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I've been a CPAP user since September 2021, initially renting a machine which was incompatible with Oscar, but then purchasing my own Resmed Airsense 10 AutoSet in July 2022 and have been using that since. Through educating myself and learning a lot here, I have "self-titrated" to my current settings, which seem to strike a balance between OA's and CA's (I had no CA's on my initial sleep study - my AHI was 21.6 about 50/50 OA/Hyp). The Oscar data below from a couple of nights back is fairly typical, with AHI between 1 and 2.
I've experimented quite a bit over the last year with both masks and settings, and more recently with EPR, finally settling on EPR of 3. This has all but eliminated flow limitations, but has increased CA's slightly. It has also reduced my tendency to exhale puff and even mouth breath compared to lower or zero EPR settings.
I suspect that the limited amount of mouth breathing is still causing fairly frequent mini-arousals. But, regardless of the cause, I can see from my Oscar data (zooming in on the flow rate and tidal volume) that I wake briefly 5-6 times per hour, but I only recall waking on average 3-4 times per night, including one toilet break.
In summary, I'm happy that I no longer have sleep which is seriously detrimental to my health, but I rarely wake feeling refreshed. Just wondering if any of the experts here can offer suggestions other than a FFM or even a hybrid such as the F30i. I tried the latter but found it way too noisy. I hope the screen shot is displayed.
It looks like you have done some pretty good work on your settings. Maybe change response from soft to standard, if you have not tried this yet.
Mouth leaks using a pillows mask. A good wide tape helps,
Curious you are having centrals as not in your sleep study. Check with your doctor for any new medicines that may perhaps impact your therapy.
Last observation - tidal volume.
It may be interesting to check your lung efficiency. A really simple test is using a "Peak Flow meter" (see photo attached). You can get from a chemists for about €15 or $, or through your doctor. A simple device made of plastic, with a piston and sliding scale when you blow hard. My doctor gave me an inhaler to improve lung performance.
Thanks for your thoughts, Expat31. Yes, I've tried the standard setting and it made little or no difference to my AHI, but I felt I slept better with the soft setting.
I've considered mouth tape, but I have a beard which has been with me for over 50 years, so reluctant to lose it! Also, I tend to need a sip of water when I wake - of course that might change if I stopped mouth breathing. I think my jaw just drops a little when I fall into deep sleep (I've woken at times with a little air coming out of one corner of my mouth), so most of it is probably more "accidental" than "deliberate" mouth breathing - hence leaks usually well below the red line. So perhaps a small strip of mouth tape might be worth trying.
I'm not too worried about the centrals. I only get them with with EPR and they rarely exceed more than one per hour anyway. But without EPR of 3 my flow limitations increase, causing the machine to increase pressure, which results in even more disrupted sleep.
Also, I have a slightly deviated septum, so that one nostril is narrower than the other. And the narrower nostril is dominant (probably 70% of nasal cycle). I use the cushion rather than the pillows/prongs with the N30i mask and those holes are quite small and tend to move around, sometimes partially blocking the dominant nostril. I used to cut the centre strip from the old cushion, but the new design is more flexible and needs the centre strip for stability. I may try the pillows again (they irritated my nostrils) and I also have an Airtouch P20 which I've yet to try.
Finally, regarding tidal volume, part of the reason it appears lower than average is simply the mouth breathing. There is a visible correlation between tidal volume drops and mouth breathing episodes (especially when I increase the y-axis on Oscar). And I also use a Wellue O2 ring (not linked to Oscar), and my O2 levels don't drop during those low tidal volume periods. BTW, my average night time SPO2 level is usually 96% which is close to my daytime 96-97% resting level (not perfect, but OK for someone close to 70). I suffer from mild, but fairly chronic, asthma during the winter months and have an inhaler which I only use occasionally. I remember using one of those peak flow meters in my local gym when I was in my 20's. I used to do a lot of running back then and could outrun most of those with higher scores than me when I was at my fittest. But I was always the slowest kid at school. So, I reckon I probably have lower than average lung capacity, but within normal range.
Thanks again for the feedback. Hopefully, other will chip in too.
Hi, thanks for the comeback. Your replies made me think a bit more.
Firstly leaks. You say "(I've woken at times with a little air coming out of one corner of my mouth). This is interesting. I had exactly the same thing.. Also I found out that air was tracking under the tape, along a facial fold/line. Long story short, I used 10cms tape, making sure the corners we well covered and secure, as well as the air tracking lines under the tape. Certainly a beard is quite likely to complicate things a bit...
Your figures a pretty good, and the machine seems well calibrated. You have explained everything really well, so what possibilities may be left? Several thoughts:-
Looking at your fow limitations, the figures look good, and controlled pretty well with the EPR. Your flow limitation graph look fine, but difficult to see the details with the actual scaling.
It may help to either double click slightly to the left of the y axis, to dynamically resize the graph, or just right click to resize the max and minimum range of the y axis.
At present the maximum is set by default to 1.0. it would be more like say 0.2 at the most. Ideal objective flow limitations during therapy should be <0.1.
This may seem like splitting hairs, but you may find something there. Your 99.5% band of 0.13 seems insignificant, but how may points at this level? Could be causing several arousal points during the night, enough to provoke enough disturbing arousals, especially in REM sleep
The devil is always in the detail.
Last point - UARS, this video maybe worth a look:-
Thanks for coming back again on this, Expat31. I don't think the limited remaining FL's are really the culprit. My reasoning is, that when I had EPR at 2, my 95% figure was usually 0.3-0.5, and there was no noticeable difference in either my sleep quality or the number of spontaneous arousals evident from close study of the flow rate. Hopefully, a few others will chip in here too, but I suspect there is no obvious answer. The arousals often happen while I'm mouth breathing, but it can be after fifteen minutes or more of doing so. Then there are arousals that happen when I'm breathing evenly and smoothly through my nose too. Perhaps, it's not unusual for a man approaching 70 to have 5-6 spontaneous arousals per hour?
A final thing, which may be relevant. I've always been a relatively light sleeper, as in easy to wake even from deep sleep. Also, it took years before I had a confirmed apnea diagnosis, because I failed to sleep at all during two sleep lab studies. I eventually managed to get some five hours of sleep doing a home sleep study about two years ago, but even then, it took me two nights (lucky to have the test kit for a week-end, so I got a second chance). Then my first three months of CPAP treatment were very difficult, struggling to get anymore than a couple of hours of light sleep for the first 3-4 weeks. It took me about 4-5 months of therapy, before I finally managed to get 6-7 hours of decent sleep. I think that's relevant, because it takes very little to unsettle me. I still use earplugs because I find I sleep better with them, especially in the latter half of the night.
So, it looks like I may have to give the mouth tape a try, even with the beard. Unless anyone else has other suggestions.
Those mouth leaks follow a distinct every 2 hour pattern don't they?
APAP is not providing enough pressure during REM or a specific sleep stage I would guess. Probabably having lots of mini events the machine doesn't care about.
Similar experience.
If you set a custom flag for 50% at 5 seconds in your preferences do you see many of these shorter events clustered together during your main mouth leak periods?
I am fixing mine right now with tape to ensure consistency and accurate data, fixed pressure and no EPR. I am not letting APAP refuse to treat shorter events when they lead to wrecked sleep stages and arousals.
Thanks for the custom flag suggestion, Apnea23. I've looked back over that particular night and several others. Unfortunately, while there is some correlation between mini-events and mouth breathing episodes on the night I posted here, the distribution generally is much more random. It does, however, confirm more clearly that I have very fragmented sleep. I've experimented in the past with higher minimum pressures (and less or even no EPR). In my case, that has led to even more mouth breathing. I reckon mouth taping may be the way to go.
I see you are using the Dreamwear nasal mask. If that's the one with the nasal cushion, I used it for the first year of treatment. In some respects, I preferred it to the Resmed equivalent, mostly due to the single slot as opposed to the two holes in the Resmed cushion. I found it a bit too flexible though and I used to wake a lot, as a result, when side-sleeping, causing the mask to move around. I switched to the Resmed mask because the cushion had a rigid plastic front portion which made it more stable. Unfortunately, Resmed have recently changed the design and the new incarnation which I've been using since January is much more like the Dreamwear one.
I have a couple of other experiments which I intend to try before mouth taping. One is to switch from cushion to pillows (same mask), and the other is to use a standard nasal mask. My logic is that both of these are less likely to cause nostril-related breathing issues. But, given my sleeping history, I reckon it could take a week or more to get used to either, and I'm not looking forward to the prospect!
04-20-2023, 01:04 AM (This post was last modified: 04-20-2023, 01:08 AM by Apnea23.)
RE: Mouth Breathing and Spontaneous Arousals
Hi Mike,
At risk of sounding preachy, I tried alsorts and spend hundreds trying to avoid mouth leaking.
You can pick up 3m micropore tape from Boots today for a few £ and tell yourself to hell with it, let's give it a go tonight.
That's what I had to do. Even tried a cervical collar which worked (kept the jaw dropping I guess, especially during REM) but it was so uncomfortable in the end I capitulated and headed to Boots.
Now I'm sat here with a bunch of different nasal masks and pillows costing hundreds wondering why I didn't do it earlier, getting the best sleep and therapy I've had for years!
I'm even using the same Dreamwear nasal mask prescribed with my first machine in 2021.
One of the main things that put me off taping was I had no idea exactly what tape to use, so here's what I bought:
