[Symptoms] Help with OSCAR Results - headaches and fatigue

[SleepyinCincy]

Hello,

I am new to this forum, and have been using a CPAP machine off and on since 2018.  I am hoping that someone may be kind enough to review the information below and attached, and let me know if anything stands out as an issue that should be addressed. 

I am 45.  I saw a sleep doctor in 2018 due to lots of fatigue during the day, frequent wake-ups, and I often have a headache & brain fog when I get up in the morning.  I did an at home sleep study in 2018, which is attached as "capture.jpg" with personal information blocked out.  My doctor advised that I had a very mild case of sleep apnea, and that CPAP isn't really necessary - but that I can try it.  

For whatever it is worth - I have issues with clenching and grinding my teeth. My wife has noticed it on some occasions.  I started using a dental night guard about 10 years ago, and I think that it helps to a degree (at least with protecting my teeth).

I took a couple of screen shots from the Oscar software, and included with this post.  

In browsing thru other posts on the forum, I've seen people talk about chin tuck.  I think I do that sometimes, and that might be something I need to work on.  I'm a side sleeper.

For additional data - I also wear a Whoop strap, mostly for the data it provides while I sleep.  My resting pulse is typically between 45 and 50.  I'm not sure how accurate the blood oxygen readings are - but my average is typically 95%. Sometimes it is as high as 97 or 98.  Lastnight, it shows an average of 94%.

Thank you for any input!
Adam

[staceyburke]

Welcome to the board.  Things look good but I think your sleep would be helped with 2 changes.

Min 7
EPR full time set to 3

Give that a try and give us a nights charts tomorrow.

[SleepyinCincy]

Staceyburke,

Thank you for the quick response.  I just updated the minimum pressure to 7, as suggested.  

In regard to the EPR - I noticed that my machine was already set as you described.  I attached a photo for reference.  With that in mind, would you suggest any further adjustments for that setting?

Thanks
Adam

[staceyburke]

Those settings look good.

[SleepyinCincy]

Also - this may or may not be a practical question to ask here on a forum....based on the Oscar data I uploaded in my original post, does it appear that using the CPAP is important and/or beneficial? I started using the machine back in 2018, and it seemed to help marginally (fewer wake-ups). I then lost ~30lbs, and stopped using it around 2021. I didn't notice a significant difference in sleep quality / fatigue when I stopped using it. However, after a couple of years, my sleep quality started to deteriorate again, and so I started using CPAP again around January of this year. I "felt" a marginal improvement, so I've continued to use it.

For whatever it is worth, I'm intending to complete another sleep study within the next couple of months, and if possible, I'll have the study completed at a lab rather than doing another at-home study. I believe the study in the lab tracks additional data, including brain activity (?) - so maybe it'll help to identify other issues.

Thank you!

[Phaleronic]

Hi SleepyinCincy

You have min pressure set at 5cm with EPR @ 3, so knocking epap min to 4cm. Please raise min pressure to 8cm and turn EPR down (off would be best) but set it to 1 for now, also your 9.5 percent pressure is right around 9cm, so you can lower max pressure to 12cm. Narrower bands of pressure help with arousals and microarousals-and you'll sleep better

[SleepyinCincy]

Phaleronic and staceyburke -

Thank you for taking the time to review my data and provide feedback. It sounds like I clearly need to raise my minimum pressure. Also, up until now, I did not have a good understanding of how the EPR setting works, or what it does. After doing a little reading on that, I think I understand better and I'll work gradually toward eliminating my use of that feature.

Thanks!
Adam

[Deborah K.]

Stacey knows his stuff, so listen to him. You need your EPR set at 3. It helps with comfort and, more importantly, it helps keep flow limits down. Flow limits are short time, unreported apneas, and we need to keep them as low as possible.

[staceyburke]

I suggested you use EPR full time and set to 3 (the setting are 1, 2 or 3).  So what is EPR?  It is Exhale Pressure Relief, which means if your min is 8 your exhale is also 8 but if you set EPR 3 then your exhale is set to 4. 
 
Why would you want to do that?”  First it is for comfort making it easier to breathe out or exhale.  That is important the higher pressure you need for your min.  Many people find they do ok with 8 or 9 min but as they get higher pressures they find it very difficult to exhale against the higher pressure.
 
Another reason is many people sleep better and easier to fall asleep.  And of course it allows each of us to set the pressure on exhale is what we like.
 
Last we have found that using EPR helps to cut down the number and how big Flow Limits happen.  FL are apnea they just are not big enough to be classified as an O or H and are NOT counted in the AHI. So many people report low AHI but poor sleep.  It is the first thing I look for when I see that complaint.

We have over 100 thousand members here and there are a lot of opinions from different members and I will not say not to listen to anyone on the board.  But please try what I suggest and let us see what the outcome is.

[Phaleronic]

EPR does not cut down on flow limits unless you INCREASE baseline pressure, and it does NOT add to IPAP pressure according to resmed's own white papers and manuals for EPR. What we have are a few forum members that always suggest cranking EPR fully regardless of what the minimum pressure is, and this does these folks no good as EPR has a major defect in how it returns with inspiration pressure, and it reduces the machine's ability to maintain ApneaControl.

I strongly suggest moving UP from EPR being off slowly; advocating for turning it on @ 3 when you know it decreases epap min pressure, which causes loss of apnea control (you'll have MORE OA/UA events and MORE hypopnea events) is either lack of knowledge on how EPR fucntions, (read Resmed's page on its functionality) or it's being a shill for the product.

I'd like to see some empirical proof of the statement that EPR curtails flow limits and functions as a form of bilevel therapy (which I've seen moderators and advisors post here) please.

I will link the Resmed's PDF of how EPR works on their machines for you SleepyinCincy.

https://ap.resmed.com/knowledge/epr-expi...ure-relief