Unsure what changes to make based on OSCAR data

[weepingwillow]

Can anyone suggest changes I might try with my settings? I'm new to OSCAR and after reviewing documentation I'm just not sure what to make of it all. I continue to have lousy sleep and do not feel well-rested.

Some potentially relevant details:

• I started using nasal pillows 1 month ago. I tape my mouth shut.
  
• I often wake throughout the night. In the attached graph, I was awake a few times, and one of those times was for at least an hour or two. (But I stayed in bed with the mask on.)
  
• I have a long history of sleep-maintenance insomnia and typically have difficulty returning to sleep after waking.
  
• I originally started on CPAP 1 year ago but only used it for a few months. I was using a full face mask and getting unbearable aerophagia.
  
• With the nasal pillows I still get a bit of aerophagia at times, but it's usually tolerable. I assume I need to refine my settings and/or taping.
  

Thanks in advance for any suggestions.

[Old Steve]

Welcome to the forum. 
 I would set your minimum pressure at 10cm and the max at perhaps at 16cm.  Leave your EPR at 3.  I am not 100% sure, but some of the apneas look as if they could be positional apnea.  This is caused by chin tucking, your airway gets out of position and it's like bending over a garden hose to stop the water supply.  In our case it shuts off the air supply.  Pressure will not fix this.  Search this site for more info on Positional Apnea.  Try the above settings for a few days to see if we can eliminate some of your OA's then post some more charts. 

[weepingwillow]

I will give that a try. Thank you!!!

[SarcasticDave94]

Agreed with old Steve, Positional Apnea is a possibility with the clustered events showing. Read the wiki, also check your pillow thickness. If it's very thick, this might tend to promote kinking off your airway as the chin is tucking down.

[weepingwillow]

I'm looking for additional input after another night. I increased the min pressure to 10 last night and loved how well I could breathe when falling asleep. Some things I'm wondering about:

1. When falling asleep -- both originally and throughout the night each time I woke -- I felt lightheaded when inhaling. I haven't experienced that before. It didn't necessarily bother me, if anything, it was kind of relaxing, like when you're dosing off under general anesthesia. But that's a slightly disturbing sensation when you're not being monitored and your mouth is taped shut! Any concerns there?
   
2. I did not change the max to 16 as Old Steve had recommended. What is the rationale for that change? Since my pressure has yet to go above 14, does it even matter if the max is 16 vs 20?
   

My latest graph is attached.

[weepingwillow]

Agreed with old Steve, Positional Apnea is a possibility with the clustered events showing. Read the wiki, also check your pillow thickness. If it's very thick, this might tend to promote kinking off your airway as the chin is tucking down.

Thanks, SarcasticDave. I do use a thick pillow, but I only sleep on my side so I didn't think positional apnea would be much of a problem for me. Does that tend to be a problem with side sleepers, too? If so, I can certainly give a soft cervical collar a try.

[OpalRose]

Does that tend to be a problem with side sleepers, too? If so, I can certainly give a soft cervical collar a try.

Yes, positional apnea can occur whether you're on your back or side. The problem is the chin tucking. I used to sleep on my side and had a habit of sleeping in a fetal position with my head curled into my chest. This can cause a lot of Obstruction.

[SarcasticDave94]

The intentional cap on the max is to prevent a runaway CPAP, where in cases like your likely Positional Apnea, without lowering to 16 or so, CPAP may go up to Max in an attempt to clear the obstruction. It might then disrupt sleep.

At least that's why I'd consider turning down Max pressure.

[weepingwillow]

I'm back for more troubleshooting help. I've attached my last 2 nights of sleep. Both were pretty bad. 

On the most recent night (August 16), I made two changes: (1) used a soft cervical collar, Caldera Releaf, and (2) switched to cover-roll stretch tape; I had previously been using a combination of 3M and Johnson & Johnson tapes.

The tape worked well and I now understand why it has such positive reviews! However, the cervical collar appears to have been a disaster for me, and I took it off after the first half of the night. Of note, after I took it off I noticed that my teeth and jaw felt like I'd been biting down really hard in my sleep, which is not typical for me. 

I went back to sleep about 90 minutes later, without the cervical collar. My chart was greatly improved afterward, although even without it I had several brief awakenings and feel that I slept poorly.

I've also attached my Overview chart which shows my most recent attempts to make CPAP work for me. In April and May I was using a full face mask. In July I switched to nasal pillows. I added mouth tape after a few nights if I'm remembering correctly, as well as the soft cervical collar just briefly last night.

I'm getting so frustrated and have felt like garbage all week. I actually really like how it feels to breathe with the CPAP with nasal pillows, and I want it to work so badly. Please help!!!

[Old Steve]

It appears that we have neglected you, how are you doing since your last post?  I can't give you much help on the cervical collar, I tried one for several days and my results were not good.  I am able to take care of my positional problem by sleeping on my left side all night.  You are correct your results do look much better without the collar.   I do know that sometimes it takes some playing around with how tight you have the collar although, I could never get mine adjusted so it would work.   In the latter part of the night without the collar it appears that 10cm is getting you in the ball park for your minimum pressure.  That's  assuming that you can get the Positional Apnea under control.   Post some more charts when you can and hopefully we can give you some more help if needed.