New CPAP user, need help optimizing machine settings

Hi everyone,

I've been on CPAP for about 2 months now, overall, it has been helpful in getting better sleep. My sleep test revealed an AHI of 16, which has reduced down to OSCAR averages of 2.08 in October and 2.01 in November. Summary attached here: https://imgur.com/a/wg7TP27

I was hoping that someone here might be able to help me make sense of my OSCAR data on a good night vs a higher AHI night and help me understand what's happening + how I can optimize my settings to get closer to or under 1 AHI consistently, as that's when I tend to feel the best.

I did struggle with aerophagia issues, and in response, my doctor recommended turning EPR on to 3 and exploring a switch from a full face mask (F40) to a nasal mask (P10), which did help quite a bit. I do use mouth tape every night to prevent mouth breathing.

Low AHI Night (felt good): https://imgur.com/a/YEea4cu

High AHI Night (felt tired): https://imgur.com/a/0Cjepzq

Happy to provide any more information that is required or try any settings recommended. Based on my physical and bloodwork last month, I do not have any other health issues and I am not taking any medications besides Allegra once per day for allergies.

Appreciate any help, happy holidays!

Please turn off the calendar and remove the mask pressure graph and use the regular pressure graph instead.

Also....how is your overall sleep quality? Waking often for some reason or other ....or sleeping soundly for the most part for each of the reports you posted?

Here are the revised graphs

Low AHI Night: https://imgur.com/a/cWPlov3

Higher AHI Night: https://imgur.com/a/9sb3y8U

I would say that my overall sleep quality is improved vs non-CPAP, but I do still feel kind of tired most days. I don't notice myself waking up at all, and I tend to sleep soundly all the way through the night until the alarm goes off.

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

Do you have more nights with a nice low AHI and feel decent or are you having more nights like the higher AHI night?

The only medication I take is Allegra (1 pill, 24 hour strength) every day for allergies.

For November, my average AHI was 2.01

for October, my average AHI was 2.08

Overall, I’d say that I have more nights like the higher AHI night.

I am afraid to go too wild and crazy with any pressure changes because we don't want to revive the aerophagia monster.
Also I am unsure what has caused the difference in AHI and how you feel.
AHI of 2 ish...not a big deal normally but you are noticing a bit of a difference in how you feel with a slightly lower AHI.
The higher AHI night really only has a little bit of clustering of events. Roughly coincided with maybe REM stage sleep where it is quite common for OSA to worsen or even need a little more pressure.

So I wonder about the chance of your OSA being worse in REM or maybe affected by sleeping position.

What about sleeping position? Do you spend much time on your back?

Did your sleep study happen to mention sleep stages and AHI????
To give you an example....my own OSA is MUCH worse in REM (documented in a sleep lab with tech in attendance) and in REM the AHI was 53 per hour average but my overall AHI wasn't all that remarkable in non rem running about 15 per hour AHI in non REM.

Have you tried a minimum starting pressure of 6 or 7 with EPR at the 3?

I agree, I don’t want the aerophagia to come back, it was awful.

I used to be a side/stomach sleeper mostly prior to the CPAP. Since I’ve gotten on it, my wife has said that I sleep on my back more often in the middle of the night. That could be contributing to it.

I was able to find this from my sleep study, not sure if this would be helpful https://imgur.com/a/AyqINmF

I can try upping the min to 6 or 7 tonight and report back!

Home sleep study and not done in a lab??? Is that correct? If it is a home study it probably didn't measure actual sleep stages. If that's the case we have no way to know if your REM is worse for OSA or not.
Doesn't really matter...have to deal with it one way or another but it would explain that little bit of clustering.
But then again sleeping on your back more could also explain it.

Usual fix for either....a little more baseline or minimum pressure. Be very cautious because of the aerophagia.

You could try staying off your back as well but staying off one's back is easier said than done sometimes.

Your reports are far from horrible though and if you were reporting feeling great and sleeping great then I don't know that I would worry about the AHI so much.
You won't sleep so great or feel so great if the aerophagia monster returns so you may have make a bit of a compromise.

If it were me....I would maybe try 6 minimum and/or try to stay off my back.
Try to limit changes to one at a time though.....if you make more than one change in something and either have a really good night or really bad night and you have more than one change....you won't know which change caused what result.