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15-minute periods of massive events (OSCAR pics included)
#1
15-minute periods of massive events (OSCAR pics included)
Hey all!

I started treatment on 3/1/24 and started using OSCAR on 3/8/24. I started treatment at my prescribed pressure of 6 with EPR at 2 and no ramp and had AHI scores of 10,10,5,11, and 16. I slept one night at 6-20 (no EPR, no ramp) and my AHI dropped to 0.3 and my 95th% was ~11. I then switched to 7-15 auto with no EPR, no ramp for three nights. My AHI was under 1.5 for the three days I tried these settings.

 Ever since I have turned it to auto and gone past my prescription of 6, I have had aerophagia.  It was causing me to wake up for 20 minutes with stomach pain and massive burping a few hours before my morning alarm at 9. It was hard to go back to sleep after these bouts as my mind would wake up. I knew I needed to address the aerophagia, so I lowered the max pressure (7-13) and turned on EPR level 2. I had the best AHI score and the best-looking data (in my unexperienced opinion) on the first night of EPR (3/10). I also only woke up once for a big burp that did not hurt and fell asleep within 7 minutes. It has made a massive improvement in reducing my aerophagia to a manageable level. So much so that I am considering turning EPR to 3. I am a bit leery of this though as I have heard of the issues EPR can cause. I think I will play with levels 1,2, and 3 to see what works best for the aerophagia and my general data.

Back to the topic at hand. The past two nights have had a roughly 15-minute period of unrelenting events accompanied by leaking. You can see the leaks last night were particularly massive. Am I having an issue with EPR, could it be my 3 days of light beard growth (I am not super hairy) causing this much leakage, or does it appear that I simply moved my head (side-sleeper) in my sleep causing massive leaks and subsequent events? I tightened my mask on 3/9 and saw general improvements in leak rate, but these two periods concern me. It's strange to me that both bouts happened on consecutive days at around the same time. Any other suggestions or hypotheses are welcome.

I am planning to try the memory foam mask sometime this month to see if it works better for me. I will stick with these settings until I get some feedback from y'all. I personally do not think I need to increase my max pressure as it seems that leaking was the issue. I was still having events at 14-15 pressure during these 15-minute periods. As you can see, I rarely touch the 12-13 range outside of these two periods. I also do not think that the EPR was the issue as I had my best data on the first night returning to EPR and it does not appear to be an issue occurring at lower pressures (say when my EPR is lowering my pressure from 7 to 5).

I have attached screenshots of the past three days where I have been at 7-13 with EPR 2. The first day looks amazing and seemed to be my best night of treatment. Any and all insights are welcome!

   

   

   
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#2
RE: 15-minute periods of massive events (OSCAR pics included)
The "cluster" of events is called Positional Apnea.

Compare your graph to the examples in the link.

You may have been sleeping in a position where you were "chin tucking".  
Using a too tall pillow would cause your head to tilt forward and restrict air flow.
Somewhat like a kink in a hose.

Also, it appears the leaking that occurred at the same time appears to be mask movement, as evident from the spikes on the leak graph.

As long as the aerophagia is under control, you are doing well.
OpalRose
Apnea Board Administrator
www.apneaboard.com

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#3
RE: 15-minute periods of massive events (OSCAR pics included)
Definitely a positional problem. Whatever position it was caused fitment trouble with your mask as well as an airway blockage like a kinked hose, which no pressure deliverable by a CPAP is going to be able to overcome. Chin tucking is a common one, but there are other possibilities involving the jaw dropping and/or being pushed back that would pinch your airway and break the mask seal.

Could also be sleep stage dependent. We lose a lot of muscle tone in REM sleep, as the body nearly paralyzes itself to avoid acting out dreams. Whatever position you were in may have been fine for deep sleep, but when the extra muscle relaxation from them being effectively disabled in REM sleep the weight of your head could push things out of whack.

Some people have taken to recording themselves sleeping to track down problems like this.
Look, I'm an engineer, not a doctor! Please don't take my opinion as a substitute for medical advice.
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