Request for help in interpreting OSCAR data

[Mardee]

Hi all - 

I have been on CPAP since March 2021 (10 months) and am still exhausted all the time, every day. I don't have a sleep doctor or DME to consult because I was diagnosed by my primary care physician and bought my machine outright over the web (reliable provider, but following forum rules, I won't post their name / website here). I have other medical conditions that can cause fatigue (hypothyroid, fibromyalgia) but they are as well-treated as they can be at this point. With the help of my doctor, I have gone off of a couple of medications that cause fatigue, thinking that would help, but it has not. At this point, my doctor is looking at my AHI readings and thinking that my sleep apnea is fully treated, so they're out of ideas as to what might be causing me to be so tired. I'm hoping that I can tune my CPAP therapy so that I sleep better and hopefully alleviate some of the exhaustion.

I tried reading the forums and help files to understand the OSCAR data so I could figure this out myself, but I'm not quite sure where to start. I only have detailed data for last night because my machine didn't come with an SD card, so I only just inserted one yesterday. Even so, I think this is a pretty average night. I go to bed with enough time to get 8 hours of sleep and I use my CPAP every time, but when the alarm goes off, I feel dead tired and like I can hardly get out of bed.

Equipment: I'm using a ResMed Airsense 10 for Her with ResMed AirFit P10 for Her Nasal Pillows Mask. I also use ClimateLineAir heated tubing. We live in Colorado and it's very dry here so I fill the humidifier nightly. (Not sure that humidity has an impact but I figure more info is better than less?). 

I am attaching my OSCAR data from the machine - I tried to follow Stacey's post about how to set up the view so hopefully that will provide the info that you need to review.

Any suggestions are welcome - I'm considering trying a different mask style but before I spend $100+ on that, it seems like it would be best to get advice first. Thanks so much for your help!

[staceyburke]

Welcome to the board.  Your flow limits are high, flow limits are apnea in the upper airway.  To treat them we use EPR (exhale pressure relief).  because you have a min of 5 it will not work.  4 is the absolute lowest pressure any pap machine can go.  We need to add a little to the min and set your EPR to full time.

Please try these new settings I believe they will help

Min 7
EPR 3 
Max 11

[Mardee]

@staceyburke, thank you so much! I will make the adjustments and see if that helps. I really appreciate your time and expertise to help me out.

[Mardee]

So, after a couple of nights on the new settings, I'm still seeing what looks to my (uneducated) eye as a peak in apneas between 2 and 4 a.m. I'm sleeping a bit better but still very tired even after a 2-hour nap yesterday and a full night's sleep. 

Here is a fresh screen shots with last night's results - I'm hoping someone can take a look and let me know if there's something else that I should tweak with my setup. Thanks!

[staceyburke]

2 things first - is your EPR SET at full time. Usually it is listed in the left hand column but I can’t see it.  Please check it. 

The obstructive events you had around  2 were positional apnea.   Positional apnea is when your chin drops to your Sternum and that cuts off your own airway. Think of it as a kink in a garden hose. There is NO PRESSURE that can help, you have to find out what position that was and stay out of that position. 

Positional apnea can be fixed by not sleeping on your back of using a flatter pillow. If it is not the easily fixed you may need a collar. I have a link I my signature on collars. Please take a look at it. 

Hopefully this can be easily fixed, it only happened once at 2 am.

[Mardee]

Hi again Stacey and thanks so much for the help!

I checked the EPR and it is set to full-time and at level 3. I believe that's what you suggested but let me know if I need to change something in the settings.

As for the positional apnea, I'll look into the cervical collars or possibly something that prevents me rolling over onto my back. I'm normally a side-sleeper but apparently I do roll onto my back sometimes and I can see why that would be a problem.

Thanks again for your help - much appreciated!

[SarcasticDave94]

Hope this helps, but the Positional Apnea clusters Stacey refers to isn't about body sleeping positions like on the sleep study. This position issue is where your neck bends when your chin points downward towards your chest at sharp angles, kinking off the airflow much like the garden hose kinked loses water flow. Using a thinner pillow or a soft cervical collar to prevent this kinking is the best remedy.

[Mardee]

Thanks for the explanation - I read what he said a couple of times but didn't quite grasp it completely. I appreciate the extra context - if I'm reading you both right at this point, it's about stopping the chin tucking rather than not sleeping on my back.

I tried the test that is in the Wiki files (press up on the bottom of your chin) and was surprised at how quickly the airway closes up even when I'm sitting upright. I'm sure he's right that this is part of the problem.

Thanks again!

[SarcasticDave94]

Yes you have it correct. Best to your success on the therapy. Keep asking questions as needed.