New user seeking OSCAR feedback

Thank you for taking the time to read my post! I have included as much detail as I can, apologies for length.

I was recently diagnosed with Sleep Apnea via home study (AHI 30) and started an APAP trial. It's been going okay but there are still some teething problems and I am not confident that my therapy is as good as it could be. My trial ends this week and my issues haven't been fully resolved, so I have downloaded OSCAR in an attempt to get my head around what is going on ahead of my final appointment. I have purchased a Fisher&Paykel Sleepstyle machine.

My key concerns are:

• My AHI is inconsistent, with some nights as low as 3 and others as high as 7. My sleep therapist keeps saying this is normal as I adjust and my improvement is still significant but I remain concerned. I use an APAP with min 7 and max 20 (it was originally min 5 but I requested it be raised as I felt I was "sucking" for air before I fell asleep). We briefly tried a fixed flow rate of air (17, then 18 max pressure) and this greatly improved my AHI (averaging 2 and never above 4), but I was 'swallowing air' in my sleep leading to stomach pain so they switched me back to auto.

• I am having trouble choosing a mask. I was first put on a full face mask because I think I mouth-breathe, but I was experiencing some mask leak (I side-sleep) and the air swallowing on fixed pressure. More recently have been trialling a nose-only mask and it is more comfortable to wear. I do not generally wake up with a dry mouth and my AHI and leak rates are comparable to when I use the full face mask, but my partner reports I am snoring a little, and since my leak rates have always been on the higher side of "acceptable", I am concerned about whether my therapy is compromised.

• I am still very tired. I experienced some early energy improvements when I began using the APAP but these haven't compounded with time. Still, I understand that it can take a while to feel the benefits of the therapy and am committed to continuing with it.

I have included two screenshots of my OSCAR data, one from a night where I used the nose mask (Tue, 28 Jun) and one from a night with the full face mask (Sun, 3 Jul). If anyone is able to help me interpret this data and advise me on what to raise with my therapist, I would be very grateful. I fear that they see my CPAP data as "good enough" and are reluctant to fiddle with it further without me pushing for it.

No need to apologize for the length.

sleepylemon wrote: ↑

Sun Jul 03, 2022 9:22 pm

We briefly tried a fixed flow rate of air (17, then 18 max pressure) and this greatly improved my AHI (averaging 2 and never above 4), but I was 'swallowing air' in my sleep leading to stomach pain so they switched me back to auto

Based on your two examples, a fixed pressure of 17 (let alone 18) is not justified.
The data indicates you spend 95% of your time a a pressure of 13 or below on the 28th or 15 or below on July 3rd.

You can also see how because your minimum pressure is too low, you're getting events that disrupt your sleep, and the pressure is shooting up. A quiet period at the minimum, and then a lot of breathing disruptions driving the pressure higher; some time spent at the high pressure, and a dive back to the minimum.
If you put your minimum at a level that will keep the majority of those events from happening, you'll probably sleep better and feel better.

How high should your minimum be?
Since it seems you were able to fall asleep even with 17 or 18, I suggest you put you minimum at 13 now, leave the max as it is, and keep that for a week or two. If 13 it not comfortable, try less.

sleepylemon wrote: ↑

Sun Jul 03, 2022 9:22 pm

my partner reports I am snoring a little, and since my leak rates have always been on the higher side of "acceptable", I am concerned about whether my therapy is compromised.

Snoring is a result of the minimal pressure being too low. You should not be snoring, regardless of mask type.

ozij wrote: ↑

Mon Jul 04, 2022 12:18 am

You can also see how because your minimum pressure is too low, you're getting events that disrupt your sleep, and the pressure is shooting up. A quiet period at the minimum, and then a lot of breathing disruptions driving the pressure higher; some time spent at the high pressure, and a dive back to the minimum.
If you put your minimum at a level that will keep the majority of those events from happening, you'll probably sleep better and feel better.

How high should your minimum be?
Since it seems you were able to fall asleep even with 17 or 18, I suggest you put you minimum at 13 now, leave the max as it is, and keep that for a week or two. If 13 it not comfortable, try less.

Thank you for your reply! This makes complete sense - I will try raising my minimum like you've recommended and see if it helps.

ozij wrote: ↑

Mon Jul 04, 2022 12:18 am

Snoring is a result of the minimal pressure being too low. You should not be snoring, regardless of mask type.

And this is really interesting to know: I had assumed that snoring was a reflection of the "jumps" in my mask leaps. I will have to get my partner to report back on my snoring levels with the new minimum pressure levels. Thank you again for your suggestions

I’m not sure senseawake is a useful
feature for many users. I have been using a airsense 10 and moved to a Fisher paykel with senseawake and with the same settings as the as10 my ahi’s have gone up from below 1 to over 2.5. Tonight i will try without the senseawake feature .