[CPAP] Oscar data help - is CPAP right for me?

[george bonanza]

Hello everyone, 

First time poster, hoping this community of experts can help me, I would be extremely grateful. 

I have been using CPAP on and off for a year, and feel worse when I use it despite getting AHI down to <5. I have an appointment coming up with an ENT to discuss surgical options, and I'm getting desperate for relief as I am exhausted all the time. Can you please look at my OSCAR data and see if there are any obvious conclusions you can draw?


Background:
- Age mid 30's, not overweight 
- Diagnosed OSA May 2023 ,
- Sleep study showed 92% SpO2, frequent loud snoring, minimal REM sleep, no PLMS
- AHI 15.3 during Non-REM, 80 during REM (non-supine, supine not measured but likely worse) 

CPAP
Trialled CPAP in late 2023 with Resmed Autoset 11 in Auto CPAP mode. 
Started with full face, moved to nasal mask, moved to pillows where I felt most comfortable
Can easily sleep 8 hours with the mask on, but wake up feeling extremely tired, puffy eyes, deep lines under eyes. Feel like a zombie all day, somehow even worse than before. 
Typically I get AHI scores less than 5 so that would indicate treatment is working according to my sleep doctor, they have refined the prescription to between 7-14 but it didn't help much.
I used CPAP every day for 3 months straight but felt no improvement.  

I've since played around a bit with EPR settings, including turning it off, couldn't notice much difference. Likewise I have tried a few fixed pressures, similar results. 

Attached are some OSCAR readings for a 'typical' night, could you help me see if there is anything you notice that might help my treatment? is it possible to get a good AHI score and still have other sleep issues that potentially surgery will assist? 

Thank you in advance 

---

Further info attached
I can see quite 'choppy' breathing when I zoom in

[Deborah K.]

The first thing I see is that you should turn off ramp.  You get no therapy during ramp, and if you stop for a bathroom break ramp starts again, robbing you of treatment.

I also suggest that you raise your starting pressure to 8.  I think those two changes should improve your therapy and comfort.  

Your Oscar charts will improve if you remove the calendar.  That allows us to see more important things below.  It would also help if you tighten things up so we can see to the bottom of the Leak rate.  We don't need to see the other two pages.

Don't give up!  Best of luck with getting your therapy to a better place!  

[quiescence at last]

If this were my chart, I would have taken the cue from the median pressure which was around 9.8, and looked at the spots that had OA or snores and see what pressure the machine was at just before the machine reacted (generally below 9.2).  I would bump my minimum starting pressure to about 9.2 to see if that resolves things.

I might be inclined to keep ramp on, but make the ramp start pressure at 7.0.

Of course I do agree with Deborah K. that a move to 8.0 would be a good first step, but think you won't see a remarkable shift unless you get closer to 9.2.

Note that the sleep test results showed a big shift in AHI higher during REM sleep.  It would be great if you could determine how your REM sleep is going. Let us know, for example, if you recall dreaming being more apparent than before treatment.

My impression is you are in REM more often and more stable now.

The restedness may be related to either Deep Sleep Stage or the REM Sleep Stage. 

QAL

[george bonanza]

Thank you both very much for your time to review and respond. 

I will bump up the minimum pressure to 9.2 tonight for a few nights and see how I go. I'll also try out the ramp settings. I'll post charts again in a few days time, since I am restarting the therapy now after a break I find I get a lot of CA's for a few days until my body adjusts, so will wait for that to settle then post. 
 
I do recall when I first started using the CPAP a year ago I was having a lot more dreams, I'll see how I go this time 

Thanks heaps