Minimal Improvement After Years on CPAP, Need Help

[niumplan]

Hello! I’ve been using CPAP since 2021 to treat mild/moderate OSA. I was first diagnosed 14 years ago.

Despite consistently low AHI (<5), I still really struggle with fatigue, brain fog, and other symptoms of poor sleep. I’ve had little success treating these symptoms, so I’m trying to revisit my sleep as a potential root cause

I've seen multiple sleep doctors, but they often dismiss my concerns because my apnea is “controlled.” Still, I feel terrible and want to rule out anything that may have been missed. If anyone can help me interpret my OSCAR screenshot below or suggest what to push for next (e.g. titration, in-lab PSG, etc.), I’d be extremely grateful.

I have included a screenshot from last night.

I’m happy to share any more context or information, but I wanted to keep this post brief. Thank you very much in advance.

Oscar-Screenshot-10-17-2025.png (604.71 KiB) Viewed 1443 times

[Pugsy]

Do you take any medications of any kind for any reason? If so, what?

Do you have any other physical or mental health issues going on?

[niumplan]

The only systemic medications I take are lamotrigine (300mg) and minoxidil (2.5mg). The rest are topical medications. All systemic medications were started within the last year.

I have depression, GAD, and social anxiety. I also have chronic muscle tension/pain.

[Julie]

Pretend you're someone else reading your note(s). What would YOU think and advise given what you see?

[niumplan]

Hi, Julie. Thanks for your suggestion. If I knew what to do, I would have done it already, which is why I've asked for help here.

I have seen several sleep doctors over the years who tell me that my apnea is treated because the AHI is under 5. It kind of ends there, even if I try to follow up. It's hard to know what to push for or who to talk to if I can't get further than this with sleep doctors. My understanding is that sleep disordered breathing is more complex than just AHI (let me know if this is wrong), but I'm not sure who to speak to about those concerns.

[ozij]

My understanding is that sleep disordered breathing is more complex than just AHI (let me know if this is wrong),

You're absolutely right.
Look at how frequently your pressure is going up an down.
Look at the flow limitations.
Look at the leaks.

ResMed machines are quick to respond to flow limitations, but stupid about lowering the pressure when the flow limitations disappear.
You're spending half the night at a pressure of 8.34 or more - and this in a constant up and down mode, never staying for long periods at the necessary higher pressure.

First thing I'd do, is aim to get my minimum pressure to 8.4 -- in the hope that it will prevent many of those flow limitations. Try moving your minimum up. Start doing it gradually - small increments until you get there - and then stick to the higher minimum for at least 5 nights. Go only as fast as you can handle the change, sometimes patience is necessary.
And put your ramp at a minimum of 7.

You're also leaking. Some people can tolerate leaks better that other. If I had those leaks, my sleep would be badly disrupted.
Now - they could be a result of a mask that doesn't fit so well, they could the result of you opening your mouth - whether because of the flow limitations or just so. Once you've gotten used to the higher minimum, lets see what happens with the leaks.