Need help interpreting my OSCAR data

Hi all,

I have started using PAP therapy for a few weeks and am looking to improve my AHI. My AHI isn't much better than what it is without my CPAP, and empirically I don't feel much better on days where I used CPAP and days where I do not. From the numbers, my sleep apnea is very mild (UARS); yet, my cognitive symptoms are very bad. Started when I moved into a new apartment that I was allergic to (I've moved out since then, though it didn't help), which enlarged my turbinates in my nostrils permanently.

Basics: Resmed Airsense S10 Autoset (APAP) with Dreamwear Full Face Mask.
Sleep study, AHI: 3.2 and RDI: 8.8 (mix of central and obstructive and hypopnea, lots of RERAs). Titration study (constant at 5 pressure), AHI: 0.2 and RDI: 0.7.

From recommendations in this forum and other forums, I started off with min:4 max: 7, EPR 2 (I know now that the EPR here makes no sense). This was before I received an SD card, but it yielded:
Day 1: AHI of 5.2 (3.1 Obstructive, 0.6 Central, 1.5 Hypopnea)
Day 2: AHI of 0.6 (0.5 Obstructive, 0.1 Central, 0 Hypopnea)
Day 3: AHI of 0.9 (0.3 Obstructive, 0 Central, 0.6 Hypopnea)
Day 4: AHI of 3.1 (1.3 Obstructive, 1 Central, 0.7 Hypopnea)
Day 5: AHI of 1.3 (0.6 Obstructive, 0.6 Central, 0 Hypopnea)
Day 6: AHI of 1.7 (0.3 Obstructive, 0.7 Central, 0.7 Hypopnea)
Day 7: AHI of 1.6 (0.3 Obstructive, 0.5 Central, 0.8 Hypopnea)
Day 8: AHI of 0.6 (0.1 Obstructive, 0.25 Central, 0.25 Hypopnea)

Then, after more recommendations, I went to min: 5 max: 8, EPR 3. From here on I have SD card data. This yielded:
Day 9: AHI of 0.4 (0.2 Obstructive, 0.2 Central, 0 Hypopnea). Link: https://imgur.com/a/ZVJX3F6

Then, I went to min:6 max: 8. This yielded:
Day 10: AHI of 0.8 (0.4 Obstructive, 0.2 Central, 0.2 Hypopnea)
Day 11: AHI of 6.3 (4.5 Obstructive, 0 Central, 1.8 Hypopnea) ---- WTF happened here?? That was worse than my sleep study without a CPAP! Link: https://imgur.com/a/phaQiMw. Note: This day I was in a different apartment that I used to live in for a year that I assume I was also allergic to since I never vacuumed the bedroom carpet in the past year (which was completely my fault). Is it likely that my sleep without a CPAP back when I used to live in this apartment used to be even worse than during my actual sleep study, because of potential allergens?
Day 12: AHI of 2.5 (2.5 Obstructive, 0 Central, 0 Hypopnea)
Day 13: AHI of 0.5 (0.5 Obstructive, 0 Central, 0 Hypopnea)
Day 14: AHI of 1.0 (0.3 Obstructive, 0.4 Central, 0.4 Hypopnea)
Day 15: AHI of 0.9 (0.2 Obstructive, 0.6 Central, 0.1 Hypopnea). Link: https://imgur.com/a/YjQ11G8
Day 16: AHI of 2.0 (0.7 Obstructive, 0.9 Central, 0.3 Hypopnea). Link: https://imgur.com/a/EaCSjKu

Last night I decided to go back to min:5 max:5, 0 EPR. Since that did well on my titration study, figured it was worth a shot. I also tightened my mask in an attempt to reduce leaks (didn't seem to work tho?):

Day 17: AHI of 1.0 (0.1 obstructive, 0.6 Central, 0.3 Hypopnea). Link: https://imgur.com/a/VVE1zM5. I found this really strange, since I had more centrals than obstructive. I thought that centrals were caused by EPR and/or higher pressure... this showed the opposite effect.

Notes:
1. These days are not consecutive - I'm roughly 50% compliant. I have definitely improved on this recently though and am continuously trying to improve this.
2. I don't get enough sleep at night - I range from 4 to 8 hours, most often getting like 5-6 hours on weekdays and 8+ on weekends. I'm trying to improve on this too.
3. Some of the lower AHI nights may be because I got less sleep on those days and thus had less REM on those days?
4. Overview page: https://imgur.com/a/BSj4d4X. Statistics page: https://imgur.com/a/jzWuv3w

I'm having a hard time putting these results together since it varies so much by the date. I've attached some recent screenshots (Day 9, 11, 15, 16, 17) and I think inspecting the specific graphs may help.

I'd love any advice from you experts )! I'm curious about how EPR, flow limitations, leaks, and anything else are leading to the results I've been getting, and how I can use intelligently use that data to optimize my parameters. Thank you so much

Please show us the whole page from Oscar - all that stuff on the left side is information we need to understand your settings and responses. To view performance over a period of time, also show us your overview page.

From what you have shown, your machine is constantly bumping up against the maximum pressure - increase it to 20 and see where the machine settles. The idea of fine tuning is to start with a broad range and gradually narrow it - you're doing it the other way round.

What medications are you taking (or took on the night of the sleep study)? You have impressive REM-onset delay.

@Rubicon I use Azelastine Antihistamine Nasal Spray, and Nasacort steroid spray (sorta like Flonase). No other medications.

Sorry I'm a beginner; how can you tell that there's a REM onset delay?

Respirator99 wrote: ↑

Sun Jul 10, 2022 2:03 am

Please show us the whole page from Oscar - all that stuff on the left side is information we need to understand your settings and responses. To view performance over a period of time, also show us your overview page.

From what you have shown, your machine is constantly bumping up against the maximum pressure - increase it to 20 and see where the machine settles. The idea of fine tuning is to start with a broad range and gradually narrow it - you're doing it the other way round.

Got it, I just edited the original post to now include side bar screenshots along with the graphs, and also the overview page in the notes section.

I'm hesitant to increase the pressure any more, since I seem to have some central apneas and am afraid that will get worse. On my most recent day (i.e day 17), I set the pressure max at 5, and had only one obstructive apnea across 8 hours, so I'm not sure how effective increasing the pressure is? Not sure though, since I am a beginner; let me know your thoughts .

Like to see the graphs horizontally on the right and the other stuff vertically on the left - in one shot. Look at other people's Imgurs and see what they do.

Julie wrote: ↑

Sun Jul 10, 2022 3:01 pm

Like to see the graphs horizontally on the right and the other stuff vertically on the left - in one shot. Look at other people's Imgurs and see what they do.

Got it, done!

You can see the pressure is at the upper limit - don't be scared of centrals unless you have LOTS throughout the night... a few early on and prior to waking are no big deal and you're shorting your therapy this way. Raise the pressure by 2-3 #s and see what happens.

newuser1002 wrote: ↑

Sun Jul 10, 2022 1:56 pm

how can you tell that there's a REM onset delay?

in your study graph:

https://imgur.com/a/V6go1dV