Frequent wakeups with mild OSA -- help me interpret OSCAR?

[mcrick]

Hi all,

I have an untreated AHI of 10.0, diagnosis of mild OSA, no clear indications of UARS (as far as I know), no major health issues, and have been on CPAP for a bit over 2 months now. I am a healthy young male in 20s at a healthy weight and physically active.

Despite my machine's reported AHI being around or under 1.0 most nights, I have generally been sleeping pretty poorly. In particular, I am waking up several times per night, and experiencing eye twitches, dry eye, and fatigue throughout the day.

Below are 2 screenshots. The first is two nights ago, a bad night of sleep resulting in the above symptoms, with a DreamWear nasal pillow mask. I woke up five times during sleep: 12:12am, 1:29am, 3:13am, 4:48am, and 5:38am (per apple watch).

The second screenshot is last night, which so far feels like it was a pretty decent night of sleep. I did wake up twice (11:51pm, 2:37am, and somewhere around 5:15-5:45am), but so far today I am not feeling the eye twitch or severe dry eye. This night was with an Airfit n30i mask.

I have a third mask that I don't use currently which is the Dreamwear nasal cushion. Generally I have been using the dreamwear nasal pillow, but it seems like I get too many leaks with it as a side sleeper. That's why last night I tried the n30i instead which seems to leak less.

My graphs don't seem to look that bad but I am concerned about the wakeups. Could anyone help me interpret the data? In particular I am wondering if some of the leaks and apnea events are caused by my mouth opening. I am willing to try mouth taping if so. Or are the arousals unrelated to apneas perhaps? Should I change up my machine settings or do anything else differently?

If it's relevant, I also find that I often wake up with nasal congestion and inflammation (my nose looks swollen and huge in the morning lol). I had a functional septorhinoplasty this past January to resolve a deviated septum and enlarged turbinates, so my nose breathing is very good generally, though often dry. Sometimes my mouth is dry when I wake up too.

Any help would mean the world.

[staceyburke]

Your AHI is great but your flow limits need to be addressed.  FL are apnea just like Oa and H events but are not counted in the AHI.  FL make the pressure of the resmed go up to stop them from becoming bigger apnea events (Oa and H) but they can disrupt your sleep, stopping you from getting into deep sleek and may even wake you up.

We use EPR to help with Flow limits.  You need to set EPR to full time and set the level of EPR to 1, 2 or 3.   I would try 2 for now.  Give it a try and post again with these settings.

Min 8
max 12
EPR full time
EPR 2

[mcrick]

Wonderful, I will try this out and report back. Thanks so much!

[PeaceLoveAndPizza]

Try this…

• Zoom in on a 3-minute window around the hypopnoea around 01:30. Take a screenshot. 
  
• Do the same for the bigger spikes around 04:45. Take a screenshot.
  
• Do it again for the normal sleep breathing around 01:00. Take a screenshot.
  

Now compare the three. Most likely the normal breathing has a nice rounded shape to the top. The hypopnoea has a severely limited flow followed by a recovery breath. The arousal likely has either a nice breathing pattern followed by an arousal breath or will have some jagged breathing as you reposition yourself followed by an arousal breath.

The pressure changes from flow limitations and arousals are part of what is disturbing your sleep. You can also drill down deeper with the data to look around pressure changes and you will likely find some interesting artifacts of how your body responds to the pressure changes.

Read the link in my sig to “Optimising Therapy” for more info.

[mcrick]

Thanks for your insight! I took the screenshots and attached below.

The first two look like "Inspiratory flow limitation" from the wiki you referred to.
I am not sure what to extrapolate from that, and would welcome any additional input from these images and on the recommend settings adjustment mentioned previously.

[mcrick]

Hi, here are a couple nights of data with these updated settings. From a glance it doesn't appear that the flow limitations are improved much overall. I feel maybe marginally better rested but it's hard to tell if that's the case for sure -- still have fatigue and eye twitches. My AHI seems to have increased slightly.

Would you have any further ideas or additional info/screenshots you want from my end? I appreciate your help!

[mcrick]

Hi all,

Reawakening this thread after trying various new settings with little success.
Primarily, I have tried various levels of EPR, which feels more comfortable, but doesn't seem to improve sleep quality.
I have tried some humidity adjustments but often experience rainout when I go manual. I've gone back to auto. I usually wake up a little stuffy but no severe nasal congestion, just a tad.

I have reduced my leaks and flow limitations by switching masks (now using a Large P30i) and mouth taping (mouth taping doesn't seem to do much, though), and I have raised my minimum pressure. If I go much higher than it is now, I feel like the air just balloons my nose without getting down into my airway passages very well. My OSCAR looks better now but I feel as bad if not worse than before. I am still waking up at least once or twice per night, usually between 3-5am (in the night below, I wake up around 5am).
Here is last night for example, with zoom-ins on my events. I also notice football shaped breathing past my second hypopnea which I remember reading somewhere is pretty bad for sleep quality. See screenshots.

If anyone can provide insight it would mean a lot to me. I've been feeling miserable despite doing all of the proper sleep hygiene habits. Maybe I need to go back to sleeping upright with my wedge pillow, which has helped in the past. It's pretty uncomfortable since I am a side sleeper.

Thanks very much and happy holidays.