Looking for help with OSCAR analysis

[Juicebox]

Hello friends,

I'm hoping to receive some enlightenment about my apnea symptoms. I did an at-home test (watchPAT) and was diagnosed with mild obstructive apea, and bought a Resmed Airsense 10. Pressure prescribed by Lofta was 4-20, but I adjusted the max way down after the first couple hours gave me severe aerophagia and discomfort.
I have used the machine for 7 days now, with little or no change in my sleep; I still wake up many times through the night, and sometimes have difficulty falling back asleep if I've already slept more than 3-4 hours. 
The machine flags the vast majority of my events as centrals (clear airway), and quite a few of them last upwards of 40 seconds, with the longest that I've seen being 71 seconds. I've adjusted my pressure range by trying to analyze which parts of my flow rate look good through the night and what pressure it's around at that time, but I don't really have a full understanding of fine tuning everything and how it's best to treat central apneas like this... my understanding is that I probably need a different machine than an APAP, but that's what my prescription was for.

I have a consultation with a physical sleep Dr / pulmonologist in a couple weeks, but I'm desperate for help and hoping I can maybe get some type of improvement from some of you smart people.

Some background of my health recently, if that makes any difference. I'm not sure what might be relevant or not:
Firstly, I believe I've had this issue or similar sleeping issues for many years (at least 10-12) but potentially MUCH longer, as far back as pre-teen years, although it has gotten worse and more frequent recently. 
I had RSV as an infant and asthma through my life until 13-14ish when I outgrew it, never really had any issues since then. 
I haven't slept well in at least 3 months, whereas before this seemed like an intermittent sleeping problem, but that may just be memory issues on my part, kind of hard to say :/
I passed out in an early-morning shower early December 2024 which led to a hospital stay where they ran probably every test they could on my heart and bloodwork, had a few EKGs and ultrasound of heart, treadmill stress test, etc.. All looked good, really no issues found other than I have a low heart rate, which regularly drops to mid-high 30's while I sleep. 
They gave me a Holter monitor to wear for 30 days, and the only event flagged was my heart stopped beating for 3.3ish seconds during sleep, around 3am.

I am a 29 year old male, relatively fit, 130-135 pounds, 5'11" or 6'0" if I don't slouch lol
I'm using a F&P Brevida nasal pillow mask, if that matters. The past few nights have had more leaks than the first few. I may look at a different mask, but not sure I want to drop more $ into all of this until I have an idea of what treatment might work for me.

Attached the daily view of every night so far, and I can provide whatever information might help anyone if they need it

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zoomed view of central apneas

[Juicebox]

Daily view of last night. My leak rate seems like it continues to be an issue, but I haven't really ever felt a leak when I wake up through the night. Running mask fit before I sleep each night and there is definitely a strong seal. I've used a soft cervical collar every night to prevent mouth dropping, I actually thought that was the main reason for my apneas before starting any of this, hah...

[Dormeo]

Welcome! Could you post a scan of your sleep-study report? Black out your personal information.

What I'm eager to see is the break-down of your AHI, plus any information about respiratory-related arousals.

[Deborah K.]

Did you have a lot of CAs in your sleep study?  If you don't know, please post a redacted copy.  If you don't have a copy, ask your doctor's office for a copy.  Under US law they have to provide it to you if you ask.  If you had lots of them, you may need a different machine.  If not, then you are having loads of treatment-emergent CAs.  If so, they will lessen on their own as time passes and are not anything to worry about.

Your flow limits are high.  I can't see your settings, but if you are not already using it you might want to turn EPR on full-time, set a 3.  This will cause your CAs to rise, so you may not want to use it, but it could make your breathing more comfortable.  It's up to you.

Your leaks are sometimes a bit high, but not always.  A collar doesn't help much with leaks for most people.  You could try mouth tape.  If so, get a good tape that's 2 inches wide and cut it about 5 inches long.  Hypafix and Cover Roll are good.  I prefer kinesiology tape as I find it more comfortable, and it adheres better to facial contours.

Again, welcome, and good luck with improving your therapy!  

[Juicebox]

Thank you both for your replies, here is the study report from the WatchPAT. I'm not sure how useful/accurate it is compared to an in-lab study.
It was just a wrist unit, finger oximeter, and 1 sensor at the base of throat.

@Deborah I am now using EPR full time on 3. Tried a few nights without it, and I think the first night I had it on at 1. Definitely helps the feeling of not being able to exhale, although I think that's less of an issue once I'm actually asleep.

I do have some kinesiology tape being delivered today, along with an ace bandage to try and act as a chinstrap, but with a full beard and moustache I'm sceptical about how well the tape is going to go.

[Juicebox]

More information about what they consider AHI, RDI, and such. No breakdown of obstructive or central as far as I can see.

[Juicebox]

Last night's results after ditching the cervical collar and using mouth tape. The kinesiology tape worked pretty well, even over facial hair. Woke up with a full seal on my mouth still. And it came off mostly pain free.

AHI down to 2.84, but I still feel like I woke up the same amount as any other night (which is a lot).
Still feeling unrested, mentally not 100% there all the time, etc. Looks like I may be trending in the right direction for better sleep though!

I may try lowering my pressure max, as it seems like I'm not really having any obstructive apneas apart from 2 on the first night.

[Dormeo]

Yes, you seem to be headed in the right direction.

On your WatchPat report, "pAHIc" refers to central events. You had some, apparently, but not a lot. You did a lot of snoring that night, and your RDI (respiratory disturbance index) was high. You managed to do a decent amount of deep and REM sleep.

In your place, I'd set the EPR to 3. It seems to be very effective in reducing your flow limitations, and while we can't be sure, that may help to make your sleep more restful. Possibly it adds a few CAs to your night, but I wouldn't worry about that.

I suspect you'll see fewer and fewer CAs as time goes by and your body adapts. In addition, I'd be willing to be a lot of those CAs come after arousal breathing, and as you have fewer arousals, you'll see fewer CAs. (Arousal breathing is deeper and more messy looking than asleep breathing; you can zoom in on your flow rate to check.)

It's good to hear you've found a leak solution. As long as your leaks stay below around 24, don't worry about them unless you think they're waking you up.

No more snoring, and virtually no more obstructive apneas -- terrific!

Give it time and I bet you'll start feeling more rested. Also, consider getting more time in bed and on the machine. With just 7.5 hours or so, you're probably getting somewhat less than 7 hours of sleep. Many people feel at their best during the day when they can sleep for around 8 hours.

Keep us posted!

[Juicebox]

Thanks for addressing all those points! Your knowledge is very appreciated.
I will 100% be updating this thread if I have any more questions haha, definitely felt helpless in the beginning with just a telemedicine doctor who I talked to for like 45 seconds.
And I will work on getting longer sleep hours in.
Just realized my EPR somehow was on 2 the past several nights... I thought it was on 3 and I will actually set it to 3 now.

[Juicebox]

Well I'm back after just 2 nights which saw no real improvement in my sleep.
Last night was particularly bad, I feel like I spent more time awake tossing and turning than asleep.
Interestingly, both nights show CSR events, one each, for the first time since starting CPAP, although the event on the first night didn't seem very different compared to other flow rates.
Last night's was worse I'd say, with the longest central apnea being 78 seconds - during the CSR event.  

Not sure what to make of this, or what I can even do. I did bump up my min/max pressures by 0.6 to try and battle some congestion.

Feeling like a trainwreck haha, I'm very glad my boss let me take this week off of work to try and figure all of this out.