Do these look like spontaneous arousals or respiratory related arousals?

Hello,

I've been on CPAP for about three months now. It has been mostly going well and I feel much better using it. However, there is still some improvement that I think can be made, since I still wake up feeling like I haven't had a full night's sleep.

I have been regularly monitoring my data on OSCAR since starting therapy. One thing that I have noticed is that I experience a lot of mini arousals (perhaps about five an hour) that last for about 5 seconds. I don't remember actually waking up though during these arousals. I used to think that these arousals are spontaneous arousals but now I am beginning to suspect that they may be respiratory arousals.

I am sharing some images below.

I am also curious about whether obstructive events that occur following an arousal are real obstructive events or not. I see that a lot of the times in my data I experience an obstruction following an arousal.

My machine and settings are: Resmed Airsense 10 Autoset. 9 min/11 max. EPR = 3.

Thank you.

I would not suspect that as a cause, as there are no RERA (respiratory effort related arousal) flags set. I think most of your issues may be related to the pressure not being high enough to stop the obstructive and hypopnea events. There may be a couple of solutions. One is to increase the minimum pressure up to 10.6 cm. Or, the perhaps better way would be to change the machine into a fixed pressure CPAP mode set at 11 cm. Then the pressure holds there all night and you do not have to incur events to get the machine to increase pressure.

If you find that is too much pressure to go to sleep with, then you could turn the AutoRamp feature on, and set the Ramp Start pressure at 9 cm or perhaps lower if you find that too much. The machine will hold the pressure at that selected Ramp Start pressure until you go to sleep. I find it works very well.

After trying to run in auto, I have now switched my machine to fixed CPAP mode set at 11 cm, and I use 9 cm as my ramp start pressure. I find it works really well for me that way.