Frequent wakeups with mild OSA -- help me interpret OSCAR?

Hi all,

I have an untreated AHI of 10.0, diagnosis of mild OSA, no clear indications of UARS (as far as I know), no major health issues, and have been on CPAP for a bit over 2 months now. I am a healthy young male in 20s at a healthy weight and physically active. I use the ClimateLine tubing with the airsense 11.

Despite my machine's reported AHI being around or under 1.0 most nights, I have generally been sleeping pretty poorly. In particular, I am waking up several times per night, and experiencing eye twitches, dry eye, and fatigue throughout the day.

Here are 2 screenshots. The first is two nights ago, a bad night of sleep resulting in the above symptoms, with a DreamWear nasal pillow mask. I woke up five times during sleep: 12:12am, 1:29am, 3:13am, 4:48am, and 5:38am (per apple watch).

The second screenshot is last night, which so far feels like it was a pretty decent night of sleep. I did wake up twice (11:51pm, 2:37am, and somewhere around 5:15-5:45am), but so far today I am not feeling the eye twitch or severe dry eye. This night was with an Airfit n30i mask.

I have a third mask that I don't use currently which is the Dreamwear nasal cushion. Generally I have been using the dreamwear nasal pillow, but it seems like I get too many leaks with it as a side sleeper. That's why last night I tried the n30i instead which seems to leak less.

My graphs don't seem to look that bad but I am concerned about the wakeups. Could anyone help me interpret the data? In particular I am wondering if some of the leaks and apnea events are caused by my mouth opening. I am willing to try mouth taping if so. Or are the arousals unrelated to apneas perhaps? Should I change up my machine settings or do anything else differently?

If it's relevant, I also find that I often wake up with nasal congestion and inflammation (my nose looks swollen and huge in the morning lol). I had a functional septorhinoplasty this past January to resolve a deviated septum and enlarged turbinates, so my nose breathing is very good generally, though often dry. Sometimes my mouth is dry when I wake up too.

Any help would mean the world.

mcrick wrote: ↑

Fri Nov 24, 2023 9:27 am

Hi all,

mcrick wrote: ↑

Fri Nov 24, 2023 9:27 am

If it's relevant, I also find that I often wake up with nasal congestion and inflammation (my nose looks swollen and huge in the morning lol). I had a functional septorhinoplasty this past January to resolve a deviated septum and enlarged turbinates, so my nose breathing is very good generally, though often dry. Sometimes my mouth is dry when I wake up too.

Any help would mean the world.

while we wait for the smart folk to show up, i just wanted to ask if you've tried adding humidity to the mix? it could be possible dry mouth is waking you up.

good luck!

Welcome to the forum, mcrick.

Look at your flow chart. See how the pressure goes up and down?
Look at your flow limitations chart.
You get batches of flow limitations, and they drive your pressure up.
APAP is programmed to raise pressure when flow limitations occur.
Unfortunately, it's doesn't keep the pressure high enough to prevent them from recurring.
Your pressure drops, flow limitations come back, the pressure rises, flow limitations go away, the pressure drops, flow limitations come back - repeat.

The solution it to raise your minimum pressure to the level at which the flow limitations won't come back when the pressure drops.
How high? Look at all your charts, use the vertical green cursor to see when your breathing stabilizes but your machine keeps lowering the pressure. Aim to have that pressure as your minimum.

My guess, based on what I can see on the charts, is that you will do better with a minimum of 8, but you have far better data than I do, so don't take my word for it.
You may have to get to the higher minimum in small steps - how big or small depends on how you feel when you try the higher minimum, people differ in their response to those changes. The machine lets you make changes in gentle 0.2 increments. If you feel you can handle higher increments, do so. 

Keep us posted.

Hi ozij,

Thanks for your comment! This is insightful and I tried a couple nights with the pressured increased to 8-12 and EPR enabled (per advice on another forum to help with the flow limits).
I've uploaded screenshots here.

From a glance it doesn't appear that the flow limitations are improved much overall. I feel maybe marginally better rested but it's hard to tell if that's the case for sure -- still have fatigue and eye twitches. My AHI seems to have increased slightly.

Would you have any further ideas or additional info/screenshots you want from my end? I appreciate your help!

zonker wrote: ↑

Fri Nov 24, 2023 12:49 pm

mcrick wrote: ↑

Fri Nov 24, 2023 9:27 am

Hi all,

mcrick wrote: ↑

Fri Nov 24, 2023 9:27 am

If it's relevant, I also find that I often wake up with nasal congestion and inflammation (my nose looks swollen and huge in the morning lol). I had a functional septorhinoplasty this past January to resolve a deviated septum and enlarged turbinates, so my nose breathing is very good generally, though often dry. Sometimes my mouth is dry when I wake up too.

Any help would mean the world.

while we wait for the smart folk to show up, i just wanted to ask if you've tried adding humidity to the mix? it could be possible dry mouth is waking you up.

good luck!

Hi zonker,

Thanks for the suggestion! I tried increasing humidity to 7 and tube temp to 84, but unfortunately I woke up at 2am that night with rainout(?) -- there was so much condensation in my tube that a puddle of water formed in it and the machine made a loud gurgling sound that awoke me. I had to get up and empty the tube and put the climate settings back to auto.

Should I try again but start at a lower humidity level like 5?

Are you experiencing any nasal congestion at night?

Rain out in the hose or mask...common issue especially with the cooler weather.

Several options...see posts number 2 and 3 here in this thread for explanation of options.
http://www.cpaptalk.com/viewtopic/t9403 ... -road.html

You have a little bit of room to increase the hose air temp but not much since the max is 86 degrees.
You can of course reduce the humidity level and it may or may not help much. I know people not using any added moisture at all and they still can get rain out when conditions are just right.

You shouldn't hesitate to try EPR of 3. After trying this for a few nights, if you're seeing an uptick in obstructive events, you could try raising your minimum by 1 to compensate for the extra EPR.

mcrick wrote: ↑

Mon Nov 27, 2023 3:06 pm

Should I try again but start at a lower humidity level like 5?

now, see, here's the problem. each of us react to humidity in different ways. hell, some don't use it at all. (but i don't trust them. )

so keep an eye on what folk like pugsy say, but do a bit of experimenting yourself. i wish i could tell you just the right combo of humidity and temp. but, tbh, i'm having a bit of trouble now, just as i do every year in winter and then again in spring. so i'm doing a bit of changes myself.

i don't see why you can't try 5. and you might want to write down the changes you make so you don't do like *I* do and keep setting the same thing again and again.

good luck and keep us posted.

mcrick wrote: ↑

Mon Nov 27, 2023 3:04 pm

Hi ozij,

Thanks for your comment! This is insightful and I tried a couple nights with the pressured increased to 8-12 and EPR enabled (per advice on another forum to help with the flow limits).
I've uploaded screenshots here.

From a glance it doesn't appear that the flow limitations are improved much overall. I feel maybe marginally better rested but it's hard to tell if that's the case for sure -- still have fatigue and eye twitches. My AHI seems to have increased slightly.

Would you have any further ideas or additional info/screenshots you want from my end? I appreciate your help!

It's never a good idea to change two things at once, because then you don't know which change was effective.
And personally, I would not mix the advice from two forums - it makes it difficult to those who help you to keep track of the reasoning behind the suggestion you apply.

On the present thread, there seem to be 3 different lines to thought:
Pugsy: Nasal issues
Miss Emerita: Changing the EPR
And me: Thinking your minimum pressure is too low to prevent the flow limitations.

EPR lowers the pressure whenever you exhale. Setting a higher EPR means your exhalation pressure is lower.

Your flow limitation look periodic, appearing consistently when the pressure drops.
I that's the case, I don't see how lowering you exhalation pressure by adding EPR will help with them.
Also, your machine reports you're spending half the night at pressures higher than 8.5
My thinking would be to raise the minimum - and try that for about a week.

I don't know that those FLs are nasal congestion but wanted to rule it out (or in) before someone goes chasing FLs with either EPR or more pressure and nothing helps the FLs.

That's all.

Hi all,

Reawakening this thread after trying various new settings with little success.
Primarily, I have tried various levels of EPR, which feels more comfortable, but doesn't seem to improve sleep quality.
I have tried some humidity adjustments but often experience rainout when I go manual. I've gone back to auto. I usually wake up a little stuffy but no severe nasal congestion, just a tad.

I have reduced my leaks and flow limitations by switching masks (now using a Large P30i) and mouth taping (mouth taping doesn't seem to do much, though), and I have raised my minimum pressure. If I go much higher than it is now, I feel like the air just balloons my nose without getting down into my airway passages very well. My OSCAR looks better now but I feel as bad if not worse than before. I am still waking up at least once or twice per night, usually between 3-5am (in the night below, I wake up around 5am).
Here is last night for example, with zoom-ins on my events. I also notice football shaped breathing past my second hypopnea which I remember reading somewhere is pretty bad for sleep quality. See screenshots.

If anyone can provide insight it would mean a lot to me. I've been feeling miserable despite doing all of the proper sleep hygiene habits. Maybe I need to go back to sleeping upright with my wedge pillow, which has helped in the past. It's pretty uncomfortable since I am a side sleeper.

Thanks very much and happy holidays.

So...some questions

1..Are you taking any medications of any kind? If so, what?
2..Any other physical or mental health issues going on?
3..What happens when you wake up a couple of times late in the night? Go right back to sleep or have trouble going back to sleep?
4..How are you feeling during the day?

Pugsy wrote: ↑

Sun Dec 24, 2023 9:00 am

So...some questions

1..Are you taking any medications of any kind? If so, what?
2..Any other physical or mental health issues going on?
3..What happens when you wake up a couple of times late in the night? Go right back to sleep or have trouble going back to sleep?
4..How are you feeling during the day?

Thanks for the quick reply!

1) No medications, just some supplements / vitamins. Morning: Vitamin D3 (~2500 IU), K2, NATURELO Whole Food Multivitamin for Men, magnesium glycinate. Afternoon/evening after meal: fish oil. Occasionally I will take OTC allergy medicine when my nose or eyes feel especially irritated but I don't officially have allergies, maybe some very minor seasonal ones at most.
2) No physical issues. Healthy 20s male. I have minor depression that's been ongoing for years and is worse in the winter. But this has been a constant through years during which my sleep has changed a lot, for better and worse. I am in therapy. I have long felt that the depression is largely caused by the poor sleep and not vice versa.
3) Usually fall back asleep in around 2-8 minutes. I don't find myself waking up in a state of discomfort (not too warm or stuffy or anything) so it's confusing.
4) During the day, I have some brain fog, memory lapse, eye twitches, very dry eyes (usually happens when I sleep poorly). Generally a small pool of energy that dwindles by the early evening.

Do you know about SleepHQ?
Software that lets you post the OSCAR report so that we can zoom in on the flow rate rather than your having to do a gazillion snippets???

Are you aware that it is normal to wake after a completion of a REM stage sleep cycle? Google "sleep stages" and take a look at the normal hypnograms and you will see what I mean. We all wake up after REM has ended but normally we aren't awake very long and we just roll over and go back to sleep with no memory of the arousals.

From a quick glance at the snippets you shared....looks like a lot of arousals going on and likely messing with your sleep cycles. I call it "crappy sleep" for lack of a better term. The cpap machine only fixes crappy sleep when the crappy sleep is caused by airway related issues. It doesn't do a damn thing for crappy sleep caused by any other reason no matter how much we want to blame the OSA or airway issues.

What kind of sleep study did you have that earned you the "mild sleep apnea" diagnosis?
Was it a home sleep study or a sleep study done in a lab setting with tech in attendance?
Why did you get the sleep study done?

Pugsy wrote: ↑

Sun Dec 24, 2023 9:33 am

Do you know about SleepHQ?
Software that lets you post the OSCAR report so that we can zoom in on the flow rate rather than your having to do a gazillion snippets???

Are you aware that it is normal to wake after a completion of a REM stage sleep cycle? Google "sleep stages" and take a look at the normal hypnograms and you will see what I mean. We all wake up after REM has ended but normally we aren't awake very long and we just roll over and go back to sleep with no memory of the arousals.

From a quick glance at the snippets you shared....looks like a lot of arousals going on and likely messing with your sleep cycles. I call it "crappy sleep" for lack of a better term. The cpap machine only fixes crappy sleep when the crappy sleep is caused by airway related issues. It doesn't do a damn thing for crappy sleep caused by any other reason no matter how much we want to blame the OSA or airway issues.

What kind of sleep study did you have that earned you the "mild sleep apnea" diagnosis?
Was it a home sleep study or a sleep study done in a lab setting with tech in attendance?
Why did you get the sleep study done?

I was not aware of SleepHQ, thanks for sharing! Here are links to recent nights with few leaks yet bad sleep:

• https://sleephq.com/public/26179b3f-408 ... d3b7fb078e
• https://sleephq.com/public/f4fe97e3-9e3 ... c52fd7d759
• https://sleephq.com/public/eef6c7aa-923 ... 379ea0157f
• https://sleephq.com/public/20588bd3-b22 ... 1702354237 (this is the night I posted screenshots of)
• https://sleephq.com/public/bc368363-6fe ... aeca7c7714
• Last night: https://sleephq.com/public/26179b3f-408 ... d3b7fb078e

I will look into the sleep stages and normal arousals. It's just weird to me that I used to sleep through these (or they were too short and I did not remember them) and now my arousals are longer and memorable. Last night for example, I woke up around 5:35am and just took off the CPAP out of frustration.

My sleep study was in lab with a tech. What I found strange was that they told me to sleep on my back even though I usually sleep on my side.

I got the sleep study done due to steadily worsening fatigue over the years (low energy, eye twitches, etc). There is some primary familial insomnia on my mom's side and some sleep apnea on my dad's side, so I went through an at home study (which actually did not show signs of sleep apnea), followed by a 2 week actigraph + sleep study and 5 naps testing, which then resulted in the mild OSA diagnosis.