Using CPAP for years, always tired (oscar analysis?)

Hi all. I've been using a Dreamstation for a few years and my AHI tends to be all over the place, ranging anywhere from 3 to 9. My sleep center docs are useless, they had me on 4- 20 pressure for over a year. It wasn't until I started researching doing my own settings that I found out that 4 was way too low. I found OSCAR and have been playing with my settings for over a year, trying various pressure combinations with mixed results and nothing consistent. The few times I've ever gotten an AHI in the 3 range, I'm still tired. Anyway, here's my result from last night. It's the first time I've ever tried CFlex. I usually have either Aflex or off.
Dreamstation (recall replaced), humidifier, airfit p10 nasal pillow M

https://imgur.com/a/anIrtdZ

Can you see that the max setting of 14 is keeping the min. from going higher as it apparently wants to do? Why not have the max at e.g. 20 as most do, or 18 and see what the min. ends up doing?

I usually do have it set higher than that, I just lowered it the other day to see if narrowing it would make any difference. I'll crank it back up to 20.

Welcome! A few things strike me:

You are spending a fair amount of your time in large-leak territory. What kind of mask do you use? Are these leaks happening pretty often for you, or was this night unusual?

DS machines are slow to raise pressure in response to events, so you will probably benefit from raising your minimum as well as your maximum. Actually, raising the minimum might head off some of your events, which might mean fewer forays into higher pressures. I would suggest raising your minimum to 13.5 for now; you may have some additional increases in your future.

You spent only 7 hours using the machine. Unless you slept without your mask for a while, you may simply not be getting enough sleep. Many people really need 8 hours of sleep; that would mean using your machine for more than 8 hours to take into account the time it takes to fall asleep. Can you schedule some more sleep-time for yourself?

Take any meds? If so, what (name, dosage, etc)?

Have any other physical or mental health issues going on?

Hi Miss Emerita, thanks for your help.

1. My large leaks are all over the place nightly, ranging anywhere from 0% to 4, 8, 24, 12 percents just looking at the past week or so. I probably just need to tighten my head strap. I forgot to mention in my OP that I also tape my mouth. If I don't, I get dry mouth and crushing headaches in the morning.
2. I will set my Min to 13.5 and max to 20 tonight.
3. If only I could get 8 hrs of sleep. I usually get around 6.5 and count myself lucky if I get 7+
If I go to bed extra early, I wake up earlier. My bedtime is normally around 10 and I just wake up with no alarm around 5 or earlier.

Hi pugsy, thanks for replying. I don't take any meds. I do have lower back pain but my apnea problems far predate that. It's not bad enough to keep me awake and I rarely take pain meds for it other than ibuprofen here and there. No mental health problems that I'm aware of.

Mask fitting:
Do it when lying down.
Search company sites and YouTube for videos about fitting the masks and troubleshooting leaks.

Consider a different pillow for your head.

Thanks for the tip, ozij. Looks like I need to fit my mask better.

Here's my OSCAR readout from last night.

https://imgur.com/WW2VWZH

Major leakage. I tried tightening the strap that goes behind my head but don't have a tightener clasp for the top one. I think I have an extra though so I'll try that tonight.

Was the minimum of 13.5 reasonably comfortable for you? I'd suggest sticking with it for a few more nights. If you still see these kinds of results, you may well need to bump it up some more.

There's a hint of clustering in your OAs and Hs. That could indicate a positional issue, especially if you're tucking your chin down toward your chest. That can slightly restrict your airway, making it easier for obstructive-type events to occur.

Common culprits include using pillows that are too high or back-sleeping. Either of those a potential issue for you?

Miss Emerita wrote: ↑

Mon May 29, 2023 11:25 am

There's a hint of clustering in your OAs and Hs. That could indicate a positional issue, especially if you're tucking your chin down toward your chest. That can slightly restrict your airway, making it easier for obstructive-type events to occur.

Common culprits include using pillows that are too high or back-sleeping. Either of those a potential issue for you?

At the risk of being called (perhaps justifiably) a broken record, I'll again promote the value of a cervical collar for back sleeping. I average about 0.4 AHI, sleeping mainly on my back and wearing a cervical collar. Last night, I simply forgot to put the collar on, and my AHI for the night was 2.2.

earlvillestu wrote: ↑

Mon May 29, 2023 11:49 am

Miss Emerita wrote: ↑

Mon May 29, 2023 11:25 am

There's a hint of clustering in your OAs and Hs. That could indicate a positional issue, especially if you're tucking your chin down toward your chest. That can slightly restrict your airway, making it easier for obstructive-type events to occur.

Common culprits include using pillows that are too high or back-sleeping. Either of those a potential issue for you?

At the risk of being called (perhaps justifiably) a broken record, I'll again promote the value of a cervical collar for back sleeping. I average about 0.4 AHI, sleeping mainly on my back and wearing a cervical collar. Last night, I simply forgot to put the collar on, and my AHI for the night was 2.2.

It can’t be said too often! But if the OP can get good results with a new pillow or staying away from supine sleeping, that might be easier.

Miss Emerita wrote: ↑

Mon May 29, 2023 11:25 am

Was the minimum of 13.5 reasonably comfortable for you? I'd suggest sticking with it for a few more nights. If you still see these kinds of results, you may well need to bump it up some more.

There's a hint of clustering in your OAs and Hs. That could indicate a positional issue, especially if you're tucking your chin down toward your chest. That can slightly restrict your airway, making it easier for obstructive-type events to occur.

Common culprits include using pillows that are too high or back-sleeping. Either of those a potential issue for you?

I didn't have any issues with 13.5, I'll leave it there a few nights as suggested. My pillow is actually paper thin and I'm a side sleeper so I don't think either of those is a problem. One thing I've noticed is that if I set my Aflex on, my CAs go way up and my OAs go down. If I turn Flex off, it reverses and my OAs are around 20 a night and my Clear Airways go down to around 7 or fewer. I've not been able to figure out how to get them both down.

earlvillestu wrote: ↑

Mon May 29, 2023 11:49 am

Miss Emerita wrote: ↑

Mon May 29, 2023 11:25 am

There's a hint of clustering in your OAs and Hs. That could indicate a positional issue, especially if you're tucking your chin down toward your chest. That can slightly restrict your airway, making it easier for obstructive-type events to occur.

Common culprits include using pillows that are too high or back-sleeping. Either of those a potential issue for you?

At the risk of being called (perhaps justifiably) a broken record, I'll again promote the value of a cervical collar for back sleeping. I average about 0.4 AHI, sleeping mainly on my back and wearing a cervical collar. Last night, I simply forgot to put the collar on, and my AHI for the night was 2.2.

wow, great numbers. I'm not a back sleeper though. As far as I know anyway.

Tightened my straps but still had some leakage. It varies every night. Last week I had a LL of 4% but AHI of 5.8 so who knows.

Latest readout:
https://imgur.com/a/VGworWi

Have you tried mask 'liners' from Padacheek.com - they're great at addressing little leaks from the mask.