Help analyzing my OSCAR data

[m415]

Hi friends,

Can you please help me analyze and offer any advice on what adjustments I can make? I've tried making adjustments on my own based on the wiki, but I don't feel confident that I'm approaching it the correct way.

For context, I've been focusing on my sleep hygiene and quality for the past year because it's been affecting my health and causing a lot of anxiety. More often than not, I wake up in the middle of the night(as it shows in my OSCAR data) to use the bathroom, and it can sometimes be difficult to fall back asleep because of aerophagia.

I'm also waiting for my wedge pillow and Caldera Releaf neck rest to arrive to see if it'll help address the aerophagia and OA.

Apologies if there's anything missing in my post. Happy to provide more info.

Thanks!

[Jay51]

Your therapy looks pretty good overall IMO.  You have some leaks that could be fixed, but not bad.  

The major thing I see is a cluster of OA's (and this happens right before you woke up and had the long break).  This is most likely positional due to chin tucking.  Hopefully, when you get the caldera collar, it will help reduce or even eliminate the OA clusters.  And maybe, without the OA cluster, you may be able to sleep longer (or when you get up, you can get back to sleep quicker).  Big OA clusters can decrease blood oxygen levels at night and increase heart rate.  You may be "wired" when you get up because of this and it takes a while to get back to sleep.  

The main way to combat aerophagia is to decrease the pressure a little bit.  You can experiment with this, but watch you AHI to see if it goes up significantly.

[gainerfull]

Looks like your minimum pressure isn't high enough to keep the obstructive events at bay. I don't know enough about bipap settings to recommend anything but perhaps someone else with more experience will chime in.

[Jay51]

Good point by gainerfull.  Typically raising EPAP is used to treat obstructive apneas. But clusters of obstructive apneas could also be positional in nature (chin tucking that can be helped with a cervical collar).  

Go ahead and raise your min pressure (EPAP) like gainerfull said.  It might work.  If not, you can try the collar when you get it.  

The VAUTO is a very capable and good machine with lots of settings to adjust for therapy and comfort.  I hope it works out for you.

[Jay51]

I'm sorry I forgot something.  You can also try raising your max EPAP pressure to try to "break through" the obstructive apneas.  You have to be able to tolerate the higher pressure though and can only go so high (if you use very high pressure and still have clusters of obstructive apneas, then it is most likely positional).   Then use the collar to help this.

[m415]

Thank you Jay51 and gainerfull for the tips. Much appreciated.

I actually raised my EPAP from 4 to 6.4 last night. I wanted to set it to 7, but 6.4 was comfortable when testing. I also placed a pillow small enough to fit under my chin while lying flat on my back.

All was well until I woke up abruptly ~5 hours into my sleep. I looked at my device and it showed 0 AHI up until that point. I woke up in a fetal position with my chin tucked, so that might be the culprit. The Caldera neck rest cant come soon enough!

Jay51, do you mean I should raise my IPAP and EPAP or EPAP only? I'm concerned that my aerophagia might get worse, but the increase on my EPAP was tolerable.

[Jay51]

Only raise the EPAP.  I am glad that you are improving.

[m415]

A few updates and questions:

I'm no longer waking up in the middle of the night since wearing the collar! For the past 5 years, I've often anticipated waking up in the middle of the night and staying awake, so this is a huge win for me.

However, I'm unfortunately still experiencing OA. If anyone can help, I have attached my charts for 7/12 and 7/13.

For 7/12, this was my first night wearing my collar and kept my EPAP to 6.4 and AHI was 1.74.

For 7/13, I wanted to improve the OA, so I decided to bump up my EPAP to 8, but I found that my AHI increased to 4.72. Is this due to mask leak? For context, I'm using Pad A Cheek's mask liner and anti-leak strap.

Any thoughts on adjustments I can make?

Thanks all!

[Jay51]

Thank you for posting those charts.  I am glad the collar is helping.  Usually people try:  side sleeping instead of back sleeping; then lowering pillow height from high to as low as possible, then the soft cervical collar as the last resort to positional apnea - tucking the chin towards the chest that "kinks" the airway (like a garden hose).  

It is strange and couterintuitive that increasing your epap resulted in worse results with OA's.  But you are right.  You have many more leaks this way.  I would say either bring the epap back down (like in the 1st chart you posted) or find a way to stop the leaks (and probably get better therapy with the higher epap.)  

Here is a link to help with mask leaks.  Possibly try adjusting the mask liners (or even trying a night without them to see if you get a better seal).  The mask size needs to be just right also.  Do you feel your masks size is just right?  

Mask Primer

[m415]

Thank you again for helping me troubleshoot!

I'll work on the mask leak before increasing my EPAP again.

Regarding my mask, it feels like it's the right size. I have to use a liner because the mask alone irritated my skin. I'll make some adjustments to the liner and tightness and see if that helps.