Mild Apnea Advice Please (OSCAR)

[PulpFriction]

Thank you for taking the time to read my post. I have a diagnosis of mild sleep apnea and was given a CPAP machine several years ago. I have never been able adjust to using it, which has caused a lot of frustration as I am still incredibly tired. I recently requested nasal pillows as a last resort, having been refused before due to the fact I am a mouth breather. I have used the nasal pillows for the last week with taping of my mouth. This is the first time I have been able to sleep with the machine and am encouraged by the fact I feel a little less daytime sleepiness. 

My clinician set the pressure to 4-13. For 4 nights my AHI was around 1. Then on the 5th night my AHI was 2.29 which spooked me a little, even though I didn't feel drastically different. I decided to change the minimum pressure to 6 for the last two nights. My AHI has lowered to around 1 again but for the first time I am experiencing large leaks and feel a little worse off than I did previously. I feel a lot more bloated today also. 

I have included some OSCAR data below. I wonder if I should return the minimum pressure to 4? I felt a slight improvement but I also believed that I could feel better which was my reason for increasing to 6. Though after 20+ years of bad sleep, perhaps I should stick with that mild improvement and be patient. 

First two attachments are with a minimum pressure of 4. The third attachment is last nights data with a minimum pressure of 6. 

   

   

   

[Narcil]

4cm is too low for most adults and since the machine cannot go under 4cm you aren't getting the benefits of EPR until it increases pressure.

aerophagia usually goes away when you get used to therapy, maybe start with min 5cm a few nights to get used to it then raise to 6cm?

Did your sleep study show centrals or are they treatment emergent? your ahi jumped to 2 because you had more CAs. if you showed none during your sleep study they should go away as you get used to therapy.

[PulpFriction]

4cm is too low for most adults and since the machine cannot go under 4cm you aren't getting the benefits of EPR until it increases pressure.

aerophagia usually goes away when you get used to therapy, maybe start with min 5cm a few nights to get used to it then raise to 6cm?

Did you sleep study show centrals or are they treatment emergent? you ahi jumped to 2 because you had more CAs. if you showed none during your sleep study they should go away as you get used to therapy.

Thank you very much for the welcome and the response, it is much appreciated! 

I just checked and didn't have any centrals on my sleep study, so that's encouraging to know that they should go away in time. 

Do you think I should be concerned about the large leak rate? I do feel a little more fatigued today. I'd like to stick with the nasal pillows, though perhaps I can look into trying a different size. 

Also do you think 6cm is a good base level based on the OSCAR information I've shared. Do I need to go any higher at this stage?

Thank you again!

[HalfAsleep]

It sounds like other posters are on top of the settings.

You are doing well with leak management. To a greater or lesser degree, leak management becomes a regular task for xPAP users, always a work in progress.

Don’t expect to feel better right away. It may take a month or two. You may go about your day and think to yourself, “wow, I feel very strange….”, and your days are more sustainable. That’s your brain on sleep. You might never have had that feeling before as an adult. It may be a subtle feeling, but you’ll look back, comparing with your starting point, and the difference in your days may be dramatic.

[Narcil]

Also do you think 6cm is a good base level based on the OSCAR information I've shared. Do I need to go any higher at this stage?

you have epr on 2? if so 6cm is fine. with epr on 2, it will start with ipap at 6cm and epap at 4cm (the minumum) thus using epr fully.

your 95% pressure is 7-8cm so i don't think you need more for now.

[PulpFriction]

It sounds like other posters are on top of the settings.

You are doing well with leak management. To a greater or lesser degree, leak management becomes a regular task for xPAP users, always a work in progress.

Don’t expect to feel better right away. It may take a month or two. You may go about your day and think to yourself, “wow, I feel very strange….”, and your days are more sustainable. That’s your brain on sleep. You might never have had that feeling before as an adult. It may be a subtle feeling, but you’ll look back, comparing with your starting point, and the difference in your days may be dramatic.

I appreciate you taking the time to post such a thoughtful reply. I'm definitely trying to trust the process and remain patient. I'm encouraged by the small improvements since I've been able to have a full week of some sleep with the mask on. I just need to get more hours under my belt as well, as I'm typically not sleeping for the full night. 

I'm not sure what normal sleep feels like as I've never woken up feeling rested in my life. I'll definitely keep going.  Thank you again.

[Deborah K.]

I suggest that you raise your minimum to 7 and set your EPR to 3.  I think those will both be more comfortable and provide better therapy.