Help interpreting OSCAR? Still so fatigued after a year.

[mrt1028]

Hello all, I was diagnosed in spring 2024 with an untreated AHI of 33, and have been using my CPAP (ResMed AirSense 11) with a full face mask (ResMed AirFit F40) since the end of May 2024. I use it consistently through the night. However, I have consistently been feeling fatigued, have difficulty waking up, and feel like I need to pump myself full of caffeine every day just to get to a "normal" wakefulness threshold. I can count on two hands the number of times in the last year where I've woken up and truly felt well-rested. I definitely feel better than before I was using my CPAP, but after a year, it just doesn't seem like I should still be feeling so fatigued.

I am very new to interpreting OSCAR data so I would be grateful for any insight anyone can provide. I have been having a very high leak rate since the beginning of June 2025 and I'm not sure why. I think I may need to try a new mask, possibly nasal pillows, instead of my full-face mask.

Thanks in advance for any information you have!

   

[jdougc]

Welcome to the forum, 
Can you post a copy of your sleep report with your personal info redacted?

Are you on any medications that may affect your breathing or your sleep?
Do you have any health issues that may affect your breathing or your sleep beside the deviated septum?

You have leaks that are compromising your therapy, Your chin could be dropping below the bottom of the mask as you fall asleep. A chin strap that goes under your chin and pulls straight up, not back at all might help. A soft cervical collar might help also to keep you chin up.

Your flow limits are too high, you need EPR to fight that, use a setting of  EPR of 3.
Flow limitations can lead to daytime drowsiness.
https://pubmed.ncbi.nlm.nih.gov/38530665/

Also you minimum is too low for an adult, set the minimum to at least 7 or 8 cm of pressure

We need to see the machine settings to properly provide assistance.

[Expat31]

As jdougc indicated, we need your settings to be visible, not just the statistics. 

Using F12 doesn't always work, so try these font settings below, (just for the left side).

[mrt1028]

Thank you for your help. I will go back and resubmit.

[Expat31]

Good, hopefully this will work. By the way, you can delete the snore graph, it serves no real purpose, just takes up valuable space!

Your  n°1 enemy are the leaks which are distorting your therapy in a big way, especially the flow limitations which is a big factor in wrecking sleep quality. The 95% level of flow limitations should be ideally at 0.05 or less or best results. 

As jdougc indicated there are several possibilities to overcome these. 

Have a look at the mask primer including notes on mask leaks and mouth leaking and also a video on Dry mouth and mouth leaks.
 
Personally I was afflicated just by mouth leaks. To combat this I use mouth tape and a chin strap. For the last 6 months or so I have been using a really simple Resmed chin strap. (retail cost €25), No problems at all, such as a dislocated jaw!  In my opinion, quite a success. 

Currently I am trialling one from AliExpress. It is a clone of the Resmed, but the strap is better at the back. The material used is the same as my Breveda mask, but better quality. On the top left is the Resmed, on the right is the AliExpress clone (cost €7), and bottom is a strap of a Breveda pillows mask.

So far really pleased also with the clone.

[mrt1028]

Hello there,

I think I have gotten the sizing right so you can see my device settings. I have also attached the doctor's notes from my sleep study in April 2024. I hope this provides better info and I am grateful for any input you can provide!

Thank you,
mrt1028

[jdougc]

I am surprised that you are having leaks with the F40 on your back, be sure not to over tighten it. 

Your ramp pressure is too low for an adult, set it to at least 7 cm.
Your Flow Limitations are too high and causing your pressure to increase throughout the night.
Flow Limitation Is Associated with Excessive Daytime Sleepiness in Individuals without Moderate or Severe Obstructive Sleep Apnea
Increase the minimum pressure to 9 cm to deal with the flow limitations, since EPR the normal tool is maxed out at 3 cm.
Good luck

[LaurenceShaw]

A chin strap that goes under your chin and pulls straight up, not back at all might help. 

What jdougc is referring to is that traditional neoprene chin straps wrap around the tip of the chin and the top, back of the head.  As shown on the More Info page of Supplier #37, the jaw joint (which is just in front of the ear) is located on the line between those two points, which means traditional chin straps force the jaw almost directly into the jaw joint.  This is the least effective and most uncomfortable angle to be applying force for this purpose.  

If you want to explore a chin strap to prevent leaks, I suggest you look into the Knightsbridge Dual Band chin strap, since its straps pass under the jaw and lift vertically to work with the natural rotation of the jaw.  (Please use the link of Supplier #37, since with a keyword search you will likely end up with a counterfeit.)

[mrt1028]

Thank you! I definitely feel like I can never get my mask to fit right. The top strap is constantly moving around and I will usually wake up with it down on my forehead. I will look into this other strap!