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Hey everyone!

I have been trying to optimize my therapy for a long time now and got it dialed in pretty well, but am still not quite 100% there yet.

Would love any advice!

• AHI: 0.0 - 1.0/h
• ODI (4%+): 0.5 - 5.0/h
• PC: 12 - 20/h

It appears that my remaining sleepiness is related to:

1. Mask off events: Taking the mask off 2/h to scratch an itch on my nose, in my nose or on my chin. I tried trimming my nose hair daily, washing my face, washing the mask w/ unscented handsoap and unscented Dr Bronner, using epilator on outside of my nose.
2. Oxygen drops: I started my therapy w/ a fairly low AHI (1.0 - 4.0) but still had a lot of oxygen drops (15/h). I got my 4%+ oxygen drops to be really low on most nights now (1/h), but there are still a bunch of 3% oxygen drops. (What helped: More pressure support, drop caffeine completely, fix mouth leaks w/ Full Face mask and changing the BiPAP triggger sensitivity to very high)
3. Pulse Change Events: My PC events were initially 15-20/h and they are now sometimes between 12-15/h after optimizing my therapy. That number still seems a bit high, may be related w/ the itchiness arousals in #1 (?)

Here's my last night, which is one of if not the best night I had yet according to OSCAR:

Welcome! I'd love to take a look at your chart, but there's so much in it I can't really read it on my laptop. Could you reformat and repost? Here are suggestions:

Close the calendar. (Click on the triangle next to today's date.)

Include these graphs only:

Events
Flow rate
Pressure
Leaks
Flow limitations
Snores.

Thanks!

Miss Emerita wrote: ↑

Mon Dec 26, 2022 11:34 am

Welcome! I'd love to take a look at your chart, but there's so much in it I can't really read it on my laptop.

If you click on the image, and say 'open in a new tab', then click on THAT and say 'open in a new tab', then you're looking at the image itself, and you can blow it up and read it ok, it's a lot of unnecessary trouble, but it works.

but, for the OP, as to 1), trim your nose hair so that the air blowing around doesn't cause itching.

2) & 3), I wouldn't worry about at this point.

And don't do the calendar and pie chart.

I don't see anything that really needs to be changed. As much as we would like it to happen, it is unrealistic to have perfect numbers across the board every night. Your oxygen level made a few small dips, but for very short periods of time. Respiration and heart rates often vary when we dream. They also vary quite a bit when we are awake.

Thanks, PR; it's a good day when I learn something new!

To the OP: like others, I don't see anything in your charts to suggest anything worrisome or anything that calls for further tweaking of your settings.

But reducing the number of your wake-ups may help you feel less sleepy during the day. In addition to dealing with nose-hair, you might try using an anti-itch cream or lotion on your skin. Cerve Itch Relief Moisturizing Cream might help to you.

Miss Emerita wrote: ↑

Mon Dec 26, 2022 7:07 pm

Cerve Itch Relief Moisturizing Cream might help to you.

Miss Em, did you mean CeraVe?

Thanks for all the input!

Lots of confirmation that my data is looking good, which is great. Obviously my oxygen and AHI numbers are really low, but does anyone have a sense of whether ~15 pulse changes per hour is normal or rather high? My hunch is this is still high and pointing to micro-arousals. Maybe not breathing related. My Sleep Doc tested my Vitamin D and it came back at 30mg/ml, which I believe is the lower end of the normal range.

Regarding anti-itch cream - I assume it touching the mask silicone will cause it to lose its friction and cause leaks. Given my itch is in areas where my nose touches the mask, I am not sure this will work, but I’ll probably give it a try on my old mask when I get a replacement.

I have also noticed that the tickle is in the areas where I sometimes get leaks as well, which is at the side of the base of my nose and on my chin. This makes me think that there is still air pushing that way and the vibration of the air and mask tickles me.

Jlfinkels wrote: ↑

Mon Dec 26, 2022 8:51 pm

Miss Emerita wrote: ↑

Mon Dec 26, 2022 7:07 pm

Cerve Itch Relief Moisturizing Cream might help to you.

Miss Em, did you mean CeraVe?

I sure did! Thanks for catching that.

Great data tonight again.

I washed my face w/ Dr. Bronner Unscented before bed and I had fewer mask off events, so maybe this actually is helping, will keep trying.

There was only one section w/ oxygen drops (1:15) and it seems like I had a few unmarked hypopneas during that time. I had some unmarked hypopneas around 3:25 as well (but oxygen didn't drop quite as much).

If I understand titration right I need to increase IPAP to fix hypopneas, but am hesitant b/c the data overall looks pretty good.

Full Night:


Hypopneas w/ Oxygen Drops at 1:15:


Hypopneas w/o Oxygen Drops at 3:25:

Why have you continued to include all that unnecessary info, and calendar, making it so hard for us to see your results?

A few hypopneas is no big deal, don't worry about them. If you had mostly hypops, I'd advise against back-sleeping, but don't think that's a problem here.

Julie wrote: ↑

Tue Dec 27, 2022 10:46 am

Why have you continued to include all that unnecessary info, and calendar, making it so hard for us to see your results?

because they have a high resolution screen.

Get over it.

Sometimes this helps with itching, worth a try:

Before you put your CPAP on, give your nose a really good scratch. You might rub it vigorously with something like a rough washcloth.

NOW put the CPAP on. The idea is to "attenuate" the sensory input of the air blowing on the nose. I don't know if it will work for itching that develops 2 hours in, but worth a try. It's free, and easy.

Let us know.

Thank you for the great advice!

Julie, please let me know which info you are unable to see that you'd like included on the screenshot, I'm not sure I fully understand what information is hidden. I believe the left sidebar is important to include since it has some relevant stats.

I have a bunch of very interesting new data points, would love your thoughts!

I went to high elevation (6250ft) for a few days and my oxygen was low throughout the day and night, my BiPAP didn't seem to help. It looks like my Minute Ventilation dropped significantly (6.0 --> 5.0) driven fully by a lower tidal volume.

Notes:

1. I used an AirFit F20 - usually I use an F30i. Leaks were really good (~zero), so I doubt it had any effect.
2. After seeing the low oxygen, I increased PS from 5.0 to 6.0 at midnight on Day 3 - no effect on respiration metrics.

Day 2 at high altitude:
Time below 90% SpO2: 1h32m (17% of sleep)



Afternoon Nap at high altitude:
Time below 90% SpO2: 3m (6% of sleep)



Day 3 at high altitude:
Time below 90%: 2h52m (32% of sleep)



Now what is almost even more interesting is last night (back at low altitude):

First day back at low altitude (sea-level):

1. [0:24 - 0:55] I was lying on my back. High heart rate variability started and stopped exactly as I turned onto/off my back. Is my pressure still too low to support back-sleeping?
2. [0:43 - 1:00] (zoomed below) SpO2 drops w/ mask on. I thought this was b/c of back-sleeping, but my SpO2 kept dropping for ~7 minutes after turning on my side. (??)
3. [4:14 - 5:00] (zoomed below) SpO2 drops w/ mask on lying on my side the entire time. (??)

Zoom of #2:


Zoom of #3:

Similar story today with a few sections of oxygen drops while wearing my mask. What do I need to adjust?