First here is a screenshot of an OSCAR report from a recent night:
https://i.imgur.com/oHyZ8ZE.png
This report consists of two sessions: one was 12 minutes (I think I interrupted it to use the bathroom) and the other was 8h27m (my actual sleep). Please let me know whether this screenshot is okay. This screenshot shows a typical night (most of my nights look like this). I remember I did feel like this sleep was restful. I woke up feeling refreshed and I don't remember any particular issues during the night.
My main problem right now is that some nights I have very bad sleep but the OSCAR report still looks similar to my good nights. I am also struggling to find what I should be doing differently. All details below. My primary problem right now is that I am experiencing apneas or sleep interruptions during sleep onset, and this is causing me a lot of anxiety. I don't know what to do.
Some background
- I've been using CPAP since Feb 2021 (a little over 3 years). When I first started using it, the settings were 8min/12max, and I slept amazingly well for at least the first two years. I also started a new diet and lost 30 pounds in my first 4 months using it. I even contracted COVID during that time (post-vaccination) and slept just fine, with minimal disruptions.
- In the last year my sleep has become less good. I am back to about 7 pounds over my initial weight when I first started CPAP. I had to change my machine some time last year because of a recall on Respironics, and the new machine was set to continuous pressure of 9.0cm. I didn't realize I should be using an APAP setting until fairly recently (December 2023), and I've set the pressure to 9min/13max.
- Some problems I had I eventually did solve. For example, changing from continuous 9 to automatic 9min/13max helped a lot. I also began vaping tHC last year and was vaping almost every single day, but I've since stopped entirely (last vape was March 1, 2024). I also had a very dirty filter at some point that I had foolishly forgotten to change for a while. (My partner was using a humidifier with tap water when he contracted COVID recently, and I think the minerals in the water just clogged up the filter. There was no other change to explain why the filter got so dirty so fast.)
- However, I am still having some problems.
- I am experiencing a lot of difficulty getting to sleep, and right now this seems to be my biggest problem. I am writing this post after a night in which I went to bed at about 2:25am and didn't get to sleep until about 5:45am. I would lie in bed for 20-25 minutes, not fall asleep, and then get up to walk around for about 5-10 minutes. Then I would try again. I did this for more than 3 hours until I finally fell asleep. Then I only got 3 hours of sleep (that session was 3h17m).
- Last night was towards the extreme end, but that is what I semi-regularly experienced for several months last year until December. I still do experience this difficulty getting to sleep on a regular basis, but usually not for more than 30-40 minutes.
- The OSCAR report shows the details, but here is my qualitative description. As I feel myself drifting off to sleep, I feel myself jerked out of that state and back into full consciousness. My heart begins to race and my body feels very flush and warm. It's similar to how I used to experience an untreated apnea before CPAP, but not quite the same. These are exclusively during sleep onset, and I don't necessarily feel myself gasping for air or having lost a breath. It almost feels like I forgot to breathe.
- I've read about sleep onset apnea or sleep transition apnea, and that could be what's happening to me.
- Some of my issues are psychological, yes. Given that the average quality of my sleep has gone down significantly over the last year, I experience anxiety around going to sleep. For the first two years, my AHI on almost nights was less than 1. Now my AHI in a typical week ranges from 2 to 4. Yes, it's not a big difference, but it's there.
- My anxiety is based off real events, not imagined ones. I've told my partner that this "feels like my body is betraying me". I want to fall asleep and I can even feel myself doing so, but then I'm jerked out of it despite using the CPAP machine.
- I usually sleep on my back. Sometimes I sleep with my body slightly turned towards the side. My back is still supported by pillows but the side of my face is partially on the pillow.
- I sleep with a travel neck pillow (https://www.amazon.com/gp/product/B01N6MJ3QI/) to support my chin to prevent my mouth from dropping open and causing bad dry mouth. The straps are adjustable so that the pillow can hug your face and neck quite tightly or just be very loose with the side pillows there for support only (not under your chin).
- I use Xylimelts to help with dry mouth since my mouth still does open slightly.
- When I first started CPAP (and when I was untreated), I slept on my side. However, now when I sleep on my side, I wake up with a lot of muscle pain in my ribs. I've slept on my back almost exclusively for more than two years now.
- I have a foam mattress.
- I keep my bedroom dark and cool. I also have a sheet I can put over my eyes (doesn't impeded breathing since I use a full-face mask) to block out light.
- I use a white noise machine.
- For about half the week, my current boyfriend sleeps in the bed with me. He does not have sleep apnea. His movements generally don't disturb me or contribute to the other issues I've described.
- Does the OSCAR report support my description of what's happening? Does my description make sense?
- Do others have experience with this sleep onset apnea? How do you manage it?
- Are my pressure settings (9min/13max) not appropriate? Should they be changed?
- Should I be concerned that a typical OSCAR report has so many RERA and VS/VS2 events? For reference, in my three years using CPAP, I've seen maybe 2 CA's. All of events in the AHI calculation are hypopneas.
- Recently I have not had problems with mask leak, but I have had this issue in the past. How can I read the OSCAR report to know whether my mask is leaking too much?
- For side sleepers, how do you prevent muscle pain in the morning? Is this a matter of proper support (pillows, mattress, etc.)? Or is this more of a matter of my body shape and size? (I'm a male, height 5'8", and weight about 265 pounds.)