[Diagnosis] Seeking advice interpreting Oscar

[PoconoChuck]

Good evening;

(The following is based on posts to Reddit/r/CPAP and Reddit/r/SleepApnea from which I was advised to also post on ApneaBoard and Supplier #1) 

I am male, 57.

In October 2020  I averaged 5 hours of sleep per night - out of habit, really - to bed around 11pm, up at 0430 for my commute to work.   

The reason I requested the sleep study was because my spouse complained I snored, to the point she wanted me to move to the sofa.     I responded ‘never’ to the initial questionnaire about falling asleep in meetings/driving/etc., because those never happened - it was just snoring.

My home sleep-study determined I had an AHI of 38, so a CPAP was ordered. On Nov 13 I began using ResMed AirSense 10.  It took me several weeks to get used to breathing during the first hour of use each night; currently, it takes me about 30 mins to fall asleep, which still feels weird as I almost always fell asleep in under 10 mins before CPAP.   Between following the CPAP advice - and because since January I no longer have a daily commute - I am now in bed between 1000 and 600.

Most mornings I wake up an hour or so earlier than I need to - I lay in bed, trying to fall back asleep, so as not to get a bad score from having less than 7 hours of “sleep.” Despite that, I wake up groggy every day.  Mid-day I am exhausted, to the point I have nodded off several times each week after dinner; this is a new behavior.    When I do nap, it is without the CPAP and no snoring is reported.

My spouse reports a change in my personality: I am less engaging, and apparently, I am persistently in a sour mood.    I now have horrible morning breath, but my mouth is never dry when I get up.

I have a periodic need to drive long distances - 2-3 hrs at a time - for both professional and personal reasons; the late-day tiredness is becoming a concern with these drives. In the summer of 2019 I weekly drove 430 miles in one sitting (with 2 pit stops) so I am no stranger to long hauls.  

I am beginning to conclude this ‘therapy’ is causing me to be fatigued.  Before CPAP, my spouse wanted me to sleep on the sofa because of snoring; if what I describe above is the price I pay for CPAP, I may as well give it up and move to the sofa.

My physician has kept saying 'give it time' but I am frustrated.  Neither the physician nor equipment provider have offered any suggestion to modify my CPAP settings

In  r/CPAP I posted these pics and have received adjustment advice which I will try this evening. Further comments suggested I post Oscar screen caps:

Since posting to r/CPAP this afternoon, I have changed MIN PRESSURE from 5 to 8, RAMP was auto, and is now off, ERP level was 2 now 3.

I appreciate any input.

[staceyburke]

You have high flow limits and they can and do cause sleep disturbances. To help we use EPR (exhale pressure relief)

I would suggest these 2 changes

Min 7 or 8
EPR 3

I believe you will sleep much better with those changes

Flow limits are apnea just like O and H events although they are smaller and are not times.

[Melman]

I agree with Stacey. The increase in minimum pressure will also reduce the large pressure swings which are probably disturbing your sleep. I suggest you also turn off ramp if you can tolerate starting at the higher pressure.