[Treatment] Troubleshooting CPAP (VPAP)

[TiredAt8000]

Disclaimer: I'm not looking for personal medical advice, I'm looking for general troubleshooting and diagnostic procedures others have had success for.
I've been on a ResMed (S9 VPAP Auto) for something like 8 years now. When I got it (after an at-home sleep study by Apria), it really changed my world. I use a nasal pillow and sleep either on my back or side. I am 100% diligent about using my CPAP, every night. I occasionally take it off if my dog wakes me up at 4am and I'm having trouble getting back to sleep, and if I fall asleep on the sofa while watching TV or something I obviously don't have it. I use OSCAR to analyze my data.
My AHI is usually sub 1.0, though on a restless night I've seen as high as 7. Total time in apnea is usually somewhere between 30 seconds and 2 minutes. OSCAR reports time over leak redline as 0% except on rare nights.
My DME (Apria) is worse than useless and I feel like the at-home sleep studies were very poor data, especially compared to the data from the ResMed telemetry in OSCAR.
The reason I'm writing is that I feel like I'm getting back to my old pre-CPAP situation. I wake up in the morning groggy and sometimes with tinnitus. My blood pressure is up. My memory and cognition are down. But nothing seems measurably off. I had an appointment with my GP and they didn't note anything amiss, and just wanted me to take blood pressure meds. I'm hoping to actually identify the causes and see if I can solve them, instead of just taking pills. I've cut out sugared soda, reduced salt, gotten more exercise, lost weight, but I can't help the feeling something is amiss that I'm not putting my finger on, and it feels like sleep is connected to it.
Since my DME and GP haven't been very insightful, I'm looking for insights about where you'd look in OSCAR data for telltales that might indicate something is off in my sleep. If I see something interesting, it's something I can discuss with my GP, but her suggestion was "get a new sleep study and see if it shows anything and then we can talk". I'm in a high altitude rural area, and it's not very conducive to go to a metropolitan facility thousands of feet lower in altitude than I am and do a sleep study there. So, I'm hoping to divine useful info from the RedMed telemetry taken of me sleeping normally, in my normal environment.

Thanks in advance. Recent OSCAR summary pasted below (sorry for the formatting, if there's a better way to share this, let me know).


AHI   0.12



ResMed

S9 VPAP Auto

PAP Mode: VPAPauto

PS 3.0 over 5.0-20.0 (cmH2O)





Date

Start

End

Hours

5/26/2022

23:16:22

07:21:24

08:05:02



Large Leak

0.00%

Clear Airway

0.00

Obstructive

0.00

Unclassified Apnea

0.00

Hypopnea

0.12





Statistics

Channel

Min

Med

95%

Max

EPAP

4.02

5.56

7.56

9.34

IPAP

7.02

8.56

10.56

12.34

Minute Vent.

2.50

5.50

6.63

8.38

Resp. Rate

8.20

14.40

16.60

18.80

Resp. Event

0.00

0.00

0.00

0.00

Flow Limit.

0.00

0.00

0.03

0.15

Leak Rate

0.00

0.00

0.00

7.20

Snore

0.00

0.00

0.02

0.12

Insp. Time

0.50

1.40

1.62

1.78

Exp. Time

1.54

2.73

3.40

4.28

Tidal Volume

140.00

380.00

480.00

640.00

 

Total time in apnea

00:00:06

Time over leak redline

0.000%





Machine Settings

 

Mode

VPAPauto

Min EPAP

5.00 cmH2O

Max IPAP

20.00 cmH2O

PS

3.00 cmH2O





Session Information

 

CPAP Sessions

On

Date

Start

End

Duration

ResMed Session #1653628560



5/26/2022

23:16:22

07:21:24
08h 05m 02s

[Crimson Nape]

Hi TiredAt8000! -
What we need to see is a screenshot of your OSCAR Daily screen. You can perform this function by pressing the F12 key if you're using either Windows or Linux. A Mac requires holding down the "Fn" key while pressing the "F12" key. For more information, please review the links in my signature.

Also, the way you are describing your energy, do you have a recording oximeter? Altitude isn't your friend in this case.
- Red

[TiredAt8000]

   

I do have a recording pulseox. I can try to keep it on one of these nights.

Obviously there's a leak event or two in that data, so I'm not so concerned about those, I have since replaced the head strap.

[TiredAt8000]

Does anyone see anything noteworthy in the data in the screenshot?

[OpalRose]

"My blood pressure is up. My memory and cognition are down. But nothing seems measurably off."    

I would say that this statement alone suggests that something is "measurably off".

I don't see anything amiss in the chart you posted, and this is not Medical advice, only advice from experience... don't ignore elevated BP readings.

Also, as stated above, your oxygen levels may be off. Use your recording oximeter for a few nights to check.

[Peach25]

How did you go with recording pulse oximetry..? 
The only thing that I could see on the data screenshot was the min’s for minute vent, resp rate, and tidal vol being low…I couldn’t see how long these minimums were in effect, however levels that low I would be reviewing the settings… however I might not be the best person to make these recommendations as I’m very rusty with these ResMed machine settings, as well as preferring to see the corresponding pulse oximetry data alongside the same nights’ download screenshot…

[TiredAt8000]

I'll capture some oximetry and some fresh CPAP data.

Do my machine settings seem plausible? I'm not sure anyone who was involved in setting them originally knew what they were about. There was a whole lot of buck passing and hand waving.

[Peach25]

Thank you - some pulse oximetry and corresponding nightly data would be of interest, considering that on face value, the settings combined with the data outcome measures (AHI, etc) aren’t remarkable…having said that, the min’s shown are quite low, so there appears to be the need to change settings (and when looking at the graphs in greater detail with them zoomed in a bit, then there might be reason to up the min pressures and PS… however, there’s common sense in reviewing this in light of oximetry if that is a possibility). 
Looking forward to seeing the data when ready