Help with OSCAR data

[lennyandcarl]

Hi all, thanks so much for all you do here.  I have been using a CPAP for just over 10 years, switching from a fixed one to my current AirSense 10 Auto a few years ago.  I am only now digging into the data and tinkering to make changes, and I'd appreciate any input.  

I am attaching my three most current reports.  For all of them I was using a p30i, pressure 10-20 with EPR 2.  

Some broader info.  I acknowledge that I've introduced multiple variables recently and not given a lot of time for any single change to play out:
 
I had previously been set at 4-12 with no EPR, and about 1.5 years of that averaged 3.17 AHI per OSCAR, albeit with a lot of variation (rarely getting below 1.7 though).  I started reading this thread, and after noticing that my 99.5% was nearly always at my max pressure of 12, and low was usually ~6-8, so I first changed my range from 8-20, and then to 9 and then 10 minimum because I was seeing my "MED" ranging from 9-11, and worked in EPR at 2 (FWIW, I see that the two days of 9-20 were better than the recent 10-20, though I think I was using different masks, see below).  It seems odd that my max pressure is varying so much?

Based on my reading here, I am worried that mouth breathing may be a culprit, because I don't think I can bear to wear a full mask, tape, or collar, etc... It is all so awkward as it is, even after all these years.

I know I have some leak issues and have been experimenting with different masks and sizes (although all of this data is with medium p30i).  I mostly used p30i or n30i for the last year+, until I recently realized I could try Dreamwear masks.. I tried the nasal cushion and pillow and they seemed to correspond with lower AHI, but I have been reluctant to stick with them because of the massive blast of air that comes through the front vents that is awkward for my wife.  So I've been using the P30i with QuietAir while I wait on an order of an n30i with QuietAir to get here (most of my earlier N30i and P30i didn't have QuietAir so had the same problem as the Dreamwear masks).  I suppose I should do some longer term testing to see if I/we just have to deal with the air blasts.

Sorry if TMI, and thanks in advance for the help.  I am going to reply to my post with some zoom-in views to some random events in case that is helpful.  THANKS!

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Some zoom-ins, in case they are helpful.  Thanks.

[staceyburke]

Welcome to the board. Your charts look good - no real problems. I would increase the EPR to 3 to see how you do with it.

[Dormeo]

Hello and welcome, lennyandcarl.

As staceyburke says, your charts look generally good, but I do think there's some room for improvement.

I would recommend raising your minimum again, to 11. (If you increase EPR to 3, then raise the minimum to 12 to compensate.) Stay there for maybe 4 or 5 nights. If you continue to see an obstructive index over, say, 1, then raise it again. The idea is to head obstructive apneas off at the pass.

Several of the zoomed-in views show what appears to be exhalation through your mouth. (That's where the flow rate below the zero line is very small in amplitude.) When you exhale through your mouth, you're not getting the benefit of pressure when you need it, even if you're not above the large-leak line.

So mouth breathing is an issue you need to address, I think. I found the idea of tape creepy before I actually tried it. Now I'm completely comfortable with it. You might want to invest in a box of Somnifix strips to experiment.

Finally, there are some places where you have a couple of OAs in a row. And although your flow limitations are generally very good, there's a little bit of clustering there too. These suggest a little bit of a problem with position. If you use a high pillow, or tuck your chin down to your chest part of the night, try using a lower, firm pillow and try avoiding the chin-tuck if you can.

[Sleeprider]

I agree with EPR 3. Your profile shows you are using nasal pillows, but Oscar reports your machine is set for a nasal mask. For the P30u nasal pillows, you should be using the Pillows setting.

[lennyandcarl]

You are all amazing, thanks so much. It is a gift to have the benefit of your time and experience. 

I'll give these a try and check in in 5 days or so.