Possible UARS

[sfgiants123]

I am still quit new to understanding oscar data. I have been on CPAP for a couple of years now and use a FFM with EPR set to 3 but I am constantly feeling tired and symptoms of brain fog and overall grogginess upon waking up in the AM. I am posting some oscar data below. My flow limit totals I think seem to be in a decent range but I do not know how to read each breathe and the curve of the breath. Any advice on what you see regarding Flow Limits and possible UARS would be great. Thanks!

[jdougc]

We need to see the full night, not just a zoomed in view.

We need to see the bottom of the flow limit chart, you can change the heights of the charts to do that.
You had excessive flow limitations, see the tops of your breaths are not rounded. 
Your airway was restricted, not fully blocked.

Studies have shown that numerous flow limitations during sleep can cause drowsiness.
Some flow limitations is acceptable. But yours are worse, the total is over 0.02 in the statistics chart.
Since you are at EPR of 3 already, only raising the pressure is the tool you have left to deal with the flow limitations.
Try raising the minimum to 11 cm tonight and see how you feel.

The tight pressure range may lower the few CAs that you have.

[sfgiants123]

Thanks for the reply! I will raise the min pressure tonight to 11 and see how that works out. I have also posted the full nights flow limit chart. Please ket me know if you see anything on the full chart that I should know moving forward. is there any chance I would need bi level to help with the flow limitations. I have been on EPR 3 for a long time now but sometime I do feel like it would help if the exhale pressure could be decreased even more. But I know thats not possible with my resemd apap.

[jdougc]

Please change the heights of your chart so that the Leak Rate and Flow Rate charts show.

You may have to raise your pressures even more to deal with your flow limitations, we will see.
Some have had success with doing this increase of pressure, but I think they give up comfort in exhaling.
You already expressed a concern with pressure during exhaling, so keep an eye on this.

I recently bought a lightly used bilevel and it is so very comfortable.
Every so often I have to wave my hand by the mask exhaust to make sure that I turned it back on.

[sfgiants123]

I raised the min pressure to 11 for last night sleep and here are the results. I believe if I am not mistaken I see a lot of flow limitations still. In an ideal world would the graph with flow limitation be almost empty? void of any spikes?  Does it make sense to keep raising the min and max pressure? Also if I were to get a bipap machine do you think this would help with the flow limitations? Would a setting of 4 pressure support help. Thanks!

[jdougc]

Please don't start all of these threads, we need to see your history.
Seems like your big leaks are back
Your therapy is compromised by the leaks.
Are you using the P10 or the evora fisher paykel mask?
Hide the calendar and the snore chart

I don't think EPR of 3 can treat you flow limitations and increasing the pressure might contribute to your leaks.
If you can get your leaks under cotrol try 12cm tonight, if you don't think you can control leaks than drop your pressure back.
Have your tried the SomNoSeal? SomnoSeal is a soft, flexible mouthpiece that prevents mouth breathing and dry mouth during sleep.

https://www.youtube.com/watch?v=1u_S1ADwVmA

Flow limitations don't seem to go away and these machines seriously undercount them.
With my newer bilevel and higher PS mine are 0.0 until the 99% and it varies 0.02 to 0.09, probably depending on my small leaks.

[sfgiants123]

Apologies for starting the new threads, I will stay here. I alternate between the fisher and paykel evora and the p10 nasal pillows mask with mouth tape. Last night I switched back to the nasal pillows with mouth tape. It seemed to bring my leak down significantly. The mouth tape stays on all night and I do my best to keep tongue posture so I am not sure how much more I can lower the leak rate. Is this leak rate low enough? As for the flow limitations , they did improve a tiny bit but still not enough. I can try and up the pressure to 12 with pillows and mouth tape, I'll see if that lowers the flow limitations a little more. Otherwise I feel like bi level with more pressure support could help me more. I never have my 95% flow limitations at 0.0. The best I have ever seen is 0.2 and it usually falls between 0.2-0.5.

[jdougc]

How do you feel today? Rested and more energetic or less of a headache?
It does take awhile to recover from untreated/undertreated apnea.

Your numbers are the envy of many of us here, even the flow limitations are outstanding, not to mention the low leak rate.
Great job.
I think the pillow masks delivery the therapy more effectively than  other masks.

Consider 11.0 cm minimum and maximum for a few nights.
The tight pressure range may lead to a peaceful, restful sweep without the pressure swings.
Raise your maximum if needed though.
I do a 5 to 10 minute ramp at or near my minimum to fall asleep stretching and not get scored for wake sleep junk.

[sfgiants123]

Thanks for the comments and help I do appreciate it. I do feel ok today. I think I have been definitely under-treating the sleep apnea with lots of leaks and flow limitations due to mask leak from the ffm. I do agree with you that nasal pillows seem to just deliver the therapy more effectively. I will bump up the pressure and make a tighter window between min and max to have less pressure swings. I do notice that on cpap even when I feel like I have a restful nights sleep I seem to have a perpetual tight neck and upper back. My theory for awhile was that the flow limitations and the partially obstructed airway was causing me to crane my neck during sleep in a manner to keep my airway open causing an unnatural position and stiffness. I do not know if this is plausible. But I will nonetheless shoot for these numbers with leak and fl to see if the stiff neck resolves over time. Thanks!

[jdougc]

Interesting theory , I was wondering if you have any night cameras to monitor your sleep?Iuse a cheap prz wifi camera from Amazon.

https://www.amazon.com/dp/B0CBBT5RMP?ref=ppx_yo2ov_dt_b_fed_asin_title&th=1