First night review using OSCAR

hi all,

New here but several months lurking....this may be a long post but trying to give proper background...

Diagnosed with severe OSA about ~15 years ago but never could get used to the machine (Remstar M ). Speed up to early 2020 finally built up will power to try CPAP again - OSA was re-confirmed and received an autoset 10. I again struggled using the machine (pressure) and failed compliance.

Late spring this year had some health issues so I re-focused on continuing CPAP therapy to help me feel better which brings me to today. After reading this forum and online, I know understand that settings play an important role in CPAP success. My sleep doctor's original RX was simply a 4-20 min max with nothing else (no ramp, no EPR, etc.). So I bought a new Autoset 10 with P30 mask and have had it n possession since 6/23 and have been working on proper settings to get the best sleep.

I just got oscar for the last 2 days (first day only used cpap for 2 hours AHI of 0) but since 6/23 I've been in "compliance" 64% of the time so definitely a drastic increase in usage with AHI never going above a 2. However I noticed some chest irritation when I use CPAP -- don't have it when I don't use it for a few days.... -- so i've been trying to find out what are the best settings to balance therapy effectiveness and comfort. That meant having ramp on auto, EPR on, narrowing the min-max range based on prior 95% max for last 2 months (9) and finally last few days turning off auto humidity. I'm in sunny humid florida with internal room humidity 55-60% already and read that too much humidity can cause chest/lung irritation so went 2 nights with no humidity but got sinus pressure. So last night the humidity was turned back on to 1 with temp of 77F and sinus pressure reduced.

So in short, looking for feedback on the chart from last night to see if there's anything else I should be adjusting or hold steady with hope that chest/lung irritation goes away (got full workup on heart/lung in spring and generally good results). This is just one days of data (with an afternoon nap ) I know its best to have more data but I'm anxious to get this right and want to do what's best to use my machine without the irritation. From what I see, there are some RERA events at the tail end and not sure if its because the max limitation setting, or me struggling with too much pressure? I woke up around 5:20 and kept mask/machine on for another 20 minutes trying to fall asleep to no avail.

I've attached screenshot of full night and snippet of when RERA events were occurring.

my equipment/specs: Autoset 10: Auto Mode Min 5.8, Max 9, ramp 4.8 autotime, EPR 2 full time, humidity 1, 77F hose, smart start. P30 mask medium/medium

Welcome! You’ve learned so much from your lurking; that shows impressive commitment to sticking with PAP this time around. You have a great machine and are doing extremely well by the numbers.

You are right to be focused on comfort, so limiting the maximum pressure, using EPR, and adjusting ramp and humidity to your preferences is just right. You want your PAP therapy to be your new friend, and you have no apnea issues to wrestle with.

Before you woke up around 5:20 you had a big burst of leaks, flow limitations, and snores. I’m going to guess you either rolled onto your back or tucked your chin down toward your chest. This might have led to your wake up—or not. Keep a lookout for a pattern.

The chest sensation is probably just a little muscle reaction to breathing against pressure. Conceivably it could be a little bit of costochondritis, which is an inflammation of the cartilage in the sternum. You could try a little icing and some over-the-counter anti-inflammatory pills to see whether that helps. It should resolve with time; if it doesn’t, talk with your doctor.

Feel free to post additional observations and charts. Be sure to say how you felt during the night and the next day. Oh, and stay in this thread so people can see the background.

You know how your muscles get sore when you go to the gym and do a new exercise routine???
That's essentially what happens to the chest wall muscles when they have to do extra work/exercise exhaling against the pressure. The longer you use the machine the more your chest wall muscles will work through the soreness. Eventually should fade away. If not gone in a couple of months with 6 to 8 hours a night use...talk to your doctor.
This is quite common.

Thanks for the warm welcome.

I have read many of posts from both of you while lurking - your information has been very helpful for people like me and finally got me to register and download OSCAR to take more control of using CPAP.

Miss Emerita wrote: ↑

Tue Aug 31, 2021 6:53 pm

Before you woke up around 5:20 you had a big burst of leaks, flow limitations, and snores. I’m going to guess you either rolled onto your back or tucked your chin down toward your chest. This might have led to your wake up—or not. Keep a lookout for a pattern.

Good point. I don't remember if I was on my back when I woke up, but will try to keep track. Maybe time for a journal on the bedside table - if that doesnt work then maybe a camera . I know I have really bad apnea if I sleep on my back so always try to sleep on my side and elevated for OSA and my acid reflux.

Miss Emerita wrote: ↑

Tue Aug 31, 2021 6:53 pm

The chest sensation is probably just a little muscle reaction to breathing against pressure. Conceivably it could be a little bit of costochondritis, which is an inflammation of the cartilage in the sternum. You could try a little icing and some over-the-counter anti-inflammatory pills to see whether that helps. It should resolve with time; if it doesn’t, talk with your doctor.
Feel free to post additional observations and charts. Be sure to say how you felt during the night and the next day. Oh, and stay in this thread so people can see the background.

Pugsy wrote: ↑

Tue Aug 31, 2021 7:37 pm

You know how your muscles get sore when you go to the gym and do a new exercise routine???
That's essentially what happens to the chest wall muscles when they have to do extra work/exercise exhaling against the pressure. The longer you use the machine the more your chest wall muscles will work through the soreness. Eventually should fade away. If not gone in a couple of months with 6 to 8 hours a night use...talk to your doctor.
This is quite common.

Ok. Yes I've read a little about the wall muscles soreness and I'm guess its something just to live with. I guess I got a little concerned that its been about 2 months now but I can be patient if that's in the realm of "normal". The most recent setting adjustment was going from max pressure of 10 to 9 (based on 95 max) on 8/26. Given my charts, I see I hit 9 pressure a few times, but since median is quite a bit lower and AHI is low, is there room to push max down more to 8.5 (or even 8.0) which may bring a little more ease on the muscles?

It’s your flow limitations that are driving the pressure up. I think it’d be fine to try lowering the maximum to see what happens, given how very low your AHI is. You could try 8.6 for a few nights to see how it goes. I’ll be curious.

I agree with Miss E in that given the AHI is so low it probably wouldn't hurt anything to lower the max a bit in an effort to reduce the chest wall discomfort. While usually it doesn't last past a couple of months I have heard of a few people where it took longer especially when they started cpap and took some time to work up to consistent 7 or so hours of use.

Sometimes just because the machine wants to go higher doesn't mean we have to let it. The flow limitations are most likely causing the pressure to max out....and probably you were on your back. It's very common.
Also REM stage sleep worsening OSA can also cause it. I have that REM worse thing myself.

As long as limiting the max doesn't allow a bunch of apnea events to happen and/or cause sleep disruptions then we can safely make so compromises and limit the max.
You could also try a little more EPR....and also make a special effort to stay off your back but that is easier said than done....and if you are like me and REM makes OSA worse you can't do anything about REM.

Pugsy wrote: ↑

Wed Sep 01, 2021 12:41 am

I agree with Miss E in that given the AHI is so low it probably wouldn't hurt anything to lower the max a bit in an effort to reduce the chest wall discomfort. While usually it doesn't last past a couple of months I have heard of a few people where it took longer especially when they started cpap and took some time to work up to consistent 7 or so hours of use.

Sometimes just because the machine wants to go higher doesn't mean we have to let it. The flow limitations are most likely causing the pressure to max out....and probably you were on your back. It's very common.
Also REM stage sleep worsening OSA can also cause it. I have that REM worse thing myself.

As long as limiting the max doesn't allow a bunch of apnea events to happen and/or cause sleep disruptions then we can safely make so compromises and limit the max.
You could also try a little more EPR....and also make a special effort to stay off your back but that is easier said than done....and if you are like me and REM makes OSA worse you can't do anything about REM.

Ok maybe I'll look to dial it down slightly more and also increase EPR to 3.

According to oscar my average usage is 05:39hrs since 6/23. I'm not sure if that includes non-usage nights (scoring a big fat 0 ) or only usage nights. I wouldn't be surprised if its only nights that machine is used as I dont sleep that much but correct me if I'm wrong. My sleeping habits are much better (getting to be earlier), but usually wake up by myself no alarm between 6-7am when using CPAP. Hopefully I start sleeping closer to 7-8 hrs/night on a regular basis.

No idea if my OSA is worse with REM sleep. I feel like I barely have any dreams last 5-10 years - though have had more with using CPAP last 2 months.

Last night:
- Slept about 6 hours, mask use 6:49 hrs.
- Feeling pretty good today. Refreshed and low chest discomfort relative to other days. Would say 2 out of 10 relative to other days.
- Woke up around 5-5:15am on my side, able to fall back asleep for another hour and woke up on side again. I sleep on both sides so definitely possible I was on my back for some time.
- AHI of 0.44 - 2 clear airways, 1 OSA.
----I'm assuming OSA event is worse. I've snipped that time frame. My pressure was relatively stable then there was a decent increase in pressure (not sure why?) and OSA quickly followed. Could the pressure increase have cause interruption to breathing and resulting OSA somehow? Am I overanalyzing 1 event?

day 3:

- Reduced max to 8.8 from 9, EPR increase from 2 to 3
- AHI 0.71; 2 Clear Airways, 1 OSA, 1 Hypopnea, 1 unclassified --- I took mask off to go to restroom and left machine on. Next time I will turn it off as I had to anyways returning because pressure was too high and uncomfortable.
- Woke up on my back ~4am (the unclassified event). I have pillows with different thicknesses and decided to use thickest on my head that I usually hug . Maybe thickest pillow was too much of a strain for neck on side along with raise bad and caused me to go on my back. Will stick to thinner pillow.
- Chest discomfort slightly higher than yesterday, 3.5/10. Took an ibprofren and it seems to help ease it somewhat.
- Median pressure dropped from 7.38 to 6.74. EPR median dropped from 5.38 to 4
- I was at max 8.8 for 11 minutes. So I think I can take this as not being a huge concern of too much restriction on my max setting?

While one night does not a trend make, I agree with you that lowering your maximum did not have untoward results. If you'd like to keep it a 8.8 for another few nights, that's fine. I think you could also safely go down to 8.6 tonight. Your choice.

In your previous post, the pressure increased in response to the obstructive apnea. The machine can't instantaneously head off an apnea as it starts to occur; instead, what it does is increase pressure to avoid additional OAs subsequently. Then when all is well for a while, the pressure goes back down.

Miss Emerita wrote: ↑

Thu Sep 02, 2021 12:32 pm

While one night does not a trend make, I agree with you that lowering your maximum did not have untoward results. If you'd like to keep it a 8.8 for another few nights, that's fine. I think you could also safely go down to 8.6 tonight. Your choice.

In your previous post, the pressure increased in response to the obstructive apnea. The machine can't instantaneously head off an apnea as it starts to occur; instead, what it does is increase pressure to avoid additional OAs subsequently. Then when all is well for a while, the pressure goes back down.

Ok thanks. Yeah taking baby steps in setting changes but will look to 8.6.

For 2 nights ago, looking at the flow charts it seemed like my breathing was normal based on flow rate, then pressure started increasing at 3:55:51 and then OA event started at 3:55:59. As there was increase, exhale became shallower and inhale increase in next 2 breaths before the OA.

Last Night:
- Reduction to Max 8.6 from 8.8
- AHI 0.44; 1 Hypo, 2 OA, 5 RERA
- Had left calf cramps in night/morning. I drink a lot of fluid, eat a banana a day, and don't drink alcohol. This used to happen more often to me, but this is first time in a long time, 1st or 2nd time this year.
- Chest discomfort low 2/10
- Woke up on my back
- 83 mins at 8.4-8.6 pressure

May look to hold steady on settings for a bit and continue to track unless there's any other suggestions. Questions/thoughts;
- Hopefully I continue to work my way down to ~8.0 max setting.
- Maybe look to tighten overall min-max range a bit. I understand auto helps body as sometimes you need more, sometimes less but also want to avoid too low of a setting that isn't enough to prevent events. For my Hypo event @ 4am, pressure was down to 5.96.

By the numbers, an excellent chart, and I'm glad the chest discomfort is subsiding. Your time at maximum pressure continues to result from flow limitations. I agree that you should stick with your current settings for now and see how things go. Later on, if you aren't feeling rested, we could take a look at the FLs, but for a lot of people they're inconsequential, so let's put them to the side for now.

ok thanks. Will stay the course for a few days while keeping an eye on AHI, flow limitations, and overall energy levels. Of course, I'll be checking OSCAR every morning

Hi folks,

Figured I'd give an update since last post. Quick summary:

9/3; 4h57m usage, AHI 1.01. Decent amount of flow limitations at max pressure settings for a 45minute period. Woke up at 5:30am and couldn't fall back asleep but had good energy throughout the day.
9/4; 6h26m usage, AHI 0.47. Nothing remarkable, good energy and low chest pain.
9/5; 6h14m usage, AHI 0.32. Nothing of note
9/6; 4h18m usage, AHI 0.23. Low usage due to bad stomach issues that woke me up around 3:30am. Stayed up for a while and eventually fell back asleep without mask on for another hour or so. Unsurprisingly, had lower energy levels and more discomfort during the day - likely from stomach but had a lot of air inside.
9/7; 6h52m usage, AHI 0.44. Back to normal, good energy levels, low chest pain. Attached this nights OSCAR image for reference.

- Have started doing some stretches on chest and on back as well for back ribcage to loosen up ribs after looking up more about costochondritis. Hopefully this helps.
- May look to increase min pressure a little to prevent events from happening as it seems when pressure is near my minimum, events follow.