I had a sleep study in January 2024 using the VivoScore ring (tangent: anyone heard of this/have experience with this?). That indicated mild sleep apnea, AHI just above 5, but with absolutely awful sleep quality according to some proprietary metric. I used what amounts to a MRD for a while to no real effect, had another sleep study (Resmed ApneaLink Air through the hospital sleep center this time) while wearing the MRD in September 2025, no real change in AHI. I notice now, looking back at it, that the device thought most of my apnea events were central apnea—though I don't know how it can tell—but the physician comments at the end say "mild OSA, recommend CPAP". We'll come back to that.
So, I dragged my feet a bit but decided to start CPAP a few weeks ago. Got a Resmed Airsense 11 with P10 nasal-pillow mask. Two problems:
First, my AHI is actually as bad or worse than before, mostly because I'm having a lot of central apneas and hypopneas. I emailed my Dr. and they said it may go away with time, which, okay, fair, but something to keep in mind. I wish I knew whether my untreated AI was mostly central to begin with (as the ApneaLink Air device claimed), because if so, isn't CPAP just entirely the wrong therapy?
Second, after a few days of basically-comfortable sleep (AHI aside), I woke up in the early morning to air escaping through my mouth. I foolishly hadn't installed an SD card, so I can't look back at those first few days, but I have almost two weeks of data now.
What it felt like is losing muscle tone in my tongue -> tongue falls away from the palate -> air pressure blows it open. And it seemed like it was only happening at pressures above 9 or so, so I experimented with lowering my max pressure all the way to 8, not as a long-term solution but to see if that made the problem go away...and it didn't. So now my best guess is either that the loss of muscle tone is sleep-stage dependent, but so dramatic that it goes from "OK at 12" to "not OK at 8", or that I'm unconsciously moving my tongue. Both of these seem more likely during REM sleep, but if so, that means my sleep pattern is really weird, since it only happens shortly before I wake up, not cyclically. Anecdotally I can say that I do have a lot of dreams that sorta "bleed" into waking, so I may well be in REM sleep at that time.
Okay, OSCAR screenshots. This is a fairly representative night—two trips to the bathroom, with the second and third blocks of sleep terminated by a period of high CPAP pressure, mouth leakage, and CA events. Some nights I only go to the bathroom once, some nights I only experience the mouth leakage at the end before I get up for real, the periods vary, but this is a good start.
- Screenshot 2026-01-06 at 12.09.35 AM.png (663.93 KiB) Viewed 1204 times
- Screenshot 2026-01-06 at 12.10.16 AM.png (649.13 KiB) Viewed 1204 times
- Looking at the flow-rate graph, it seems like the mouth leakage may be contributing to, and/or caused by, breathing instability/CA events. Does this make sense, or is it more likely that the causation is different and the mouth leakage and instability are both caused by e.g. REM sleep? But isn't it weird and wrong in its own right to have REM sleep only in a couple big blocks like this?
- How does my CA/OA ratio/pattern compare to others? Am I just on the entirely wrong therapy, and if so, how do I talk to my Dr about it? How long should I wait to see if CA events resolve?
- ChatGPT says nasal pillows might exacerbate the tongue-seal failure problem, but TBH I didn't really follow its reasoning, and it could just be hallucinating. And I asked before I realized that it wasn't actually pressure-dependent, so I'm not sure any of GPT's reasoning even applies any more. Thoughts? I like the nasal pillows better than a cradle otherwise—cradles pinch my nose.
- General thoughts on pressure settings in my situation? I've had a couple nights where the machine backed way off and then let an OA event through which caused it to kick way back up. I got some super unclear and possibly hallucination-prone advice from ChatGPT about whether to consider a higher minimum pressure or not.
- Thoughts on nasal-breathing trainer devices? MouthShield, SomnoSeal, OptiO2+. Something that sits between your teeth and lips to create an additional seal.
- If I break my lip seal, with or without tongue seal, my cheeks inflate like a chipmunk, and it's legitimately difficult to get them to deflate again (unlike restoring my tongue seal, which I actually do automatically in my sleep). Basically, I assumed "oh, I'm losing my tongue seal, so we just equalize the pressure in front and behind the tongue and it doesn't matter"...but I neglected to consider that the mask doesn't cover my whole face, so anywhere the mask doesn't cover my cheek, there is now a pressure differential between the inside and outside of my cheek. How does this not drive people insane?!
- If I keep the straps to a tightness level that is comfortable at 5cmH2O, I have hilariously bad leaks at 11cm. If I tighten them enough to seal at 11cm, my nose feels like it's being crushed at 5cm. Even a smaller pressure range than that seems like it would be difficult to get a single strap tightness that works across the entire range. A range of only 1-2cm would be fine I think. I see a lot of recommendations here tend towards relatively narrow ranges, but I haven't heard this talked about as a reason before.
- What is the best bang-for-the-buck in terms of additional data collection (e.g. pulse oximetry, position sensor)? How reliable is any method of determining sleep stage short of EEG?