person's breathing LOOKS LIKE the breathing that is commonly seen when someone has some sort of airway/apnea related arousal.
So it's a potential symptom of poor sleep or arousals.

RERAs themselves won't cause drops in O2 or anything like that.
Now whatever airway related event that caused the arousal breathing might but the RERA is just a symptom and not the cause.

Periodic Breathing itself is just a waxing and waning of the air flow that last at least 2 minutes. Not a big deal most of the time especially when someone sees a very small percentage of time spent in PB.
PB is only a problem when it is chocked full of central apneas and lasts a lot longer than just a few minutes here or there.

A lot of time awake breathing irregularities will get flagged as PB...awake breathing is simply a lot more irregular than asleep breathing....easy for false positives to happen and if we aren't sleep then whatever is flagged simply has to be disregarded.

It is entirely possible that someone might see some flagged PB time around the time they also see RERA flagging but all it means most likely is there was some sort of arousal/awakening (may or may not remember it) but this is a symptom of potential awakening and not the cause of the problem or awakening.

Side note....flow limitations are NOT flagged at all when in cpap mode...doesn't mean they didn't happen but in fixed mode the machine doesn't flag them and they are kinda important to know if they are happening or not. You know FLs are one of the driving forces for the auto adjusting algorithm to increase the pressures in an effort to prevent them. FLs are early warning signs that the airway is trying to collapse.

If you prefer a fixed pressure for whatever reason I strongly suggest that you at least turn auto mode on so you will get to see if you are having in FLs or not....you can still do a fixed pressure if that is what you want in auto mode.....just set the minimum to equal the maximum and the machine will deliver a fixed pressure but FL flagging is turned on.


Perfect thanks! I will change to AUTO mode tonight so that flow limitation gets reported.

Logically I just figured that whatever pressure is optimal for me would be a constant throughout the night, so a fixed CPAP pressure would make sense and a reliable way for me to determine what best suits me.

But I am definitely open to the idea of using variable pressure, it seems like it could complicate my therapy, but also be useful when interpreting the graphs and seeing at what pressure different events occur.


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Respirator99
Unread post  Post subject: Re: Seeking OSCAR Report Feedback  |  Posted: Fri Apr 02, 2021 1:58 am
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Joined: Mon Apr 27, 2020 1:06 am
Posts: 339
Location: Australia
PAP Mask: Resmed Airtouch F20
PAP Machine: Resmed AirCurve 10 CS Pacewave ASV
Pressure Setting: Min EPAP: 8.0 Max EPAP: 11.0 PS Min: 3.0 PS Max: 8.0

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Quote:
Logically I just figured that whatever pressure is optimal for me would be a constant throughout the night, so a fixed CPAP pressure would make sense and a reliable way for me to determine what best suits me.


A lot of docs and therapists still try to get patients onto a single fixed pressure, reasoning along the same lines that you do. The thing is that your needs change over time - during the night and from night to night. An automatic machine will run at the lower end of its range until an apnea or precursor (eg flow limitation or snore) occurs. It will then bump the pressure up to head off any further events.

While it's more-or-less received wisdom on these forums that auto is preferable to fixed, some patients find that the fixed pressure is more comfortable and suits them better. Given your very good results to date, there is probably little to gain by going to auto, other than the improved reporting Pugsy mentioned.

_________________
Regards from Australia

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LaPorte429
Unread post  Post subject: Re: Seeking OSCAR Report Feedback  |  Posted: Fri Apr 02, 2021 12:30 pm

Joined: Mon Mar 08, 2021 9:37 am
Posts: 5
PAP Mask: Philips Respironics DreamWear Nasal
PAP Machine: Philips Respironics DreamStation Auto CPAP Machine (DSX500S11)
Humidifier: None
Pressure Setting: 10 cmH2O

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Thank you both!

I switched to auto mode and set the minimum pressure to 10.5, and maximum to 10.5.

Is flow limitation supposed to be a graph option?

It looks as though for me it just being reported as an event in a binary, yes or no fashion, as opposed to being quantified.

The y-axis on my event flags looks pretty congested, is there a better way to format that?

I'm not sure if those are RE or FL events shown in the graph.


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DeltaBravo3.8
Unread post  Post subject: Re: Seeking OSCAR Report Feedback  |  Posted: Fri Apr 02, 2021 2:03 pm
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Joined: Sat Jul 04, 2020 8:38 am
Posts: 595
Location: Waynesboro, Pennsylvania, USA
PAP Mask: F&P Vitera & Simplus, ResMed F20 N/P30i & old Amara View
PAP Machine: Required to start over on ResMed AirSense 10 AutoSet.
Humidifier: HumidAir and Heated hose
Pressure Setting: Auto PAP 7-14, EPR full time 3

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I think on your Respironics it's just going to be a decimal number on the left panel data. Here it's just below the yellow RERA line, it shows FL as .57. A ResMed shows flow limit as a graph.

BTW either version of the flow limit is going to have a corresponding decimal .xx and how I interpret it is basically converting that decimal to percentage. Your .57 would then be 57%. The higher the more likely it's going to disturb your sleep and rest.

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https://www.sleepfiles.com/OSCAR
http://www.apneaboard.com/wiki/index.php/OSCAR_Help
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Pugsy
Unread post  Post subject: Re: Seeking OSCAR Report Feedback  |  Posted: Fri Apr 02, 2021 2:12 pm
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Joined: Wed Aug 02, 2017 8:01 pm
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PAP Mask: Bleep/DreamPort nasal mask
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FLs on a Respironics machine get flagged as an event.
So on the events graph you see them...and the statistics .57 is the index or per hour average number of FLs you had for the entire night's use of the machine.

ResMed machines show FLs differently.

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


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Respirator99
Unread post  Post subject: Re: Seeking OSCAR Report Feedback  |  Posted: Fri Apr 02, 2021 6:01 pm
User avatar

Joined: Mon Apr 27, 2020 1:06 am
Posts: 339
Location: Australia
PAP Mask: Resmed Airtouch F20
PAP Machine: Resmed AirCurve 10 CS Pacewave ASV
Pressure Setting: Min EPAP: 8.0 Max EPAP: 11.0 PS Min: 3.0 PS Max: 8.0

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Quote:
The y-axis on my event flags looks pretty congested, is there a better way to format that?


You can turn off the flags you're not using, such as VS, VS2, BND. Use the event flag selector in the bottom left corner (see attached image).


Image

_________________
Regards from Australia

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Pugsy
Unread post  Post subject: Re: Seeking OSCAR Report Feedback  |  Posted: Fri Apr 02, 2021 6:09 pm
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Joined: Wed Aug 02, 2017 8:01 pm
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PAP Mask: Bleep/DreamPort nasal mask
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Minute vent graphs are pretty much useless.

The pressure graph is also useless unless when there is to auto adjusting going on...it isn't going to change when fixed pressure is used even in auto mode unless there is a range.

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


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LaPorte429
Unread post  Post subject: Re: Seeking OSCAR Report Feedback  |  Posted: Sat Apr 03, 2021 2:56 am

Joined: Mon Mar 08, 2021 9:37 am
Posts: 5
PAP Mask: Philips Respironics DreamWear Nasal
PAP Machine: Philips Respironics DreamStation Auto CPAP Machine (DSX500S11)
Humidifier: None
Pressure Setting: 10 cmH2O

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Thank you kindly for all your guidance!

I have made some modifications to the OSCAR formatting and now it's a lot more user-friendly, that reference photo posted by Respirator is exceptionally helpful!

I tried going under a pressure of 10 for the first time last night, set it to 9.5, and cannot believe what happened.

Am I reading it correctly that I had zero obstructive apneas and zero central apneas last night? That would be a first for me, I have never had such a low AHI, awesome!

I will definitely stick with this pressure for the time being.

Could anyone rank in descending order the degree of concern for each type of event, i.e., obstructive, central, hypopnea, and so forth? That would be awesome!

-Jason


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Respirator99
Unread post  Post subject: Re: Seeking OSCAR Report Feedback  |  Posted: Sat Apr 03, 2021 6:15 pm
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Joined: Mon Apr 27, 2020 1:06 am
Posts: 339
Location: Australia
PAP Mask: Resmed Airtouch F20
PAP Machine: Resmed AirCurve 10 CS Pacewave ASV
Pressure Setting: Min EPAP: 8.0 Max EPAP: 11.0 PS Min: 3.0 PS Max: 8.0

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Great results Jason! It's a good idea to make small changes one at a time then wait a few nights to ensure any result is a real effect. We're looking for trends rather than one-off changes.

Quote:
Could anyone rank in descending order the degree of concern for each type of event, i.e., obstructive, central, hypopnea, and so forth? That would be awesome!


The order you have listed is probably about right, but there are other factors to consider. Eg a 60 second central apnea will cause a greater O2 drop than a 10 second obstructive. In addition, events that come in clusters are likely to be a lot worse for you than the same number of events spread out over the night - but even that depends on other factors. There's no one simple answer.

In your case this isn't an issue. Keep doing what you're doing!

_________________
Regards from Australia

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* Oscar help
* Organise your Oscar charts


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