[Treatment] CatFisherman - OSCAR data, restarting therapy

[CatFisherman]

Background:
Mid 30s male, 180lbs, 5'9. Diagnosed a year ago and gave up after a few months. I recently learned my settings were never changed from Min 4 Max 20!

I've restarted based on newly acquired information about using Oscar and online resources.

I've attached my 3 Oscar charts for my first 3 days.
Please notice that day 2 [Second Image] (Sunday) had the best results I think.

Please take a look and I would appreciate any suggestions on where I should start my settings at a default and go from there. I did wake up a few times in the night and took the mask off, but I haven't been sleepy during the day for the past 3 days which is a small miracle - I usually have to nap during my lunch break.

Day 1: AHI 8.14      Min 7    Max 12, Ramp Auto 6,     EPR Off,            Humidity 3
Day 2: AHI 4.48      Min 8    Max 15, Ramp Auto 7,     EPR Off,           Humidity 3
Day 3: AHI 13.76    Min 10   Max 20, Ramp Auto 8, EPR Full time 1,     Humidity 3

Please help me start fresh with the default settings or should I do something close to Day 2's settings?

Thank you so much for the help.

[CatFisherman]

Day 5, still not feeling sleepy during the day!

I was at Min 8 and Max 10 last night 3/5 Wed and will be moving up to Min 9 but keeping Max the same at 10.

I don't understand the Leak Rate and Flow Limit. Are my leaks bad?

What is the point of the RAMP? And why do some folks recommend to turn it off?

thanks

[Deborah K.]

Were there many CAs in your sleep study? If you don't know, post a redacted copy of the study.  Ask your doctor's office for one if you don't have a copy.  By US law they have to provide it if you ask.  This will help us determine what your CAs mean and whether they will lessen on their own.

For now, set your pressure range to 10 to 16.  Although your AHI was higher that one night, it was due to the CAs, which we will ignore for now.  You clearly need the extra pressure.

As to ramp, you may not need it.  The point of ramp is to ease new people into the higher pressures they generally need, but one receives less therapy while it is on.  Yours is set fairly high, so you can leave it on if you want, but set it to 10 minutes, or you can turn it off and see how you feel.

Your leaks are not high enough to worry about, and your flow limits are fine.

Again, welcome, and best wishes for achieving great therapy and comfort!  

[CatFisherman]

Thank you Deborah for your reply! 

I slept with those settings last night, and although I woke up around 1AM (I think my nose pressed against my n20 mask and blocked the airflow) I went back to sleep and I think this is the longest I've been able to rest in years! I still have this oxigenated feeling behind my eyes which feels amazing since starting cpap over.

Here is my attached sleep study report from 2023 and last nights numbers. Any more advice would be appreciated. Do I keep EPR on at 3?

Sleep study summary:
Obstructive Sleep Apnea (G47.33) - Severe based on pAHI=32.9 , pRDI=35.5 and O2 nadir of 85%

[CatFisherman]

I woke up at 1:05 AM, I'm not sure if I can remember exactly why that was, but I have the N20 mask (after trying full face, nasal pillow, and others) and this one seems the most comfortable but I think my big nose blocked the intake of air at some points in the night. I have the largest N20 (large) and my nose is maybe 1-2mm away from touching inside of the mask.

I wore a cervical collar last night, and I sleep on my back on an extremely firm futon that I recently purchased to help with lower back pain, as well as a 15lb weighted blanket, and 2 pillows on each side of my body to keep me from moving, and 1 pillow under my legs. I do not have a pillow for my head.

[Deborah K.]

Keeping the EPR at 3 is up to you.  If you turn it down, your AHI will drop a little, but you may be less comfortable.

The CAs in your study were proportionately low, so you may always have a few, but they should lessen over time as most of them are treatment-emergent.

As to your mask, you show only very minor leaks, so your nose possibly touching the mask did not interfere with your therapy at all.  If it was uncomfortable and woke you up, you may need to consider another mask.  Most DMEs will allow you to swap to a different mask at no charge.  I get mine from an online DME, and they sent me a new mask to try, and I returned the old one (postage prepaid by them) only after I was sure the new one worked.

Your chart will be easier to read if you remove the Snore and Tidal Volume from the chart side.  We only need to see the top five items that you list, and your Tidal Volume shows on the left panel.

[CatFisherman]

All right I've made some changes to the view in Oscar - thank you! Should I stay the course for now and see how things go for a week?

Looks like my Median = 10.54,
                    95%    = 11.98
                    99.5% = 12.58

I got ahead of myself,  and will not wear the cervical collar tonight, I think it was pressing up on the headgear and making the N20 uncomfortable. My basic chin strap has been working fine previously.

On Sunday Mar 2, 2025 my AHI was 2.54 at a Min 8.0 and Max 15 with Median 8.92, 95% ~ 10.64 and 99.5% ~ 11.26. It seems that was the lowest AHI?

Is my goal to have the flattest pressure graph with the lowest AHI? If my current Median is 10.54, should I bump my Min to that? Or is 10 fine? It's almost 7pm and I still don't feel sleepy so I feel like the CPAP is working as intended so far even with waking up in the night (and visiting the fridge).

[CatFisherman]

I think my charts are starting to look better! Feeling pretty good this morning.

The pressure looks less erratic, no waking up in the night (removed the bulky cervical collar and stuck with the chin strap).

[Deborah K.]

Yes, things do look better.  Your AHI has dropped and your flow limits look good.  Stay with these settings for a while unless your sleep seems worse.  You are adapting quickly and have made good progress.  This is great!