New to the board & Oscar - Looking into Mask Leakage and any other potential issues

[Barrington]

Hi all,

 I'm a 44 year old male, I was diagnosed with severe obstructive sleep aponea 7/8 years ago after a sleep study showed I was stopping breathing between 50 and 55 times an hour.

Once I was diagnosed, I was given (am in the UK) a cpap machine and a mask (mask was new at least, the cpap machine wasn't! was incredibly loud!) and was told to use it for 6 weeks or so and to see how I got on with it. Used it all night every night from the day I got it, which meant I got a nice shiny new resmed s9 I believe it was which I had for the next 4 or so years.

I've generally responded well to cpap treatment since then. I've had my cpap machine upgraded to an Airsense A10 which does autopap which has been working for me, however over the past few months things have slowly being deteriorating it seems. I do feel like I used to prior to having cpap therapy which is pretty terrible. I've tried various masks, all resmed however, in full face and nasal varieties. I really don't get on with the pillows so I've not had a lot of those. I'm currently using a full face mask as I think I'm a month breather when I sleep, however this hasn't really solved the issues I've been having.

I've got it into my head that the issue is down to mask leakage so I've been having a look at my data on Oscar over the past 3 or 4 months or so. From what I can see, whilst there is some mask leakage going on, it's probably not bad enough to cause me to feel as tired as I do during the day. The pressure to me looks reasonable, I'd expect this to go up and down depending on what stage of sleep I'm in. It doesn't exceed the pressure I used to be on with cpap (11) too often, so I don't think changing from apap to cpap would help too much either here. From having a look at other peoples graphs (and I'm not sure that's actually a good idea!) the flow rate, limit and tidal volume appear to be in line however I'm not sure if they're indicating any issues.

I've attached 3 random screenshots of days form the past couple of months or so. If anyone could have a look and see if there is anything apparent that jumps out, or if I'm wrong about the mask thing and it is a bigger issue than I'm thinking it is, or anything else that needs to be investigated further, that'd be great!

Finally, it might not be relevant, but I have a go2sleep device too, which is a ring that goes on your finger and tracks things like AHI and oxygen levels etc, however this is done by light I believe so I'm not 100% sure how accurate it is. It does say my oxygen level does drop to under 87% at times, which is alarming, but I'm guessing it'd be a better idea to get one of the oximeters compatible with Oscar so it can be over-layed on top of the cpap data?

[Dormeo]

Welcome! A few questions: Have you gained weight recently? Started using new medications or new dosages of old meds? Has your sleep environment changed?

Your AHI is great. If you're not aware of the leaks waking you up, I suspect they are not where you should be focusing. The one area where I think you might experiment is your flow limitations. Please raise your minimum to 7, increase your EPR to 3, and turn off the ramp. EPR gives you a boost when you inhale, which can help to reduce FLs. Let's see whether these settings help you feel any more rested during the day.

[clownbell]

While I am just a user, not an expert, I would have said exactly what Dormeo said. With only a very small percent of the night in large leak territory, the machine can compensate for virtually all of your leaks. You have hypopneas, which are typically treated with more EPR. Flow limitations are typically treated with more EPR. So set minimum to 7, increase EPR to setting 3, and ditch the ramp. Don't expect overnight results; it may take a few days for results to materialize.