[Treatment] Interpreting OSCAR data - any assistance would be incredibly appreciated :)

[Expat31]

At what pressure did aerophagia start?

Keep EPR @ 3, pressure at 9 to see if reduces the obstructives/hypopneas.

Leaks, you have quite a few spikes. Whilst these leaks are not of a particularly  long duration, you may be sensitive to them and could be causing "micro awakenings" (arousals).

I know you are concerned about the centrals, but let's try to clear up the above basics first, get some more data, and see what is left. 
Often centrals clear up on their own once the other basic issues are settled.
Final point- you must get a copy of your detailed sleep report. It is part of your personal medical records.

You could need need it in the future, especially if you change doctor.

A detailed report will show, amongst other things, oxygen levels and AHI sleep position breakdown. This will give you the possibility to ask probing questions, if the need arises at some future point. 

I am a firm believer in keeping a paper trail. 

You just never know! 
 

[Sleeprider]

In your last chart, EPR was still off. Looking back at all your charts, the pressure is too low resulting in more OA and flow limits. EPR should partially offset any pressure increases, but based on what I'm seeing here, you need to get your EPR back on a setting 2 or 3 and use Auto pressure with minimum 7.0 maximum 10.0. Do you use multiple pillows or sleep on an incline?

[SleepyVoyager]

Here is last night; I tried at 10 pressure and 3 EPR and got a good result (I think). Been feeling rested today for the first time in awhile.

---

At what pressure did aerophagia start?

Keep EPR @ 3, pressure at 9 to see if reduces the obstructives/hypopneas.

Leaks, you have quite a few spikes. Whilst these leaks are not of a particularly  long duration, you may be sensitive to them and could be causing "micro awakenings" (arousals).

I know you are concerned about the centrals, but let's try to clear up the above basics first, get some more data, and see what is left. 
Often centrals clear up on their own once the other basic issues are settled.
Final point- you must get a copy of your detailed sleep report. It is part of your personal medical records.

You could need need it in the future, especially if you change doctor.

A detailed report will show, amongst other things, oxygen levels and AHI sleep position breakdown. This will give you the possibility to ask probing questions, if the need arises at some future point. 

I am a firm believer in keeping a paper trail. 

You just never know! 
 

Gotcha - 10 pressure seemed to work well, so I'll try 10.5 tonight. Sorry, I know you suggested 9 here. That said, I am still getting some slight hypopneas on 10.

Yep, I'll see if I can get my report.

[SleepyVoyager]

In your last chart, EPR was still off. Looking back at all your charts, the pressure is too low resulting in more OA and flow limits.  EPR should partially offset any pressure increases, but based on what I'm seeing here, you need to get your EPR back on a setting 2 or 3 and use Auto pressure with minimum 7.0 maximum 10.0.  Do you use multiple pillows or sleep on an incline?

I have this pillow, no incline. I removed the bottom height layer.

Should I be switching to APAP? I've been using CPAP this whole time...

[Expat31]

A 10.5 pressure seems a good move to me, edging up, bit by bit to see where it goes. 

It appears you have made some significant progress; with just 2 centrals and 3 hypopneas left from the night, leaving the large leak peaking on the to-do list

It's only one night, nevertheless moving in the right direction.

Footnote:-
The events tab, (to the right of the details tab) gives the duration of each event. It  can sometimes make interesting reading.

[Sleeprider]

This pillow look like it's excessive in terms of elevating the head and encouraging chin-tucking. Hard to judge from the pictures, but I have not had much luck with foam or memory foam pillows or ones with contours like this. I use a down pillow with 650 fill power. It is flexible, adjustable and comfortable in any sleep position, and soft enough not to dislodge the mask. Many members have shown improvement when they get rid of these specialty pillows. https://www.costco.com/pillows.html?fill..._attr-Down

I was suggesting auto pressure, however your last chart looks very good at pressure 10 and EPR 3. Auto pressure would let the machine adjust pressure in a narrow range if necessary. I suggested minimum 7.0 and maximum 10.0, but I think based on last night I would go 9.0 to 11.0.

[SleepyVoyager]

So, I am running into heavy aerophagia again, even at level 10 now. I tried 10.5, 11, and 11.5, with the aerophagia progressively worsening. It seems the 0.50 AHI result at 10 pressure was an aberration. I'm feeling tired all the time, as usual.

I am not sure what to do. Should I look into getting a BiPAP machine?

I've bought a wedge. Maybe that'll help. Should I go ahead and buy that 650 pillow as well? Or maybe switch my mask out?

I also have the Knightsbridge chin strap that I could try again; it seemed to make things worse when I used it last time, though.

Here are my results from the last few days:

[Expat31]

Hello, 

Thanks for your latest graphs. 

Now we have 9 days of data, thought I would just do an overview to see if there were any useful trends. 

6 days were at EPR of 3, of these only 2 days (24/2 and 26/2) had a flow limitation values. These two days were overwhelmed with some serious leaking, the 26/2 being the worst with an EPR of 3.26

The 4 remaining days has ZERO flow limitations. 

So it seems to me, providing no errors on my part, that EPR has done its job in suppressing your flow limitations, and the exceptions easily explained by the significant leaking. 

There is however a fair amount of generalised spiking of leaks, could be mask movement, but not always easy to tell. Although at a low level, could be sleep disruptive. You have a pillows mask, and usually have excellent seal properties. But watch out for mouth leaking, and that the skin is really clean before affixing the tape. I found that tape could loosen aften a couple of hours, especially if the humidity level was a bit too high. 

Regarding pressures, try to keep them as low as possible. (I did ask about the pressure that contributed to the start of your aerophagia) 

I noticed you sleep on average 10+ hours a night. Are you taking sleep aids on a regular basis. You mentioned this once. Can be quite disruptive to the sleep cycle. 

I  think your present machine is OK, but if you were able to have an Autosense 10 it would I believe be an upgrade.

Regards

[Deborah K.]

You need to follow Sleeprider's settings advice.  He knows way more than the rest of us.  

[SleepyVoyager]

I am not taking sleep aids, no. I did it as a one-off. Unfortunately, I drink a lot of caffeine (to be able to function) and often later in the day. This is probably also contributing.

I think I will buy that 650 pressure pillow and try the APAP settings of 9-11, EPR 3, as suggested by Sleeprider, and then report back. This said, I am tempted to go BiPAP, but this is probably premature. I am booking in to see a sleep clinic locally (my previous one was overseas), so they may have some further advice.

And yeah, I may be getting mouth leaks despite the tape. That might explain the leaks. I'm not sure what else it could be. I can sometimes feel the air being forced into my mouth, especially in the morning period. I'm unsure how to fix this beyond using the Knightsbridge, but the problem is that the Knightsbridge strap is quite uncomfortable with the AirFit P30i.