Sierra

Yes, some good things, and some not so good. The auto ramp worked as it should. Hypopnea, RERA, and Flow Limitations are down, which is good. However, OA events are up, and especially when the pressure is at max. My suggestion now would be to increase the minimum pressure to 10 cm, and the max to 13 cm to see if that helps with the OA events.

And as you can see the first part of the sleep was not too bad for mask leaks, but the second part was not so good. Perhaps more tweaking to the adjustments of the mask.

When posting screenshots it helps to get a full width window so the screenshot is larger on the screen. Use the orange Write a Reply button at the bottom left to get the full window. I have had cataract surgery and am trying to be eyeglasses free! That last post forced me to dig out my readers... I'm 75, the pleasures of getting old...

I should not paint all sleep clinics with the same brush, but many are really only in it to the point of selling a CPAP machine at a big markup. They pretend to offer follow up care, but really do not do much. Where I am if you get a "free" sleep study done and if you test positive for the need to use a CPAP they offer it at a cost of about $2500. Things have changes due to COVID and a microchip shortage but at the time the whole machine and mask kit could be bought on line for about $800. The difference is their markup.

The other little dirty secret of the industry is that the MyAir app sends very limited summary data over the air. If the clinic even looks at it, there is not much to see. However, AHI's over 5 should be raising red flags, and it sounds like it has not. MyAir is mainly intended for those who get their machine paid for by insurance or medicare on the condition that it is used a certain minimum amount. MyAir designed to measure that compliance, and not really to provide information on how the machine should be adjusted.

Approved clinics that sell ResMed machines should have a program called ResScan that produces similar report to OSCAR. The only way they can see the detailed data that you see with OSCAR is if you bring your SD card into the clinic and they download the data like you do with OSCAR and view it in ResScan. Only then can they see the details needed to evaluate what is going on and make good recommendations for adjustment. This takes time that they don't want to spend. Instead they want you to come in and do a sleep study which they can bill for.

Dirty secrets of the industry! But, I am sure some are much more responsible....

I don't bother to lock the cards before downloading the data. Both my machine and my wife's are AirSense 10's and I don't think they have this issue. Her previous machine was a S9 and OSCAR claims that might be a problem.

I look at that Daily screen primarily to see when the apnea events are occurring, and at what pressure they are occurring at, and of course the types of apnea and how much each contributes. Next I look at the Overview page. This has a bar chart by day which breaks down the contribution of each type of event. You can quickly see from that what types of events are occurring and if they are increasing or decreasing in response to settings changes. Last I look at the Statistics page to get a little more detail on the breakdown of events. This page will give a running average of your AHI for each setting. A new line starts each time you change the settings. It keeps a useful history of what setting you have tried and what the AHI outcome was for each.

A couple of comfort and convenience things you could consider are:

• Change the Ramp Time to Auto, and set the Ramp Start Pressure to 7 cm. Instead of ramping up the pressure based on time, it will start at 7 cm and hold there until the machine determines you are asleep. Then it will ramp up to your minimum set pressure. The maximum time it will hold is 30 minutes, and then it ramps up regardless. This can be more comfortable when going to sleep.
• Turn your Smart Start to On. This setting will start your machine automatically when you put the mask on and start to breathe. It will also stop it if you just remove the mask. However, my habit is to turn it off manually before I take the mask off.

Good luck! Post what you get with EPR at Full Time. That may make a significant change, hopefully for the better.

Another thing that some people do is move their machine and wear it during the day while watching TV or while on the computer. A big part of it is getting comfortable with the machine, and realizing that you are not going to suffocate or anything bad. A screenshot will be helpful even if you do not sleep. It will show where all the settings are at, and I may be able to offer some suggestions for improvement.

I did not take to wearing a CPAP well at all. I recall thinking that I would get up and throw the whole thing out the window. but fortunately I did not. Getting the settings right, along with finding a mask you can "make friends with" goes a long way to improving comfort. What mask are you using?

If you can post a screenshot of a typical night with OSCAR I may be able to help you with the device settings to gain some more comfort.

That looks better. On the mask the Full Face is the right setting. However, there is no leakage reduction benefit in taping your mouth while using a full face mask, because your mouth is already covered. Mouth taping is typically only used with a nasal or nasal pillow mask. I have heard from others that when you tape under a full face mask the tape gets soggy and does not stay on. Some also have expressed concern that the tape may be more difficult to get off in the case you need to get it off in a hurry...

Your EPR is on Ramp Only, and needs to be switched to Full Time. That may improve your Hypopnea and RERA event frequency. Lets see that that does to the flow limitations. They seem to be driving the need for more pressure. Perhaps with EPR on full time they will decrease and pressure will decrease too.

On the humidity control I just leave it in Auto, but my level seems to default to 4 not 6. But, with a long night's sleep I do use most of the water, but not all.

On the pillow a down or down alternative is a good choice. I try to sleep with my head resting on the pillow but with my mask hanging over the edge of the pillow. And the satin pillow case seems to help too.

Try the EPR on full time and see what happens to the pressure.

After thinking about your OSCAR screenshot a little longer I realized that if you are using mouth taping, you must not be using a full face mask. The machine should be set to match the type of mask you are actually using. Setting the wrong type of mask can make the leakage rate less accurate. However if you have it set to full face and are using a nasal mask the error would be in under reporting your actual leakage rate. Each type of mask has a calculated vent flow which is subtracted from the total flow to give the leakage rate. The full face has the highest vent flow and the nasal pillow the least. So if you have it set for full face and are using a nasal pillow then air leakage will be under reported.

I am a determined mouth breather. My solution has been to use two layers of tape. The first layer is 1" wide 3M Micropore tape which you can get at Walmart. I fold the end over to make a tab that I can quickly remove the tape in an emergency. I have never had to actually do it. At first that is all I used, but found it was coming loose at night and not sealing for the whole night. So then I added a wider second layer of tape 4" wide which I cut to about 60 mm long. It is called Molnlycke Mefix. It is more flexible and keeps the first layer on through the night. You probably have to go to a medical supply place for this or to Amazon, which is the last place I bought it at. Again I fold the edge over in case I have to remove it during the night. This works for me. You may get away with the Micropore tape only.

This said, I think your leaks are so large that I suspect your mask is become dislodged at night totally breaking the seal to the face. The first step may be adjustments to the headgear. Unfortunately too tight is not good either. It may take a different style of mask to get to a happy place. What mask are you using currently? I see it is set for full face.

There is nothing wrong with having the mode in AutoSet at least initially. However, when you nail down the best pressure it can be worthwhile to switch to fixed pressure CPAP mode. That is what I do. My wife still has her machine in AutoSet but with a very narrow band between min and max pressure. That is almost the same as fixed pressure mode. She averages less than 0.5 for AHI so I don't like to fool around an change it. Also if I change something and she has a bad night sleep then guess who gets blamed?

As for quirky things to blame or solve issues here are a few of mine. I blamed the weather, and more specifically the atmospheric pressure. After tracking it for a while I found that was a red herring. On the more successful side I have found that keeping the temperature cool at night seems to help. And the other thing is using a down alternative pillow that conforms to my head, and a satin pillow case cover. I believe it is slippery and helps to not drag the headgear out of place on my head. And I find the down alternative does not push back against my face and move the mask out of position. You mention shaving. I shave and wash every night before I go to bed as I think that makes the tape stick better and not come loose during the night!

The first thing I would try is turning your EPR on, and set it at 3 cm. That has the potential to reduce the hypopnea (H) events, and possibly the RERA (RE) events as well. And, you have to find a way to stop the mask leaks. The leakage is way too high, and is keeping the machine from determining what kind of events you are having. It is just reporting them as UA's, or unclassified apnea which is not very informative. Of the events reported clear airway (CA), or central apnea events are the highest. More pressure does not resolve CA events as the airway is already open, and in fact higher pressure can make it worse. I think the pressure may be going too high. I would suggest you reduce your maximum pressure to about 12. Post another report after you make those changes. If you need help making the changes just ask. There are some other changes for comfort I could suggest, but this is probably enough for a first change.

Finding is good mask that suits you is difficult. I use a ResMed AirFit P10 nasal pillow mask. It is a very minimalist mask and is comfortable. If there is a weakness, it is the headgear. Fairly recently they have come out with a somewhat improved headgear for it. I believe it is the most popular mask used. But if you open your mouth in your sleep, it is best to use mouth taping. I mouth tape every night.

With the ResMed machine events are not reported when the leak rate of the mask exceeds the redline of 24 L/min. If evens are flagged during a high leak period they should be identified as Unclassified Apnea (UA) events, and the machine does not respond to UA events. So, pressure should not increase while the mask is leaking. You can confirm that by looking at the OSCAR pressure graphs to see what the pressure does when you are having a large leak - there will be grayed out areas of the graphs when the leak exceeds the redline.

If you want to post a typical OSCAR Daily Report screen here I can take a look at it to see if there is anything obvious that can be done. To do that on a PC make the Daily report full screen with a full screen window and press F12. A box will pop up asking where you want to save the screenshot image. Save the file. Then with a full width post here, find the file with File Explorer, left click on it, and then drag it into the post here. It should upload.

Based on what you report your AHI readings do seem fairly high. What is the average breakdown of the various components of the AHI? You should be able to see that on the Statistics page. AHI, OA, H, and CA events are the important ones. The 95% pressure is also a useful number. If you have imported a year's data there should be some good averages there.

However, I can tell you the most if you post a Daily report screenshot for a typical night. I posted an example of one in an earlier post.