[CPAP] UARS/Mild OSA New To CPAP. Please Help!

[alwaystiredpleasehelp]

Hi everyone! I'm a long-time reader of this forum, and now I'm asking for help.

In 2019, I underwent a Watchpat sleep study, which showed an AHI of 3.3 and an RDI of 14.3.

In 2022, I underwent an in-lab poly sonogram study which showed an AHI of less than one and an RDI of 9/hr.

Most nights, I wake up multiple times a night, and I'm incredibly exhausted and dizzy the next day.

I also suffer from severe, non-allergic nasal congestion daily due to turbinate issues and narrow nasal passages.

I've received a mild OSA/UARS diagnosis based on the above. 

I have used the Resmed Airsense 11 for two months. I've had 5-7 nights where I woke up feeling great the next day. Unfortunately, I feel the same the remaining nights, meaning I'm exhausted, dizzy, and sleepy during the day.

Masks: I have tried nose pillows, which worsened my nasal congestion. I have tried the N30i small, medium, and small wide. My nasal breathing feels fine for the first 4-5 hours before becoming increasingly difficult, almost as if I'm congested. If I lift the mask off my face for a second and put it back on, I get five or so seconds of breathing normally before I feel like I cannot breathe again. 

I also use Intake Nasal Strips, which are similar to Breathe Rite strips. However, the adhesive strip starts coming loose in the middle of the night, and it's possible what feels like nasal congestion is just my nose beginning to collapse inwards. I'm not sure.

As I feel like I can breathe a lot better immediately after taking my mask off, I'm doubting nasal congestion and instead thinking that my mask is somehow pinching my nose.

Regardless, I usually take my mask off after seven or so hours because the sensation of not being able to breathe out of my nose becomes unbearable.

I also tape my mouth.

OSCAR: For the first time, I pulled data from my CPAP and loaded it into OSCAR. The results are attached to this post.

Questions:

1. Does anyone have any suggestions regarding my nasal breathing difficulty?
   
2. My EPR is set to 3. Does anyone know whether this is the correct EPR setting for someone with UARS/mild OSA?
   
3. Based on my OSCAR data, does anything stick out? It looks normal to me.
   
4. Any other suggestions for me based on what I wrote/my OSCAR data?
   

I will keep adding my OSCAR data to this thread for the next few nights.

Thank you so much in advance! You all are amazing!

   

[Gideon]

Welcome to the forum.

Your numbers are great, four symptoms not as good.

On your settings you should never have your min less than 7 as that is the min that fully enables EPR.

You are very sensitive to flow limits, see how your pressure increases with the hits on your flow limits chart. EPR treats flow limits so we want that fully enabled.

Because of your stated difficulty with breathing I'd like you to set your min to 9. I think you will find that much more comfortable.

[alwaystiredpleasehelp]

Hello,

First off, I really appreciate the prompt and detailed response!

Attached to this post is a screenshot of last night's data.

I have a couple of questions for you.

1) Are my flow limitations out of the range of normal? I would suspect that most people have at least one per night.
2) If my flow limitations ARE out of the range of normal, are they high enough that they could cause my daytime fatigue?
3) Am I correct in understanding that flow limitations are the defining characteristic of UARS?
4) Are flow limitations different than RERAs?
5) Do flow limitations cause awakenings?
6) Could flow limitations be caused by my nasal breathing difficulty? I've read that nasal breathing difficulty/congestion alone can cause UARS.
7) If my flow limits ARE out of the range of normal, and EPR resolves flow limits, and EPR is similar to a Bilevel, should I consider switching from my APAP to a Bilevel?


To clarify my previous post, I have no breathing difficulty for the 4 hours or so a night. The problem starts when my nasal strip adhesive (similar to Breathe Right) starts coming off my nose. This makes me think that my nasal breathing difficulty may be do to the collapse of my nasal wall and not congestion/APAP setting issues. Thoughts?

Again, I really appreciate any support you are able to provide!

   

[alwaystiredpleasehelp]

Hello,

Over the past week, I've increased to 7, then 8, and last night nine. 

I feel better than I did when the pressure was at 6, but I still feel tired and brain foggy.

My OSCAR chart (attached below) still shows flow limitations. Any other recommendations? Are some flow limitations normal?

Thanks again for your help!!!

   

[Sleeprider]

Trying to eliminate all flow limitations can be counter-productive. We consider them fully treated when the 95% flow limit is 0.03 or less, and acceptable under 0.1. You may have moved into the realm of diminishing returns by pursuing zero. Set your pressure back to where you felt most comfortable and hold at those settings for a while. Your sense of well-being will take time to catch up.

[alwaystiredpleasehelp]

I appreciate the prompt reply!

Three follow-up questions.

1) It sounds like you're saying that my flow restrictions are okay?

2) I've attached a closeup of my flow rate chart. Per what I've read, the waves should be sinusoidal, which mine are not. Do my breathing waves look normal?

3) Are you saying I should go back down to my prescription setting of 6? I feel quite a bit better since I increased to 8, though its only been a couple of nights.

Thanks again!

   

[Sleeprider]

Your flow limitations are okay, and practically absent based on the posted zoomed flow rate. What I said was return to the pressure at which you felt most comfortable. You have moved from 6 to 9 in a fairly short time, and suggested that 9 was not as comfortable, but better than 6. To me, that means you need to back-off to 8. Remember the use of EPR takes 3 cm off that pressure setting during exhale, so 9/6 is much closer to your prescription for OSA than 6/4 (inhale/exhale). I suspect you will eventually tolerate and like higher pressure, but you are moving a bit too quickly at this point.

[alwaystiredpleasehelp]

Understood! Thanks for the prompt response! I'll give it another week or so and post an update if I'm still not feeling better. Thx again!

[alwaystiredpleasehelp]

Hello,

I've decided to post sooner than a week as the past few nights I've woken up a few times, and I'm totally exhausted again during the day; today is terrible.

Last night, I hit my machine's on/off button when I realized I was awake. The three awakenings referenced on my OSCAR chart are only full awakenings. I know I woke up partially a few more times.

Based on OSCAR, the three awakenings occurred right after the machine increased pressure and registered flow limitations. So this makes me think either a) the increased pressure is waking me up or b) the flow limitations are waking me up, or c)I just randomly keep waking up for no reason when the machine increases pressure.

In the past week, my nasal mask sometimes whistles, which has woken me up. I think it has something to do with the seal, but I cannot figure out how to fix it.

Last night's chart is attached below.

Any thoughts?

Thanks 
   

[alwaystiredpleasehelp]

Hello,

I was finally able to go up to 9 last night!

I also put in my oral MAD device, in addition to using the CPAP.

@Gideon or @Sleeprider, I'm hoping you can assist with a couple of questions.

1) From 11:10-12:10 OSCAR is not recording any data, except for a small blip. I did not have any power outages; any thoughts what happened? This has occurred a couple of times this week.
2) Symptoms: Nothing has changed. I'm still exhausted and I still have multiple awakenings. You'll notice at 12:45 AM and 4:20AM I turned off the CPAP to mark that I was fully awake. Any other CPAP adjustments I should make? Is it possible that flow limits are waking me up?

3) I also included a closeup of my breathing chart around 3 AM. The waves do not look sinusoidal, and many appear to have a "shelf" before reaching the peak. These waves are representative of what I see each night. Are these breathing waves normal?

Thanks again for everyone's assistance!