Need help optimizing and figuring out data variability please

[fert]

hey friends, thanks in advance to those who read this -- 

i could really use some help with optimizing my settings and figuring out the variability in my data. i was diagnosed with OSA (AHI ~19) in Nov 2022 and have been on CPAP for a year+. while i've noticed improvements since, im still tired and foggy despite low AHI numbers. these also tend to move around despite an identical nightly setup, and i can't figure out why. i use nasal pillows and have played around with different sizes too with different results. 

current setup: Resmed 11 with P30i nasal pillows; 4-9 pressure setting; 0 ramp time; humidity setting 2 
what i've tried previously: 4-10 pressure (prescription); different pillow sizes and different mask

• Nasal mask: i used this for most of 1H23, and saw only incremental improvement. was still tired and foggy, and on occasion when i've switched back from pillows, i've woken up feeling terrible. i wouldn't go back to this.
  
• M size nasal pillows: i find these the most comfortable, but still wake up tired and foggy despite low AHI numbers
  
• L size nasal pillows: they feel just a bit large, are prone to more air leak, and the discomfort wakes me up more often. however, i wake up a bit less foggy. my numbers move around more with these too -- i got a 0 AHI reading recently and felt fantastic, but similarly have readings >1 too and feel tired with elevated anxiety the next day
  

i took the opportunity over the winter break to experiment between M and L and track how i feel, and have included screenshots here. for the duration i slept with M-size, i was still very tired the next day despite low AHI. on days with L-size, i had some really good readings (that i cannot figure out how to replicate) but also some bad ones. 

what are the best graphs and screenshots to include here, and any ideas on what i can do to improve? for now, i've included the L-size duration overview screenshot, my 0-AHI day and my most recent screenshot from 2 nights ago. 

i think i'm on the right track, but can't figure out what to try next. i could use any advice here that might help. thank you a bunch in advance!! 


P.S. I cannot for the life of me figure out why my axes are all messed up compared to others on this forum. if someone knows how i can fix this, i'd be happy to repost screenshots for easier reading

[staceyburke]

My suggestion would be to do 2 changes.

The first change the min pressure to 7

2nd change Turn on EPR to FULL TIME set to 3

See how that helps tonight and post again tomorrow.

[fert]

Thanks! I'll give that a try. 

One thing I'm wary of is that I did once try raising my min pressure to 5 for a night, and felt pretty awful the next day. My Central AI went up. I think that was on M pillows though and without the EPR setting change. Maybe with that + L pillows it'll be better

[fert]

Gave it a try last night with those suggested settings, and attached the 1.9.24 screenshot. The EPR was already set to the settings you recommended, so only the min pressure changed. AHI numbers were slightly better, but not by a lot. Can't quite tell if I feel any different to yesterday.

Also included a 1.8.24 (pre-changes) screenshot.

One thing I also can't understand is why since returning to the US (where I am) on 1.6.24 from break my numbers have been higher than the 0.4-0.8 average during the prior week; I can't seem to get them back down <1.

Thanks again.

[Expat31]

I think it may be a good idea not to squeeze so many graphs on one page.

All that's needed are:-

1.Events
2.Flow rate
3.Pressure
4.Leak rate
5.Flow limitations.

If you look at the bottom right of your page, you have 14 graphs selected. Cut it down to the above 5 for the moment. It will make it much easier to a analyse your data.

[Crimson Nape]

fert - If your monitor is a 1920x1080 resolution, go to File (OSCAR for a Mac) > Preferences > Appearance > Graph Height. Change the setting to 120.   When taking a screenshot, make sure OSCAR is in full screen mode.

- Red

[fert]

Thanks for both of those suggestions. Set my resolution to the 1920x1080 and limited graphs -- worked. 

I've reattached the two screenshots from the past 2 days - (1) 1.9.24 with the pressure set to min 7, and (2) 1.8.24 with min pressure 4 (before the recommended changes). Also added a third, which is the overview since I switched to L-size nasal pillows, if helpful.  

Curious what else I can try here. Perhaps the only difference since 1/6/24 vs. 12/26-1/1 was that I was in a much more humid country vs. dry winter in the US since 1/6/24. Can humidity settings have an impact? Is it worth increasing?

[fert]

Continued with the recommended settings again last night, but bumped up humidity to 4 from 3. 

More comfortable, but my AHI seems to have climbed drastically. I missed first half of the night's data because my SD card wasn't in, but I realized when I woke up middle of the night, and put it in

Not sure what I'm doing wrong here..

[fert]

trying my luck again here. still haven't managed to figure this out. 

I didn't tolerate pressure at 7-9 very well, so experimented with 6-9 for the past week and change. my AHI readings have mostly been >1 the few days, and particularly high the past 3 (attached). i can't figure out why. oddly enough, when i traveled down south to a slightly warmer (but still cold/dry) part of the country, my readings went down <1 to the 0.8-0.90 range. since then, it's been back to >1.0 every night. 

i did also try one night back at my default settings of 4-10, and while my AHI was a bit lower at 1.24, i felt awful the next day -- supremely tired and foggy, to the point of needing a long afternoon nap

anyone able to shed light on what else i might try here? 

having struggled with this for some time now, i also have an upcoming polysomnography that i hope yields some useful information....