New member looking for Oscar data help

[mttm]

Hi all, here is my SleepHQ with updated data and I added the night of 10/1: https://sleephq.com/public/teams/share_l...afa709fe65

Hey coutherino, I don't want to speak too soon because I still had some issues with the mouth tape and it was half on when I woke up but I saw your advice about my mask before I went to sleep. I realize that it was on pretty loose and whenever I slept on my side it would tend to leak I thought this was just normal so I avoided sleeping on my side. I tightened up the mask a lot and the data looks a decent amount better from what I can tell but obviously I'd like someone else to look at it too because I am very new to trying to understand charts. 

I've been using this generic tape from CVS: https://www.cvs.com/shop/cvs-health-sens...id-1011867. I think I'll order that tape you recommended because initially I thought the issue was me pulling the tape off but I think it might just be falling off from drooling or something else. 

I woke up a little earlier than usual but didn't want to try and go back to sleep without mouth tape properly applied and it was only about an hour or so less sleep than I normally get. I'm not sure if it's a placebo or not but I feel more rested than usual today and even managed to dream which I can't even remember the last time I dreamed. 

I'll work on getting better mouth tape and I'll monitor how I feel with these changes, thanks again for the help. 

Hi Phaleronic, I'll try lowering the EPR rate tonight. In your opinion do you think it's still something I should do given my most recent results from last night from tightening up my mask? Thanks!

[coutherino]

Oh, wow. Yea, that definitely looks a lot better. Part of it is seemingly still mouth leak if the tape is coming off during the night, but your mask shouldn't be leaking at all, even if you're on your side. Just tighten it as much as you can to guarantee it's snug WITHOUT being uncomfortable. That's the main thing, after all. I'd expect you to feel more rested though, your breathing looks miles better, at least in comparison to the night before.

And yea, I'd definitely recommend ordering cover roll stretch tape. It's really amazing stuff. I drool a ton in my sleep (tmi) and it never comes off as long as you cut a big enough piece to extend beyond the edges of your mouth. All you have to do is purse your lips together inwards to make sure there's a seal and stick it on. There's certainly a method, but once you figure it out it's 0 leaks every night. The only thing that might affect it is if you have a lot of facial hair.

Also, I'm gonna have to respectfully disagree with what Phaleronic said. In no world are those true obstructive apneas. They're both "centrals" (I'm using that term very lightly here) caused by 2 position changes. When you shift during the night, you'll often find periods where you hold your breath while doing it. This is natural, and these constantly get mistagged by your machine. Like I said previously, not infallible. In the second "obstructive apnea" you can even see a deep breath literally the breath prior. This... simply is not how obstructive apneas work. Typically they are characterized by a slow decrease in airflow as your airway collapses, until it eventually flatlines, and you arouse, gasping for air. It seems more plausible that you simply took a deep breath as you prepared to move, and then held it as you did so. That's not to say this isn't a period of unstable breathing, it certainly is. But what precedes it? A period of high and variable leak. Which is likely what woke you up in the first place and caused you to toss and turn.

Leak rate doesn't really mean anything either in my opinion. The threshold of 24 L/min is merely ResMed's definition of a large leak, it might as well be a number pulled from thin air. The leak you are experiencing is disturbing your sleep, it is a problem, and I do feel like I have already proven this by comparing different periods of your breathing at different levels of leak. But I'll give more examples from that night specifically anyways. The first image shows basically the only periods of very low, stable leak in that entire night (the 29th). Notice how stable your breathing is? Flat all the way across except for a few tiny spikes. The second image contains 3 of the multiple periods of leak. The quality of your breathing literally plummets as soon as it starts happening. I promise it is disturbing your sleep. 

   

   

If you want any more proof, simply compare that night, the night where you were below the "threshold" for large leak—but had a constant baseline of highly variable leak with lots of spikes—and this night, where the leak was much better. Or even the night of the 30th where your leak was technically still below the threshold, at least for the 95%. 

Look at the difference in your breathing. It is quite noticeable. You'll find that comparison in the image below. The top image is last night and the bottom image is the night from the other two images. Don't get me wrong, it's still not perfect, and there are multiple periods of wonky breathing. But overall it is better, especially at the beginning of the night where there is almost no leak. What you're looking for is for it to be almost completely flat across the top and bottom of the waveform, with just a few spikes here and there as you change positions.

   

As for EPR though, you can do whatever you want with it. It's not a bad idea to try lowering it and see what happens.

[mttm]

Thanks again for the extremely detailed post I appreciate it. I'll make sure the mask is tight enough tonight and I ordered the tape you recommended so I'll be able to try that tomorrow when it comes in. I don't want to make any drastic changes so I can see what changing small things does so I'll probably only drop the EPR by one tonight just to experiment, otherwise I'll leave everything else the same and hope my not-so-good mouthtape holds up for one more night.