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.

[mttm]

As I said earlier, I didn't make any changes last night besides dropping the EPR to 2. For some reason the machine settings didn't save on the SD card not sure why. Here is the SleepHQ link with last night's data: https://sleephq.com/public/teams/share_l..._id=YLVAmj

For some reason the leak was not great last night, not sure why because it felt like the mouth tape was pretty secure and I had it on when I woke up but I guess there could have been a gap or it moved a bit and I didn't notice when I took it off in the morning. Should be fixed tonight when I get my new tape. 

I think that tonight I will try to consciously sleep only on my back because if I don't focus on this, I end up rolling around throughout the night which I'm assuming is another thing that might mess with the data.

I also see a lot of new Hypopneas in the data when leak is low and I'm not sure why that is, the only thing I changed was EPR. Maybe I am getting used to this new setting or should my CPAP pressure be changed? Thanks everyone for any advice

[Crimson Nape]

The Resmed writes that day's configuration on its first use for that day. If you change your settings after that, it will not be reported until the next day, providing you don't change them again. It is possible to use the CPAP, change its settings and continue using it, then set them back to the original settings within the same 24-hour day, and it would never be reported.
- Red

[mttm]

Last night I felt like a had a pretty good sleep. I used the new cover roll stretch tape and that worked so much better than the other tape I had and I don't think that it's even possible there was a mouth leak because the tape stuck so well. Unfortunately, I didn't remember to put the SD card in before sleeping so I have no data which sucks but I'll be extra sure to have it in tonight. I was only able to get the most basic data which I've attached below. 

I decided to keep the EPR at 3 with this new mouth tape and consciously trying to stay on my back because I only want to change one variable at a time. As I said before, I'm going to make sure to the SD card in this time and I have to stay I'm pretty hopeful that the leaks are solved and I feel like I'm starting to slowly improve.

[mttm]

Hey all, here is my data for 10/4: https://sleephq.com/public/teams/share_l...afa709fe65. 

It felt similar to 10/3 and that day I did start to feel very tired around 2pm and the rest of the day. I think that the leak is mostly fixed due to the new mouth tape I got but correct me if I'm wrong. 

Although the AHI seems low, it seems that some events aren't getting marked by my machine but I'm not really super experienced at picking these out. 

What should I do next in terms of pressure/EPR if anything? I was leaning towards increasing my pressure but I'm not sure if there's something I'm overlooking so I would greatly appreciate if someone lets my know, thanks!

[coutherino]

Hi! Apologies for the late response. Your leak looks much, much better. I'd say it's pretty much fixed at this point. I'm glad the tape is helping.

There sure does seem to be a lot of spontaneous arousals this night though. Do you recall tossing and turning a lot? Were you comfortable with the mask and the pressure? Is there anything else that's causing discomfort, such as aerophagia? There are definitely a lot of spikes in the flow rate graph that don't appear to be attributed to obstructed breathing.

The next step might be trying to lower EPR just to see what happens, but I'd really like to see another night of data with these settings first.

[mttm]

I don't really recall tossing and turning a lot because I'm pretty sure I stayed only on my back the whole night. The mask and pressure were also comfortable and no aerophagia. There is one thing that I could think of that might affect it I'm not sure but I am mildly congested and it is sometimes difficult for me to breathe out of one/both nostrils. I'm working on fixing this with my ENT but so far no luck. 

This most recent night 10/5 I decided to try removing the EPR and making it 0 because I found some sources saying Resmed EPR/EPR in general is not great. Link is same as before: https://sleephq.com/public/teams/share_l..._id=YLVAmj. Last night I found I had trouble staying asleep but that could have been due to other factors too like not eating great food too close to sleeping and sleeping at a later time than usual. I'm sure I can get used to no EPR with time I think my brain would just get used to it. 

Should I try these settings for a little while longer with EPR 3 or just keep going with EPR 0. Thanks!

[mttm]

I've added data for the past 3 nights (10/6, 10/7, and 10/8) to my SleepHQ here: https://sleephq.com/public/teams/share_l...afa709fe65

I am wondering where I should go from here if I still feel the same amount of brain fog and fatigue as before. Should I be raising the pressure or changing any other setting? I think I am used to the EPR at this point so I have left it on. The past two nights I have woken up a couple times due to congestion and this most recent night congestion and the mask getting water inside. Because of the congestion that I've been unable to solve with my ENT, I've ordered a full face mask as a temporary fix while I look for a second opinion on my congestion. Outside of the waking up due to congestion, is there anything that jumps out from my data that can be fixed or improved?

I also got a Wellue o2 ring just out of curiosity to track my pulse and oxygen levels so I'll be using and adding that data soon too. 

If anyone can help me out I'd greatly appreciate it, thank you!