Help me find out what went RIGHT on this random extremely good night

[astral_fns]

First of all hello, first time poster here. Recently diagnosed about 2 months ago and all of what I know about OSA is self taught. Anyways, for my background:

Context and background:

I was diagnosed with Mild sleep apnea with 122 total events. AHI of 12.9. Significantly worse on my back. All of these events EXCEPT one was a Hypopnea. No CAs (outside of the occasional treatment emergent). Hypopneas were classified as a 3% desat. Lowest desat dropped down to 85%. I also have severe asthma with a deviated septum and nasal valve collapse in both nostrils as well as chronic rhinitis. I have an appointment scheduled for someone to take a look at my nose so we can do surgery to fix both. I'm taking an oral steroid as well as a nasal spray to address my severe inflammation and winter time breathing issues both of which seem to have little impact on my sleep. I am using the Airfit F20 at the time of these results. It is a large which is definitely a little too big. That's about all i got for an introduction.

My sleep test results: https://imgur.com/a/T4G5oIb

The good night:

https://imgur.com/a/T4G5oIb

I have literally no idea what I did differently on this night. I woke up the next day and felt pretty alert, energetic, my anxiety was very low and my ability to stay on task and not get overwhelmed or bored of what i was doing was close to it was pre sleep apnea. No "numbness" headache or slurring my own speech. Although ironically I just realized that my REI is substantially worse while on my back while taking these screenshots, maybe that has to do with it? While looking back I had my humidity set to 6 as opposed to my usual 4. Would that make this much of a substantial difference?

Almost identical settings but felt lousy the next day:

https://imgur.com/a/Of4RcZ0

As mentioned previously: no idea what I did differently. Woke up and felt awful. All of my typical daytime symptoms were back. Brain fog, ringing in ears, slurring speech, random loss of focus and "thousand yard stare" is back, tiredness, the usuals. I tweaked the pressure slightly but i doubt changing my min and max down 1 would make a crazy big change like that. This was also the literal night after my good night.

Conclusion:

My good and bad nights of sleep seem to happen completely at random. I just started using a nasal pillow last night (the P10) with a strap to keep my mouth closed since just about every time i wake up im on my back with my mouth open butthe quality of my sleep felt lousy like usual. It did help keep my nostrils from collapsing when i breathe which is nice. If anything else is needed or if anyone has any questions please feel free to ask.

[ozij]

"Almost identical" is meaningless.
I saw minimum pressure of 10.8 on 6 January, the good night, and 9.6 on the next day, and quit looking.

It beats me why you went and changed settings after a good night. But it makes me think that you've been changing your settings randomly on a daily basis.

Put yourself on exact same settings of the good night, and stick to them for about a week.

[Pugsy]

We simply don't sleep the same each night EVEN WITH the same settings...even with same number of hours slept.
So some nights we just don't sleep so great and if we don't sleep good there's a good chance we won't feel so good the next day. It just happens and it isn't always tied to settings on the cpap machine. There are a lot of variables involved.

As Ozij says....go back to the settings that worked on the "good" night and keep them for at least a week and see what happens. You know you can get a good night at those settings but don't expect every single night to mirror other nights.

[zonker]

i'm posting this reply mainly for others who might be reading it, rather than the original poster.

this is why having the software program, oscar, is so important. the op was stymied by why something good happened on one particular night. by posting his/her charts, the forum was able to focus in on the charts and see where the possibilities for improvement lay.

in other words, s/he got advice upon fact based evidence.

[luciferin]

Your 95% flow limit is high. Looks like you already have EPR on max. I'd recommend you keep increasing your minimum pressure by 1 each night until you get it below 0.05. I got mine to 0 at CPAP 10 with EPR 3.

Your asthma, rhinitis, deviated septum, etc are going to contribute to higher flow limits, unfortunately. Anything you can do to treat those will likely help you. I'd consider changing your humidity settings lower by 1 each night to see if lower humidity lowers your flow limit. Humidity is a known asthma trigger.

[Miss Emerita]

Your 95% flow limit is high. Looks like you already have EPR on max. I'd recommend you keep increasing your minimum pressure by 1 each night until you get it below 0.05. I got mine to 0 at CPAP 10 with EPR 3.

Your asthma, rhinitis, deviated septum, etc are going to contribute to higher flow limits, unfortunately. Anything you can do to treat those will likely help you. I'd consider changing your humidity settings lower by 1 each night to see if lower humidity lowers your flow limit. Humidity is a known asthma trigger.

When you make changes, I'd recommend sticking with your new settings for more than one night -- a week would be good. The reason is that sleep is fairly variable from one night to another, so with just a one-night trial, you can't really conclude that the change you made was what made a difference. Of course, if you make a change that leads to a disastrous night, by all means undo it!

As others have said, you should go back to the settings you had for the really good night and stick with them for at least a week.

About flow limitations: they mess with the sleep of some people but not others. Your FL graphs were busy on both your good night and your bad night, so we don't have a specific reason to suspect they bother you. The other thing is that if your flow is restricted by conditions inside your nose, higher pressure is unlikely to help, because the tissues in the nose are relatively rigid and are less likely to be successfully stented open by higher pressure.

The really bright spot for you is that you now know you *can* get good sleep. So making that happen more consistently is a reasonable goal.

[luciferin]

About flow limitations: they mess with the sleep of some people but not others. Your FL graphs were busy on both your good night and your bad night, so we don't have a specific reason to suspect they bother you. The other thing is that if your flow is restricted by conditions inside your nose, higher pressure is unlikely to help, because the tissues in the nose are relatively rigid and are less likely to be successfully stented open by higher pressure.

The really bright spot for you is that you now know you *can* get good sleep. So making that happen more consistently is a reasonable goal.

Count the number of unflagged vertical jumps on the flow rate graph between their good night vs. the bad night. It's over twice as many. We don't have the ability to zoom in, but when I've seen that on my own chart it is from unflagged RERAs due to a high flow limit. I agree, it's a sticky situation because their EPR is already maxed, and they could have anatomical issues that prevent it from getting lower, but since their AHI is already so low, making adjustments from here targetting flow limit is the best gauge I am aware of.

I've only got my own therapy to go on of course. And no argument with conservative adjustments and waiting a week in between. I'll admit I'm very impatient.