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[CPAP] Wake up snoring despite low AHI, low leak rate etc
Wake up snoring despite low AHI, low leak rate etc
Hi, new to the forum (send here from Reddit's r/cpap/).

41 year old male, moderately overweight. I've been on CPAP for around 11 years, with varying success. Have perfect compliance, but I've had lots of ongoing issues with insomnia and fatigue over that time. Recently I've found that I'm repeatedly waking myself up snoring. 

I'm no expert at reading Oscar data, but my pressure readings seem good (last night 6.2 average, last six months 6.27), my AHI is low (last night 0.69, last six months 1.17), and leak rate isn't too high (last night 11.52, last six months 7.58). 

I'm on ResMed AirSense 10 AutoSet
Min 6.0 Max 20.0 (cmH2O)

Would really appreciate some help interpreting my oscar information. The forum won't let me post a link as a new user, and it limits image uploads to three under 700k images, so I'm not sure which information to provide. But let me know and I'll post below.

Thanks a million. Any help would be greatly appreciated, as I'm on the public health system in my country and have basically no contact with the prescribing clinic.
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RE: Wake up snoring despite low AHI, low leak rate etc
For  chart information see the bottom of this post for Charts organization.    Take off the calendar by clicking the triangle next to the date and remove the pie chart -go to view at the top and get rid of it.  Use F12 to get a screenshot, that about does it.  Post the first page of your charts, if we need to see other charts we will ask to see those.

Example of a screenshot and the charts needed....

Attached Files Thumbnail(s)
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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RE: Wake up snoring despite low AHI, low leak rate etc
Great thank you. Please find that screenshot attached.

Attached Files Thumbnail(s)
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RE: Wake up snoring despite low AHI, low leak rate etc
Regitimate, it looks like your F20 full face mask is not doing very well at sealing. A different model or size might be needed to get the leaks under control. Leaks in a full face mask are disruptive to sleep and can shoot air into your eyes. The mask primer in my signature links might help with some ideas.

Your pressure is set in a wide range from 6.0 to 20.0 with EPR at 2 and a 5-minute ramp starting at 4.0. Maximum pressure is not very important as the machine will only go as high as necessary, but an upper limit of 12.0 is fine if you want it. I would think after this many years of using CPAP you can just turn off ramp. It doesn't help therapy, and you are accustomed to the pressure. I think you will be more comfortable with a minimum pressure at 7.0 and EPR at 3. This will help to avoid the snoring you have noted (not too prevalent in this graph) and will reduce flow limitation by giving your inspiratory effort more pressure support. This makes breathing easier in both directions, and the reduction of flow limits will reduce arousals.

Autoset Mode (standard or soft)
Minimum pressure: 7.0
Maximum pressure 12.0
EPR: On full time at setting 3
Ramp off.
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RE: Wake up snoring despite low AHI, low leak rate etc
Welcome to AB.

A couple of things. Your large leaks are just a bit over the threshold and your numbers are good. Your pressure is a little bit erratic being driven by flow limits.

Your second large leaks is a nice flat table top indicating a mouth leak. The one before that is a combination, jagged indicating a mask leak and a table top again showing a mouth leak.

Set your min pressure = 7, we may go higher later, and EPR=3

EPR is your friend when treating flow limits and snoring

On Ramp, while yours is short at 5 minutes, if you don't need it turn it off.

I would also like to see your sleep studies, including the charts and tables, redacted of course.

I want to see if UARS was indicated, if not discussed.

I would also like to see a couple of random 3-minute segments of your chart to evaluate your normal breathing.

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RE: Wake up snoring despite low AHI, low leak rate etc
Hi Gideon, thanks so much for that. I'm located in Ireland and as I mentioned on the public system. As I mentioned I'm not in contact with the clinic that diagnosed me initially. They didn't provide me with any kind of information after my sleep study beyond a diagnosis. While I am legally entitled to that information, I might have to submit a formal Freedom of Information Request to get it. We're also under an extreme lockdown right now nationally due to Covid, so they might take some time to respond. Do you think it's worth going down this road?
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RE: Wake up snoring despite low AHI, low leak rate etc
Hi Sleeprider, 

Really appreciate the info. I forgot to mention, I also use a mask liner called CPAP Comfort Cover, which I suspect may worsen the seal. However before using this and similar products I was getting severe, permanent burn like marks from my mask (presumably due to a silicon allergy). I also suspect my mask isn't particularly well fitting, but I have a large nose, small lower jaw and relatively narrow face, so it's difficult to find one that fits. Also you mention testing lying down under pressure, but this isn't provided as an option by my CPAP provider. They provide one free mask replacement every year or two. Other than that, it's just a case of ordering one and seeing if it works (with no opportunity for return). So if you've any advice about potentially measuring my face to try something different I'd appreciate it. I can afford to order another if necessary, but not a variety. 

BTW - It's a relatively new mask so damage or degradation shouldn't be an issue.
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RE: Wake up snoring despite low AHI, low leak rate etc
Everyone that has taken a sleep study should maintain their own personal copy of the full study, not just the summary. It can prevent the need to have to redo one. Also we have seen many that are, let me nicely state this, grossly "misinterpreted".
Your chart has low obstructive events, and flow limits that are not high, are likely driving arousals.

So, yes, but a hurry is not needed.
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RE: Wake up snoring despite low AHI, low leak rate etc
Great thanks. The standard of public care in Ireland is pretty terrible, so I wouldn't be surprised if there was misinterpretation. There was certainly no 'tweaking' of the CPAP settings post prescription - machine was always set to full auto, any changes are my own trying to increase comfort. I wasn't provided with any paper info believe it or not, not even a summary. I'll contact the clinic now. I've implemented those settings changes. Really, really appreciate the help.
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RE: Wake up snoring despite low AHI, low leak rate etc
Do you breathe through your mouth during the day? If you don't, might you want to try a nasal pillow mask? This might cut down on leaks, which can be disruptive to sleep. (With fewer points of contact with the face, nasal pillow masks will tend to leak less than full-face masks.)

If you're interested, I could follow up with some further thoughts.
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