Oscar data review - 2 years in without the relief I was hoping for

[hexlabsnick]

Hi all,

31 year old male. Started CPAP in April of 2023 but was taking the mask off after 1 or 2 hours while sleeping until until June of 2023 when I was able to determine I needed around a minimum of 14 pressure to go a whole night. Since then I never really paid more attention because the daily report I got from Resmed/Lofta showed my numbers were usually good and I did experience some relief but it was never the "life changing" relief I was hoping for. That was until a few months ago when my partner let me know she would hear large air flows very frequently (assuming leak) and also said it would seem like I was still waking up frequently (even though sometimes it was not enough for me to know I was awake). Basically just never actually seem like I am deeply asleep, always just in and out of it like something is always interrupting me. This lead me down checking the Oscar data more and trying to see if I could get a better experience. 

First time I pulled the data I noticed large leaks detected and since she was also hearing large amounts of air (and I know I am a mouth breather) I started trying my 2 full face masks I have (F40 and F20) but after ~2 or 3 weeks I could not adjust and eventually gave up and went back to my tried and true N30I and decided to try mouth taping. Took a bit to get used to the mouth taping but now that does not bother me and I have been doing that for a month or so. But the machine is still showing large leaks so I attempted to try turning down the pressure some. I used to need/be comfortable at a 15 to 20 or 16 to 20 rate when I did not mouth tape as I imagine a lot of the air was leaking out. I found I can have it down as low was 12 or 13 to 20 when mouth taping without feeling like I am not getting enough air.

I will also point out that I do experience aerophagia pretty regularly even with lower pressures and EPR set to 3 (the only thing I have ever been able to handle).

This leads me to my Oscar data now. The reason I am reaching out for a review is I am seeing (some nights a lot) CA events, RERAs, and flow limit spikes. Some of my research seemed to show that these items may indicate I may be a better candidate for a BiPaP machine but then I was reading with the amount of CA events maybe a BiPaP ASV machine may be needed. I know the CA events can be caused by the treatment itself but I was seeming to understand your body should adjust to the treatment and they should have gone away, especially by now but maybe I mis understood.

Here is the Oscar data from a few random nights from the last 2 weeks. Really interested to see if anyone has any thoughts or suggestions.










Thanks!

[SarcasticDave94]

You definitely have a bad leak and frequent large leak issue. This must be fixed. With the amount those leaks are, I would seriously question the data involving therapy as being inaccurate. By this I mean that the leaks are bad enough that your events are probably reported much lower than reality.

I'm seeing what's likely mouth leaks with wider arching looks in the leak graph, but also mask leaks that are sharper spikey.

You need to revisit the mask cushion size, type, brand and model, your tape method, basically review everything involved with the mask. While your leak rates aren't an absolute disaster, because I've seen worse, it's also not far off from being that bad.

The mask comfort and leak control is likely one of the top 3 issues that hinders CPAP therapy.

Please use my mask primer link to get some pointers on the mask and leak issue.

[hexlabsnick]

Yes, I agree very much. 

I am just not sure what I am doing wrong. I have reviewed the mask primer but I will again. I have oily skin so I know the n30i can shift around at night so last night I attempted the p30i (first screenshot) and still had similar leaks. 

The full face mask had lower leak levels (I’ll try to find a screenshot of that one and post up shortly) but I struggled to get though the night with it and felt I was sleeping worse because of it. 

Thanks for the input!

[SarcasticDave94]

Do you use any kind of hose management, holder, etc.? This would take most of the weight of the hose off of the mask.

[Nightynite]

Your problem is the air leaks, your flow limits are great and be thankful of that. Once you figure out the leaks you will be well on your way. You may just end up with a box full of mask that didn’t work. I went through 6 mask with my own money. Stay the course and get this figured out. Good luck.

[hexlabsnick]

I have not tried any hose management I will do some research today and pick something up to try.

Here are the graphs from when I was using the full face mask (Resmed F40). I know it's probably data overload but they may be more helpful as I do not think they show the same level as leak as I have had with the nasal masks. I know the leaks are the main issue, but maybe this will show something else going on and or just provide useful data at all that does not include the leaks.













Thanks again for the help, I will get a hose management solution today.

[hexlabsnick]

I used the Resmed F40 last night with a pressure of 12 to 20 and EPR 3 and the data does look better. I will give the F40 another shot and see if I can get more used to it. Last time I tried it for 2 or 3 weeks and for the first bit I didnt have too many issues with it but by the end of the 2nd or 3rd week it kept irritating me and was making my sleep worse. Still seeing RERAs with the full face mask (although not many last night) and I know one of which did actually wake me up. Any way to fix those? I also notice when I wear a full face mask like this my snore chart is always worse.

[SarcasticDave94]

It's possible the therapy might have felt different if the mask type were switched to full if that's what you're using. ResMed speak on masks F for Full as in F40. P is pillows, N nasal.