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Bit of a backstory: originally I had a sleep study done in 2020, AHI while side sleeping was 30, back sleeping resulted in 70. Doctor said I had "mild" apnea and said if I continued to sleep on my side then I wouldn't need a machine, so I never bothered getting one.
Years later and after getting off shift work (now working straight 7 am - 3 pm shifts) I still have brain fog and lousy short term memory, so I went to my GP and got referred for another sleep study while also ruling out vitamin deficiencies with bloodwork. The latest sleep study said I have an AHI of 7 which seems off to me. The sleep study doctor has prescribed APAP setting of 5-15 cm h2o.
I started using the machine right away and have used it every night except for a couple nights where I was traveling. There hasn't been any issues sleeping with the mask on throughout the entire night and also haven't had any issues with mouth breathing.
So far I haven't noticed any difference in my quality of life, although my DME supplier said it would take months. I go to sleep between 9 and 10 pm every night, and wake up at 6 am. I am sometimes waking up because of rain out. Condensation will form and trickle out of my mask (I have a beard) so I'll take the mask off and just wipe the inside of it to dry it out.
I am just looking for some feedback and if there is anything obvious sticking out with my OSCAR results. I've included 3 screenshots, Aug 3 is a typical sleep at home for me. August 11th was when I was across the country visiting family, and the 14th is my first day back home. I don't normally sleep for 13 hours at a time but I was extremely tired and jet lagged lol
The first 2 was with a min 5 and epr 2. Your epr was really 1 because the epr (exhale relief pressure) is subtracted from the min (your inhale pressure) 5-2 should make your exhale at 3 but it can NOT DO THAT. The absolute lowest the machine can go is 4. When you were at min 6 EPR 3 it made it 4 BUT notice your flow limits were much lower because you really had a epr of 2 instead of 1.
You will do even better if you set the min 7 and epr3 again your exhale will be 4 but you will be using all of your epr.
EPR helps to lessen the flow limits. Flow limits are apnea just the same as Oa and H events. The higher the flow limits stops you from getting into deep sleep and can wake you up.
So a quick update here. Set the minimum pressure to 7 to see how that goes.
Didn't sleep very well on the 16th, didn't actually fall asleep till about 11 pm after getting into bed at 9 pm. Experimented a bit with setting my mask to full face instead of pillows after watching a video from CPAP Reviews on youtube about how it's supposed to "lessen" the pressure and make it more tolerable. Didn't notice any difference at all
Slept much better last night (Aug 17th), fell asleep at about 9:30 pm according to my fitbit. 7 hours and 54 minutes asleep, 47 minutes awake. The two OA's at the beginning of the night were from holding my breath to see how quickly and aggressively the machine would respond. Leaks were all over the place, I think the large leak at 11:20 was me taking off the mask to reposition it.
I have also been referencing the awake phases my fitbit reports with OSCAR and have discovered that there is usually always a deviation in flow rate that corresponds with an arousal. I've uploaded 3 screenshots showing this. Fitbit said I was awake briefly at 11:43 pm, 12:11 am, 12:52 am for example. Could these be from mouth breathing for a bit, or maybe mask leaks?
Could you repost Aug 16th and 17th after you've calibrated the y-axis of flowrate to be the same as the other images (60 to -60). It would be nice to have a closer look with comparable values. Flow limit is less for the 16th and 17th, which is good and tells me that we could keep the changes for now.
You have a considerable amount of leak. Leak isn't necessarily a dealbreaker, but you want to control it if you're trying to figure out your source of tiredness. Air blowing on your face, an extremely sensitive part of your body, is bound to disturb your sleep. Additionally, it compromises therapy, as the pressure delivered is less than what it's configured at, as you lose the pressure through the leak.
That's what you should expect, deviations in flowrate that line up with arousals. The 17th 1134PM zoomed-in looks like the leak woke you up to me. Same with 1211AM.
1252AM looks like flow limitation. Something to keep in mind is that the flow limit chart isn't as sensitive as the flowrate chart, so shallowed waveforms in the flowrate chart may not always show up in the flow limit chart.
(08-18-2023, 07:17 PM)jwest Wrote: Could you repost Aug 16th and 17th after you've calibrated the y-axis of flowrate to be the same as the other images (60 to -60). It would be nice to have a closer look with comparable values. Flow limit is less for the 16th and 17th, which is good and tells me that we could keep the changes for now.
Here you go, I forgot that I had changed the y-axis
What have you tried so far? And what do you feel like the best settings have been so far? And how many nights of sleep did you use those settings which you believe have been best so far?
The main difference I can see between 16th + 17th and the remaining nights is that flow limit has measurably come down, which is a good start.
I originally started therapy on July 18th, the sleep doc prescribed apap at 5-15 cm h2o. The DME I bought the machine off of had epr set to 2, which I've now learned isn't a "correct" setting as epap can only go down to 4 on this machine. I turned ramp off and set epr to 3 & full time almost right away. Temperature I've left at the default auto temp of 27 for the most part, humidity is set to 2 as it seems like anything more than that and I get a bit of rainout. Eventually the condensation pools and trickles through my beard, waking me up.
Originally I tried the ResMed N30i but gave up on that about a week later and trialed both the F&P Brevida and ResMed N20, using each for about a week at a time before deciding on the N20. I'm a side sleeper so I'm still learning how to position my head on the pillow without pushing the mask to one side or the other, which usually causes a leak.
Before cpap I would get a solid 8-9 hours of sleep without waking up throughout the night, but would still have fatigue halfway throughout the day and brain fog towards the afternoon/evening. Since starting therapy, I don't think I've had one solid night without waking up at least once. I am fully embracing it though and haven't ripped the mask off once yet in my sleep.
Flow limit has definitely come down over the last two nights, I'm wondering if setting the minimum pressure to 8 might be the next move for that. Eventually I think once I hone in on a good setting, switching from apap to cpap might be something to try.
One thing I don't quite understand is that your PSG showed 30 AHI on your side and 70 AHI on your back, and your sleep doctor said it's "mild"? Do you have a copy of the sleep study that you can share here?
APAP is comfortable for a lot, but I personally believe it is less effective at delivering consistent therapy.
Try hanging the mask off the side of the pillow, by placing your head as close to the edge as possible? Alternatively, what I do, is I just sort of lie between my side and back, using pillows as needed to help support that position.
Although you are waking up, do you notice any difference in your subjective quality of life?
The pressure increase to 8 is what I was considering too, but it's important to take things slow with PAP therapy. You've only just started, and you don't want to move variables around too much too quickly, or you risk losing the gathering of actionable data. Go to 8cm, and get some more data points out of it. There's only so much we can say so untravelled into your journey of PAP therapy.
One last thing, which I always peddle to people, is pulse oximeters can be very helpful. I firmly believe they are very well aligned with sleep quality, at least for me personally. But no rush.
