Newbie to CPAP & OSCAR.... Where should focus be?

Hi all! Diagnosed with mild OSA in Late January and started Autopap treatment. Slowly feeling better, and excited about treatment! Was able to use my autopap for 2 wks, then had tonsils out, and now back on treatment for about 4wks. Read thru a ton of the "newbie Threads" and table of contents. I finally obtained an SD card and downloaded OSCAR 3 nights ago. My data is about the same all 3 nights, but I guess my question is.... where should be my main focus be when looking at the sleep files, early on in treatment? I've spent hours reading through the different OSCAR Tutorials, but it can all be so overwhelming. Even for a techy guy like myself. My sleep specialist doesn't really reach out to me for checkups, so I just want to be able to give her any concerns I may have. So I'm curious on which important pieces of the graphs/charts i should focus on? I already know my mask leaks are an issue and I've addressed that with her numerous times (she just says "give it time") ~ But It's gotten better since I purchased a CPAP pillow. I'm just a bit of an active sleeper! Although I think i'd be better off with something like the f20 memory foam mask that goes over the nose.
I'll attach last nights' data to give a 1-night snap shot of my sleep. (took off mask 1 time for bathroom, i think about 1130pm.) Thank you in advance to everyone!

(My equipment is Resmed Autoset 10 & mask is airfit F30i, with heated tube & humidifier)

#1--the wide orange line.
Your AHI is awesome!
Your leak rate is well within acceptable boundaries.
Congratulations.

chunkyfrog wrote: ↑

Thu Mar 25, 2021 5:21 pm

#1--the wide orange line.
Your AHI is awesome!
Your leak rate is well within acceptable boundaries.
Congratulations.

Thank you!! I really appreciate the feedback. I've been concerned with my leak rate but it's gotten better since I've been using the cpap pillow

jt1212 wrote: ↑

Thu Mar 25, 2021 12:43 pm

(she just says "give it time")

You figured out time doesn't heal leaks. Maybe, the doctor will also.

ChicagoGranny wrote: ↑

Thu Mar 25, 2021 5:39 pm

jt1212 wrote: ↑

Thu Mar 25, 2021 12:43 pm

(she just says "give it time")

You figured out time doesn't heal leaks. Maybe, the doctor will also.

She originally said she just likes to go with the newest model. After about 50 nights of use ,I've never had a night under 25 L/min on my ResMed app. That can't be normal.

She's probably avoiding the issue till it's time for my insurance to replace the mask.

Your baseline leak even at the very beginning of the night is higher than normal.
Makes us wonder why because we assume at the beginning of the night and while awake you shouldn't be seeing much above a baseline of 0.0 L/min leak line.

If it were me I would first verify I have the correct mask type selected on the machine and then I would start looking for a leak somewhere in the circuit. Loose fitting, hole in hose or something.

Now I do have one question....do you have facial hair of some sort?

See my report from the other night...when I start out the night I am pretty much at 0.0 or slightly above. That's more normal.

Pugsy wrote: ↑

Thu Mar 25, 2021 6:56 pm

Your baseline leak even at the very beginning of the night is higher than normal.
Makes us wonder why because we assume at the beginning of the night and while awake you shouldn't be seeing much above a baseline of 0.0 L/min leak line.

If it were me I would first verify I have the correct mask type selected on the machine and then I would start looking for a leak somewhere in the circuit. Loose fitting, hole in hose or something.

Now I do have one question....do you have facial hair of some sort?

See my report from the other night...when I start out the night I am pretty much at 0.0 or slightly above. That's more normal.

MondayMar22.JPG

First off, yep I do have a beard. It's very short, but still....it's there.

The sizing and fit is supposedly correct. The sleep technician fitted me during my first appointment. I even brought the mask in a few weeks later and she checked it again.

She also stated that the leaks I have are from the mask and not from the equipment (apparently she can see that on her side) who knows...im just trusting her.

The mask feels "leak proof" as I go too bed. I can't feel any air coming out , expect for the front exhale ports. I did check all the hose a while back and it looked fine. I just swapped the original hose with heated hose too...so the hose has no leaks. I've tried adjusting straps on the mask dozens of times. Finally I've been keeping it as is. The last week or 2 has been the best at 25-30 L/min. I know that's not great....but it's better than the 50-60 I use to get.

I never noticed before, bit i see what you mean though. I start off each night with a leak.... That sucks!

It's your facial hair allowing the baseline leak.
As long as it stays about where it is and you are sleeping fine and feeling decent then I wouldn't worry about it.

The 24 L/min line that ResMed uses is a bit "conservative" IMHO. From my own experience with larger leaks the machine actually does a decent job recording, responding and dealing with leaks up to around 35 L/min. After that it gets a bit iffy and the higher it goes the iffier it gets.

My first rule about leaks....they can't be waking me up. If they wake me up then they need to be fixed no matter how big or little they are.
After that I look at how far into large leak territory I went and how long did I stay there.
10 minutes at 50 L/min...I sort of shrug my shoulders if I slept through it....now half the night at 50 L/min then I would know I need to do something.

Overall I think your reports look quite decent now that we know what is causing the higher baseline leak.

Pugsy wrote: ↑

Thu Mar 25, 2021 8:34 pm

It's your facial hair allowing the baseline leak.
As long as it stays about where it is and you are sleeping fine and feeling decent then I wouldn't worry about it.

The 24 L/min line that ResMed uses is a bit "conservative" IMHO. From my own experience with larger leaks the machine actually does a decent job recording, responding and dealing with leaks up to around 35 L/min. After that it gets a bit iffy and the higher it goes the iffier it gets.

My first rule about leaks....they can't be waking me up. If they wake me up then they need to be fixed no matter how big or little they are.
After that I look at how far into large leak territory I went and how long did I stay there.
10 minutes at 50 L/min...I sort of shrug my shoulders if I slept through it....now half the night at 50 L/min then I would know I need to do something.

Overall I think your reports look quite decent now that we know what is causing the higher baseline leak.

Thank you!
Overall I feel like my health is improving and feeling more rested. I know it takes time but I'm slowly feeling better.

The leaks aren't waking me up, so that's a plus.

I was just concerned being a "newbie" if it was more to it and should be looked into. Beings that I have facial hair, will a different mask make a difference anyway? I don't think I can do a nasal mask.....too much mouth breathing for me. Chin strap didn't work for me unfortunately.

jt1212 wrote: ↑

Fri Mar 26, 2021 1:08 am

I was just concerned being a "newbie" if it was more to it and should be looked into. Beings that I have facial hair, will a different mask make a difference anyway? I don't think I can do a nasal mask.....too much mouth breathing for me. Chin strap didn't work for me unfortunately.

Not really much more to look at unless you want to drive yourself crazy looking for every minor little detail in something that might cause something.
You know what that KISS principle is????

The simpler that you can keep things ...less work for you and less stress on you and that's always a good thing IMHO.

Think about your goals....getting good sleep and controlling the apneas. It's not getting a good math score or having pretty perfect leak lines unless your sleep isn't good and you aren't feeling the good numbers.

It does sound like you have to make peace with a full face mask...and chin straps aren't meant to be vise grip tight to prevent the jaw from falling down and opening the mouth. They work well for the people who only need a gentle reminder to keep the mouth shut but some people simply have to open the mouth to breathe for various reasons and it is what it is.
I tell people if they can't breathe during the day without using their mouth because of nasal congestion issues....probably going to need a full face mask. Now if they only mouth breathe at night and don't during the day....nasal masks are an option for those that want to try them.

So...do you have a lot of nasal congestion going on that forces you to mouth breathe and you can't ever get your nose cleared up enough to not have to mouth breathe? If the answer is yes...keep peace with the full face mask...and since you have facial hair and I assume want to keep it...you are going to have ugly leak lines but not so ugly that your therapy suffers. We accept it and shrug our shoulders and move on.

Now if your answer is no...and you don't have to mouth breathe during the day...we could have a different discussion about using some sort of nasal mask and maybe something else besides a chin strap to help keep the mouth shut. Up to you if you want to go there.
FWIW...I thought I was a mouth breather and needed a full face mask too.....but I absolutely hated full face masks that were available 12 years ago when my cpap journey started. I found out I was mouth breathing at night only and out of habit from gasping for air so much because of untreated apnea events happening.
With time I was able to break the mouth opening so much habit and successfully use a nasal pillow mask. I made it work because I had no full face mask alternative at the time that I could really even sleep with.
Choices today are much better than the FFM choices available 12 years ago.

jt1212 wrote: ↑

Fri Mar 26, 2021 1:08 am

too much mouth breathing

I'm a believer that every beginning CPAPer should have a consultation with a trusted ENT to discuss obstructive sleep apnea. The ENT should do an examination and evaluation of the entire airway. An in-office nasal endoscopy should be performed on this visit.

The very least that could come from this visit is an understanding of why you have sleep apnea and maybe why you mouth breath at night.

As others have said, you're doing great! And I hear Pugsy when she says to keep it simple.

But.... One change you might try to to introduce some EPR to see how you like it. EPR gives you a lower pressure than your IPAP when you exhale -- or you could also think of it as a higher pressure than your EPAP when you inhale. A lot of people find that it feels more comfortable, which is one reason I suggest it.

Also, the little pressure boost with inhalation can reduce flow limitations. Your FLs are not horrible, and it is quite possible they don't disturb your sleep at all. On the other hand, they may be keeping you from sleeping as soundly as possible.

Generally speaking, when you introduce EPR, you should also raise your minimum pressure to make sure your IPAP minimum stays the same. EPR comes in 1, 2, or 3, and so, for example, if you introduced EPR of 2, you'd want your minimum pressure to be 6 rather than 4. I'd suggest you give that a try for maybe a week; if you like it and your numbers stay good, then you could go to EPR of 3 and a minimum of 7 and see how that goes.

A pressure of 4 leaves many people feeling a little air-starved. If that's not an issue for you, great, but again, you might get a little more comfort if you raised your minimum to 6 or 7, quite apart from the EPR question.

Finally, I bet you could turn off the ramp feature and never miss it. This would eliminate any possibility of disruption from the shift from ramp to non-ramp.

So much great info, thank you so much everyone!!

Miss Emerita wrote: ↑

Fri Mar 26, 2021 11:10 am

As others have said, you're doing great! And I hear Pugsy when she says to keep it simple.

But.... One change you might try to to introduce some EPR to see how you like it. EPR gives you a lower pressure than your IPAP when you exhale -- or you could also think of it as a higher pressure than your EPAP when you inhale. A lot of people find that it feels more comfortable, which is one reason I suggest it.

Also, the little pressure boost with inhalation can reduce flow limitations. Your FLs are not horrible, and it is quite possible they don't disturb your sleep at all. On the other hand, they may be keeping you from sleeping as soundly as possible.

Generally speaking, when you introduce EPR, you should also raise your minimum pressure to make sure your IPAP minimum stays the same. EPR comes in 1, 2, or 3, and so, for example, if you introduced EPR of 2, you'd want your minimum pressure to be 6 rather than 4. I'd suggest you give that a try for maybe a week; if you like it and your numbers stay good, then you could go to EPR of 3 and a minimum of 7 and see how that goes.

A pressure of 4 leaves many people feeling a little air-starved. If that's not an issue for you, great, but again, you might get a little more comfort if you raised your minimum to 6 or 7, quite apart from the EPR question.

Finally, I bet you could turn off the ramp feature and never miss it. This would eliminate any possibility of disruption from the shift from ramp to non-ramp.

I'll definitely look into this, I never really knew what EPR was. Just saw the feature but was afraid to mess with it lol.
I can definitely do without ramp....makes no difference to me. I call asleep in minutes. I'll take that off and try tonight!

ChicagoGranny wrote: ↑

Fri Mar 26, 2021 7:35 am

jt1212 wrote: ↑

Fri Mar 26, 2021 1:08 am

too much mouth breathing

I'm a believer that every beginning CPAPer should have a consultation with a trusted ENT to discuss obstructive sleep apnea. The ENT should do an examination and evaluation of the entire airway. An in-office nasal endoscopy should be performed on this visit.

The very least that could come from this visit is an understanding of why you have sleep apnea and maybe why you mouth breath at night.

I did have most of this, but I agree that they could have been more thorough with their evaluation and explainations.