Solved obstruction but CA events increased

[BarbikyuChikin]

I've been using my APAP for 5 months now and along the way I tried numerous masks, sleeping positions, settings and other accessories used in conjunction with CPAP treatment. At some point I also got turbinate reduction surgery. My AHI and obstructive events decreased, but I was still tired during the day. I believe the issues I had were related to a slightly oversized tongue and narrow nasal passages. I didn't have much luck with the F20 mask since it dried my mouth out and my jaw hurt in the morning, so I settled on the ResMed N20 mask with memory foam cushion. 

My prior combo that was working relatively well was using a tongue stabilizing device (TSD) and chinstrap, with 5-10 cmH2O pressure. The issue with this was that there was too much on my face which made it harder to fall asleep, there were large leaks that would sometimes wake my partner up, and my tongue would be swollen for 30 mins after waking up.

I've switched to using an internal nasal dilator with mouth tape instead, and changed my pressure to 7-12 cmH2O, , though I upped the max pressure to 13 for a night to see if it made a difference (it didn't). I no longer deal with those same issues but I do wake up with dry mouth. And I'm still feeling the fatigue during the day, just a tad bit less. I noticed that with both of these solutions, they minimized obstructive events, but I'm getting a lot more CA events and waking up more frequently throughout the night. I have EPR and ramp switched off.

Based on these screenshots, do these seem like actual CA events and are there any suggestions or insight into why this happened? I can provide more screenshots if needed. Thanks!

TSD + chin strap:
   

Nasal dilator + mouth tape:
   

[clownbell]

Why do you suspect they are not CAs? Do you think you were asleep? How do you know for sure?

In SOME (not all) people, a wide range of pressure settings (your is 4-10) can cause/exacerbate CAs. If it were me, I would increase minimum to 7 and set EPR to 3. Give it a few nights and check again.

[Brazen]

In your first screenshot there is too much mask leak for the machine to accurately report/respond to disordered breathing.


You need to consistently have lower leaks so the machine can do its thing.

I'm not an expert so I can't speak to settings or tweaks for you.