New to CPAP - Question about results

[Urimare]

Dear all, apologies in advance if not posting per guidelines or clear in my request - I'm learning the ropes here.

I have started CPAP two months ago, after being diagnosed with sleep apnea using a WatchPat One with an AHI of 45. Have been pretty much compliant since. Fixed pressure of 8.
AHI down to <5 from first night onwards. However, I feel  no change whatsoever in my energy levels or daytime fatigue - or drowsiness at waking up.

I've started using OSCAR and have activated the custom User Flags at standard settings:
- UF1: 20%, 8sec
- UF2: 50%, 8 sec


I'm seeing strong clusters of UF2 custom events, which if I'm correct in my understanding means flow constricted by min 50% for at least 8 seconds (just borderline short for ResMed to have flagged them as actual events).

I have included three screen shots, the first for one of the clusters of approx 45 minutes, the second a detail of 10 minutes within that cluster - and a last one as an overview of the full night.

Am I correct in reading into this that during the 45 minute cluster I have, for the most part, have been having issues with constricted airflow?

Your help is much appreciated. Thanks!

[SarcasticDave94]

While the flow limits aren't high in the median, they are higher than you want at times. You're likely to need EPR full time, trying settings 1-3 to see which is the best balance for flow limit reduction while not increasing CA, including how it feels.

Your leak rate is a bit high with consistent leaking going on all night. I would address that as it can cause sleep disturbance. Much higher leaks and you'll lose even more CPAP therapy benefits.

Even two months might not be long enough to feel much better in the sleep department. You likely suffered many months with Apnea.

Just to clarify, it's not ResMed that determines what an Apnea is. Universal definition of Apnea is 10 seconds. Your user defined events might fall into the flow limits I mentioned earlier. Those aren't timed.

[Urimare]

Thank you. I'll need to look into EPR as I am unfamiliar with that functionality - and am unsure if this is something I can set myself here in the Netherlands without first getting doctor on board.

With regards to leaks, by coincidence I had a short review telephone call with my health care provider and I mentioned what I understand to be my high leak rates. I've attached two screenshots from Oscar. The person I talked to however said she was not concerned and thought the leak rates were fine, but if I look at the charts and interpret correctly it does seem to be more elevated than preferable - if I check daily charts its pushing the 21l limit with periods of large leaks.

Am I seeing this correct? This is the first mask they've provided me with and given I've been reading that its uncommon for the first mask to be a great fit on the first go don't want to accept too easily. Thank you.

[SarcasticDave94]

I'm with you on the leaks thoughts. It's a bit high trending than a CPAP user wouldn't address. Medicals may be OK with it, but they're not wearing your mask or depending on your CPAP therapy for good sleep.

Is the Fisher and Paykel Simplus your mask? Personally I like F&P, and used the Simplus for a bit until I got the newer model called Vitera. Now my most recent therapy attempt and I got the new Evora Full hybrid, full face lower and nasal cradle top half.

Consider one of those, or other Fisher and Paykel masks. You could be open to try nasal pillows and nasal, not just full face. Your choice though on all this. One big Fisher and Paykel benefit I found is you can wear them looser than others but seal better.

[Urimare]

How do you like the Evora?

Correct! It's the Simplus! I decided to start out with full face as I am a strong mouth breather and can't breath well through my nose (so can't use chin strap). 

I have no complaints comfort wise, my only issues is the leaking (which I do not notice in general, except when moisture gets stuck between seal and skin and makes noise - an unfortunate side effect from mouth  breathing I cant describe in any prettier way). I am also suspecting my leakage may be related to my side sleeping, though I 've tiried adjusting straps / sleeping on lower edge of pillow.

They did mention the Evora as a possible alternative during an earlier call - so maybe I will give this a few more days during the weekend and give them a call early next week with extra data on leakage to ask them to send an Evora to try out. 

[SarcasticDave94]

My Evora Full hybrid is fine, same loose fit as other F&P masks. I've used only the S/M cushion, versus Simplus and Vitera being large cushions. Top of head strap on Evora is stepped but OK enough to get it fitting well. Cradle section not bad, both in comfort and leak control.

Adding in, my Evora was standard headgear, extra large is available.

I don't remember if Simplus and Vitera were like this, but the Evora Full has a short hose already attached, 18-24 inch or so.