Oscar Advice for recently diagnoses UARS

[SleepTea]

Hello,

I was recently diagnosed with UARS (3.5 AHI, 5.9 AHI in REM, 24.0 RDI) through a WatchPAT test and have started treating it with an APAP through Lofta. I struggled a lot the first week with a nasal mask since I mouth breathe during sleep, which led to a ton of leaks, but since starting with the AirTouch F20 I have been able to eliminate large leaks and massively improve the comfort and sleep fragmentation. I now use the mask throughout the night every night.

While I have noticed that some days I have a more energy than I otherwise would, the results haven't been life-changing and my numbers still don't seem great. I've uploaded three nights of data to give an idea of what my stats usually look like. I should mention that I keep my mask on for a while before sleeping so my AHI is a bit deflated.

Does anyone have any thoughts or suggestions as to what I should try next? 

I also have a few questions:
1. I was diagnosed with sleep apnea based mostly on my RDI, but as far as I can tell machines are not great at detecting RERAs . How do other people with UARS tell if their therapy is working? In my case, my AHI hasn't really improved much, but it wasn't so bad to start with, so I'm more interested what my RERAs look like. Are the 5/hour, 10, 20?
2. Are my flow limitations problematic? They seem worse than most people I see post Oscar charts but not awful.
3. I've noticed some congestion when I lie down and go to bed. Could this be contributing to the flow limitations?

Thanks in advance!


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[BoxcarPete]

I'll take a swing at this. I'm looking at three things here:

1. Flow limits, which are occurring throughout the night at a 95% just under 0.1 most here would consider marginal. That means they may or may not be bothering you, but I'd say they are, considering 2. the flow graph itself. Spikes often indicate arousals. They may not score as RERA, but you have many times every night where your breathing pattern is disturbed by suddenly deeper breaths. Even this isn't too valuable to score as a number IMO, because of 3. Your tidal volume and minute vent. Good sleep architecture contains light sleep to start for 20-30 min, followed by an hour of deep sleep, followed by 20-30 min of REM, another hour of deep, and a mix of light and REM from there on out. You don't have respiratory stats with the right kind of squiggles for this to be happening properly.

Try EPR full time starting at 2, and bump your minimum pressure up to 8 as well. This may help with flow limits and reduce your number of arousals.