OSCAR Data Review

Hi all, I hope everyone is doing well!

I am a 25-year-old male (6'6", ~210 lbs; ~198 cm, ~95 kg) with a family history of sleep apnea (mother and maternal aunt). I was diagnosed with sleep apnea through an in-lab sleep study conducted in April 2024. Since January 2025, I have been using a ResMed AirSense 11 APAP machine with a ResMed AirFit N30i nasal mask. (Before this, I used a rented machine but have no data from that period, as no SD card was provided.) My apnea primarily stems from having a small airway caused by a jaw that is positioned too far backward. This anatomical structure pushes my tongue back in my mouth, which partially blocks my already small airway, an issue that is not pronounced enough to be noticeable in my appearance but is clearly significant enough to cause apnea... lucky me! I have received mixed opinions from doctors regarding mandibular advancement surgery and would prefer to explore less invasive options before considering such a major procedure

Over this time, I’ve made minor adjustments to my settings with guidance from my somnologist. However, I have had several unsatisfactory experiences with this doctor, which has led me to feel less confident in their advice. They have generally recommended keeping my pressure range at 6.0 to 2.0 cmH2O because, as they say, that’s what they “tell all patients,” but from my research, this seems to be misguided advice. Please do correct me if I am wrong here. I have actively pushed for help in adjusting my pressure range but have seen little success. Additionally, I have spoken with many friends who have sleep apnea and have had similarly frustrating experiences with their sleep doctors. I am a mouth-breather and have tried mouth-tape and a chin-strap, which did not significantly affect my leak rate or AHI. I’m not sure why a nasal mask was prescribed given this, but I’m not disappointed... I would prefer to avoid a full-face mask if possible.

I exported and analyzed my data in Excel to gather the following information: 

As I said, I've been using my machine for a bit over a year (381 nights, Jan 2025–Jan 2026) with very consistent use: 381 total nights, essentially nightly compliance, averaging ~8–9 hours per night. Overall control is good but not perfect. Monthly AHI generally ranges from ~1.1–1.7, with an overall average around ~1.4–1.5. Obstructive apnea index is usually ~0.5–0.8, hypopneas ~0.1–0.3, and clear-airway events are consistently present at ~0.4–0.7 CAI. Flow limitation is very low throughout (95% FL typically ≤0.05).

Pressure behavior has been fairly stable despite multiple range adjustments. Most of the year was APAP with EPR full-time at 2 cmH₂O (briefly 3 early on), minimum pressure generally 6.0 cmH₂O (briefly 4.0 early, very briefly 7.0 once), and have experimented with max pressure varying between ~11–20 cmH₂O depending on the period. Median/average pressures sit around ~7 cmH₂O, with 95% pressures usually ~9–10.5 cmH₂O. The machine does not appear to spend much time near the max except during short excursions.

Leak control is decent overall. Average leak rates are low, with time above large-leak threshold usually under ~5% (occasionally higher but not persistently). CSR is 0% throughout. Despite good adherence, stable pressures, and minimal flow limitation, residual events remain split between obstructive and clear-airway rather than clearly trending one direction with pressure changes.

I’m looking for guidance on whether further optimization (minimum pressure, EPR level, or pressure range tightening) is likely to meaningfully improve my therapy. Any help would be greatly appreciated! 

Best,
Dan22

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The first page of my sleep study is attached below, but I could not fit all 7 pages for obvious reasons. If it would prove useful to anyone, I can share it using an encrypted (and open-source) file transfer service in a PM or via email. Thanks! 

Summary of all settings changes:

Jan 2–3, 2025: Min pressure started at 4.0 cmH2O, max at 20.0 cmH2O, with EPR at 3 cmH2O.
Jan 4–Jun 22, 2025: Min pressure increased to 6.0 cmH2O, max remained at 20.0 cmH2O
Jun 23–Jul 3, 2025: Min pressure kept at 6.0 cmH2O, max lowered to 11.0 cmH2O; EPR dropped to 2 cmH2O.
Jul 4–Aug 1, 2025: Max pressure gradually increased from 11.2 to 12.0 cmH2O.
Aug 2–Sep 16, 2025: Max pressure gradually increased from 12.6 to 13.0 cmH2O.
Sep 17–Nov 3, 2025: Max pressure increased further to 14.0 cmH2O.
Nov 4–Dec 20, 2025: Max pressure slightly increased to 14.2 cmH2O.
Dec 21–27, 2025: Min pressure raised to 7.0 cmH2O, max pressure increased back up to 20.0 cmH2O.
Dec 28, 2025–Jan 13, 2026: Min pressure set to 6.0 cmH2O, max pressure lowered to 13.6 cmH2O.
Jan 14, 2026: Max pressure increased to 15.0 cmH2O.
Jan 15–21, 2026: Max pressure increased again to 20.0 cmH2O.

What symptoms are you having that makes you want to or think that you need to further improve your therapy?
You wanting a lower AHI? Don't go chasing that goal....it's unrealistic and will drive you crazy.

Are you waking often during the night or sleep soundly for the most part?

Do you take any medications of any kind? If so, what?

Hi Pugsy,

Thank you for your prompt reply. As you mentioned, lowering my AHI below ~2 seems nearly impossible, so that is not my goal. I generally still wake up every morning feeling sluggish and groggy, and my fatigue generally continues throughout the rest of the day. I'm not sure if this is due to another condition or lifestyle choices, but I thought it might be related to my increased leak rate in the second half of the night, as seen in the OSCAR screenshots above. I currently take Wellbutrin XL (300 mg) for the purposes of lowering my anxiety. I generally sleep fairly soundly with occasional wakeups to use the bathroom or get a drink of water. Thanks!

Best,
Dan22

I think that your Wellbutrin is part of your problem with feeling sluggish, groggy and fatigued.
It's well known to mess with the sleep cycles and cause unwanted daytime symptoms.
Look up the side effects....dig deep....read multiple sources.

If the leaks are waking you up then they are also part of the problem but if you sleep through them then they really aren't all that large or prolonged so it's unlikely that they are much of an issue unless waking you up and disturbing sleep.

Anything that disturbs sleep is unwanted and it's the not so great sleep itself that is a potential culprit in those unwanted symptoms of yours.

I have been on cpap almost 15 years now and I can count on one hand the number of times I got lucky with AHI of 0.0.
Also...the machine sometimes records events and we aren't asleep. I wouldn't be surprised if we could zoom in on the flow rate that we would see that the bulk of your flagged events were awake or post arousal and those don't mean anything except you weren't sound asleep.

If you load your report in SleepHQ (free version does all we need) then we/I can zoom in and see how many of those flagged events you were really asleep or not.

Hi again,

I imported my data into sleepHQ, I believe that this link should direct you to the data from 01/18/26. Thanks!

https://sleephq.com/public/f4a603da-2da ... 5ed2d56dbd

I looked at all of your SleepHQ data and zoomed in on the flow rate or breathing.

All of the flagged OAs, CAs/centrals/hyponeas are either post arousal or you weren't asleep. You had maybe one flagged event that might have been the real deal but I have my doubts.
You did have a very large number of episodes of post arousal or awake breathing. Some with flagged events but a large number with no events.

Your sleep quality is horrible. Why??? That's the million dollar question but certainly enough breaks in sleep to trash sleep quality and be a factor in your unwanted daytime symptoms.

Your sleep apnea is very well treated but your actual sleep quality is in the toilet from something unrelated to sleep apnea.
I don't think you need to make any changes in any of the settings at this time.

You have a problem that is fairly common that we call "bad sleep" and the cpap machine only fixes sleep apnea issues....it can't fix bad sleep that isn't caused by sleep apnea.

I recognize it myself. My sleep quality is also "bad sleep" and I wake often but in my case I know what causes it....pain.
Not easy to fix though. My AHI usually ranges between 1 and 2 with 90 % being post arousal or awake flagged events.

BTW if the leaks didn't wake you then I wouldn't worry about them. The machine doesn't really start missing events until the leak is over 35 L/min and it's a prolonged big leak. Your biggest leaks don't last very long at all.

Hi there,

Thank you for these insights. It's a bit disheartening to hear there isn't necessarily an obvious reason for the significant fatigue I'm dealing with, as I was certainly hoping it could be resolved through settings or equipment changes. As someone with "bad sleep" quality yourself, what would you recommend for next steps? Thanks!

Best,
Dan22

You've got one obvious reason for the unwanted symptoms.....that Wellbutrin medication.
That would be my primary suspect.
Remember we may or may not remember awakenings or partial awakenings but that doesn't mean it didn't happen.

Dan22 wrote: ↑

Fri Jan 23, 2026 7:03 pm

As someone with "bad sleep" quality yourself, what would you recommend for next steps?

Talk to your doctor I guess. It's been over 15 years on cpap and I still try new stuff to help me get the pain reduced every chance I get.
I would have to say that I get marginal relief.

Even with prescription sleeping pills like Belsomra....it's nothing to write home about.

There's not a magic setting on my machine either. No magic button to push to fix my pain issues.

Unfortunately, I have severe anxiety, so it's somewhat a matter of having to bite the bullet to keep it under control. Of course, poor sleep does compound my anxiety issues, but I also feel as though I had very poor sleep prior to being on Wellbutrin. Perhaps it is just something I will have to live with...

I think I'll start by getting second opinions from somnologists, because I most certainly do not trust my current one. Thank you for your help, and I wish you good luck in finding some semblance of relief from your sleep issues. Thanks.

Best,
Dan22

Talk to your doctor. There are other medications for anxiety that might work out for you. No one should have to say "this is as good as it gets" until they have maybe tried multiple meds with no improvement.

Might also have a chat about Rx sleeping medications short term.

I don't think your meds are the total sole problem but it can certainly mess with a person's sleep quality. It's rare that we have just one problem that messes with our sleep. I have the pain issues but I also have stress levels that cause insomnia as well as the pain.
AND the pain is difficult to treat....I used to take a medication that helped reduce the pain but unfortunately it also was well known to cause insomnia. Talk about being damned if you do and damned if you don't.
Also pretty much all mood meds mess with sleep and/or come with so rather nasty daytime symptoms.

Are you aware that anxiety disorder can be the result of untreated sleep apnea? Think about it: every night that you were sleeping without cpap, you were getting partially (or fully) choked, and your brain was jumping info full emergency panic mode, waking you up to make you breathe better. Those wake up calls (actually arousal) are not necessarily conscious, but your brain and body remember them. Sleep time was danger time.

Once you get better sleep, you may eventually be less anxious as well.

Looking at your data, if it was mine, I'd start raising the minimal pressure. Take a looksat 03:30; 06:18 07:45 and onwards.
At all those points you can see how your breath flow diminishes, making the machine scramble to raise the pressure.
With a higher minimum you may not get these flow interruptions, and thus have a more restful sleep.

ozij wrote: ↑

Sat Jan 24, 2026 1:12 am

Are you aware that anxiety disorder can be the result of untreated sleep apnea? Think about it: every night that you were sleeping without cpap, you were getting partially (or fully) choked, and your brain was jumping info full emergency panic mode, waking you up to make you breathe better. Those wake up calls (actually arousal) are not necessarily conscious, but your brain and body remember them. Sleep time was danger time.

Hi Ozij, thank you for your response. I definitely agree that poor sleep quality worsens my anxiety disorder, but I was actually diagnosed with anxiety at a very young age—long before I was diagnosed with sleep apnea. Thankfully, I didn’t have OSA during my early years, though it took quite some time before I was tested, as I had no obvious reason to suspect it. Thanks!

Best,
Dan22