[CPAP] New to CPAP, low AHI, but waking up almost every hour. Need help please.

[placeau]

Hello,

I have recently started CPAP around a month ago. I use Resmed 10 autoset.
Have been fine-tuning my settings a lot to find something that works, but Im still waking up extremely tired and groggy most days.
One thing I've noticed is Im actually waking up much more often than I was before using CPAP. 
It varies, but most nights I fully wake up every 1-2 hours.
I am male in my late 20's with a BMI of 24.4 & no other health issues.

My AHI is low & it continues getting lower, but my wellbeing & wakefulness is not improving.

Recently a person on reddit has suggested I try CPAP instead of APAP, with EPR 3.
They recommended I try this because they think I had 'expiratory flow limits'.
First night felt 13cm was too high & slept like sh*t, so dropped it down to 12cm & slept sort of okay, but now increased it to 12.2cm and slept like sh*t.

I use resmed F20 full face mask and sleep with a woodyknows backpack which keeps me off my back.
I also bought a soft cervical collar months before starting CPAP, but found it unbearable to wear in bed. Should I give it another go with CPAP?

Here's my SleepHQ link: https://sleephq.com/public/teams/share_l.../dashboard
Also happy to provide oscar screenshots if required.

If anyone could take a look and share their perspective on my sleep reports I would greatly appreciate it, as I'm starting to feel hopeless.
Thank you so much.

[Sleeprider]

If expiratory flow limits are present, we would need zooms of the flow rate to verify. Typically we see normal inspiration with a disruption in the expiratory flow, or with palatal prolapse, a quick rebound off expiration to zero flow as the air shunts around the mask through the mouth. PAP is not an effective therapy for most palatal prolapse. Strongly prefer Oscar charts rather than the unattributed use of Oscar by SleepHQ for their business.

[placeau]

Hello sleeprider,

Thank you so much for responding so quickly.
I have attached some screenshots of my flow rate. 
Im very new to this, so unsure if this is exactly what you requested to look at (let me know if not!)

These screenshots are from a night using these settings:

CPAP: 12.2 cm
EPR: 3

Please let me know if you need any additional information.
And again, thank you so much for your time.

[placeau]

Forgot to mention my flow limit tends to be quite low during every night.
I think this might be valuable information?

Have attached screenshots

[Sleeprider]

Overall, therapy looks very good with low AHI and what appears to be minimal inspiratory flow limit.  In your flow zooms, what I see is:

Arousal, most likely position change with breath-hold (inhale with no exhale). Typical recovery from the two breath-holds and resume normal breathing.



This one is a bit harder. It appears to be cardio-ballistic oscillations during expiration which causes the small flow pulses in the exhale.  We see that in the previous graph, but these are a bit more pronounced, but all in the expiratory phase.  These are not considered expiratory flow limits, but reflect the movements of the heart pressing on the lungs while you are very relaxed and probably sleeping on your side. If you were able to get a pulse-trace, the interval of the oscillation probably matches pulse. See the cardiogenic oscillation wiki https://www.apneaboard.com/wiki/index.ph...cillations

Finally, the third appears to be normal interval respiration, perhaps some flow limit on the inspiratory peak, but nothing remarkable.


 
Summary statistics appear normal but show a longer inspiration time than expiration. That is likely an artifact of the cardiogenic oscillations as the examples above all feature normal respiratory timing with shorter inspiration and longer expiration.  I don't see enough flow limit on either the inspiratory or expiratory side to explain frequent awakening by itself.  I'm sure it happens, but some of us are just lighter sleepers and are aroused by minor disturbances from both therapy and the environment.