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New member, first night of Oscar data - michael7 - 09-18-2023
Hi everyone, new member here!
It's been a confusing journey so far, mainly because of a messy at home test I did a couple years ago when I went in for severe 70 DB snoring. It recorded an AHI of 7 the first night but the equipment malfunctioned and woke me up every few minutes, while the second night where it worked better it recorded an AHI of only 2, though there were two times that it recorded a group of hypopneas. From that, they gave me a prescription but after talking about it with the doctor I was concerned that the home test was faulty and not convinced I had sleep apnea and I wanted to do a retest in the near future. I figured at worst I had mild sleep apnea that could wait until a more convenient time to investigate.
Fast forward 2 years later, and I'm dealing with blood pressure in the 140s, insomnia until 2-3 AM, massive health anxiety, morning grogginess, a lack of energy, lots of hazy memories of waking up feeling like I can't breath well, and a few times where for several days in a row I would wake up in the middle of the night heart racing. I talked with my doctor about investigating the sleep apnea angle for these symptoms and she agreed, but didn't think I should bother redoing the home test, and should just use the previous home test to get an APAP. I'm a software developer, so the idea of an APAP where I can handle my own settings and analyze my own data with OSCAR was right up my alley.
I'm still not entirely sure if I've got sleep apnea, but I've now used it two nights and already feel like a different person with a lot more energy. I'm still learning a lot, but my main focus for now is how to figure out the ideal pressure as I'm still using 4-20 for pressure. I didn't manage to get the first night's data, so I only have one night of Oscar data so far. How many nights should I keep it on the 4-20 setting to gather data before I start changing it? From the attached Oscar graphs of last nights sleep, what values does it look like I should I change it to? Additionally, from this data can I tell that I do actually have sleep apnea and that the home test wasn't faulty in some way?
One last thing, I remember waking up for a minute last night and messing with the mask straps because I was hearing a leak. From the graphs I'm guessing that occurred at 3:03 and my messing around was what caused the big spike in the leak rate.
Thanks!
RE: New member, first night of Oscar data - michael7 - 09-19-2023
Here's my second night's data, and I think I screwed up attaching the first night's in my previous post so I attached that as well.
I slept well overall but I woke up once for a minute and I am still remembering minor disturbances. It's still far better than before the CPAP when those disturbances involved hazy memories of choking.
I left the pressure on 4-20 still last night so I need to fine-tune it, any suggestions as to what values? Is two nights of data good enough to start fine tuning it?
RE: New member, first night of Oscar data - upsman - 09-19-2023
I'm surprised you are comfortable with such low pressure. Most adults find that 4 cm minimum pressure causes a feeling of suffocation.
Since this setting is as low as the machine can provide, using an EPR of 1 cm isn't doing you any favors.
Even though your events are well within the treated area and you have no obstructive events, your 95% pressure is 9 cm. You were at or below this for the night. I would suggest raising your minimum to about 7 cm and using an EPR of 1 or 2 and see how that feels.
Overall, your OSCAR data indicates you're getting proper treatment. So, at this point, your main goal is to make sure you're completely comfortable.
RE: New member, first night of Oscar data - OpalRose - 09-19-2023
michael7,
I agree with the assessment above. Your minimum pressure is too low.
Move it up to 7cm with a EPR setting of 2 (to start).
The Leaks (which look to be mask movement) coincide with the high Flow Limitation.
Using EPR should help lower FL, Hypopnea and help you to breathe out against the pressure easier.
So let's narrow the pressure range with 7cm minimum, 12cm maximum and EPR 2.
See how that feels for a couple days.
Plus, work on your mask fit. It may just be a slight adjustment.
Have you read the mask primer?
http://www.apneaboard.com/wiki/index.php?title=Mask_Primer
RE: New member, first night of Oscar data - michael7 - 09-19-2023
Thanks both of you for the recommendations!
And about mask fit, I'll go read that mask primer, I haven't read that yet, so thanks for the resource. Both nights I've woken up slightly for a minute and messed with the straps, so definitely still getting used to the fit.
RE: New member, first night of Oscar data - michael7 - 09-20-2023
Well, I adjusted a bunch of settings for my third night on the CPAP didn't go well but I learned a lot. First, I learned that I don't like the EPR setting at all, it made it feel like the mask was moving around on my face. I woke up a couple hours after falling asleep and turned that setting completely off and it took me a while to be ready to go back to sleep hence the big gap.
Second, and more importantly I'm pretty sure my mask is too small and is causing lots of issues with leaking. Even when I have it really tight, if I move my head or mouth around it will start leaking, which has woken me up at least once a night. I looked at the mask, and I realize that it's about as wide as my mouth so the silicone is actually sitting on the corners of my mouth, which isn't very comfortable but also explains the leaking issues. For the Resmed F20, my measurements indicated that I was between a normal and a large so I initially went with a normal, but after realizing this I'm overnighting a large cushion. I'll still have to deal with my current cushion tonight though.
The pressure changes to 7-12 seemed good and more comfortable, but I couldn't tell for sure as mask fit is definitely my biggest issue right now.
I also changed the humidity from 4 to 5 and I think that helped a bit.
RE: New member, first night of Oscar data - staceyburke - 09-20-2023
I read you don’t like the EPR well you have flow limits and they are controlled with EPR.
What by are flow limits? They are apnea just like Oa and H events. They are smaller obstructions and shorter in length ( less than 10 sec).
Why are they important? Your pap machine raises pressure as soon as it finds a flow limit to stop it from becoming an Oa or H event. Because of this they stop you from getting o to a deep sleep or even wake you up.
EPR stops flow limits and stop rising pressure.
RE: New member, first night of Oscar data - michael7 - 09-20-2023
Oh I didn't realize that EPR was needed beyond comfort, thanks for the info. I'll have to do some research on that. I found EPR 2 to be unbearable to sleep with, but maybe I could get used to a setting of 1. I wonder if that would be enough to help.
RE: New member, first night of Oscar data - Gideon - 09-20-2023
What Stacey said.
Basicly Exhale pressure is used to treat OA events and is increased for some comfort issues.
Differential pressure between inhale and exhale is used to best treat Hypopneas (yours are insignificant) and flow limits (You have a bunch) including RERAS (you have a few) and UARS. This is EPR on your CPAP.
You can start with 1, but do try to increase it, take it slow. EPR must be Fulltime, Not Ramp Only to be effective.
Also realize that CPAP is a very low pressure device. A practical experiment. Get a tall glass of water and a straw. Now with the straw very near the bottom simply blow bubbles. Assuming 8 inches in depth you just exhaled against the max pressure a CPAP can produce, 20 cm of water. This is not saying you are not having issues, just that theses are really low pressures.
RE: New member, first night of Oscar data - michael7 - 09-25-2023
Thanks for all of your advice. I'm back after getting a better handle on my mask leaks, though I'm still trying different masks as I have to make this mask as tight as I can to not have leaks. I'm still not using the EPR yet as I've found even at 1 the constant flow of air in and out distracting enough that it negatively affects my sleep, I'm willing to play around with it in the near future, but I'd rather increase the overall pressure instead if at all possible.
Overall I felt like I had a great night of sleep last night, except I did wake up once and around that time I see a 10 minute window of 6 events, so I must have been having a bad issue there. I've attached a snapshot of this 10 minute window as well as another snapshot of the overall night's sleep. Any advice as to setting changes?