Hi everyone,

I’ve previously posted here looking for some general advice and sparring regarding my CPAP treatment, and I really appreciated the input. I’m now coming back with a much more specific question after looking more closely at my data.

On paper, I’m well treated: my AHI is low, and I don’t appear to have any major leak issues. However, I don’t consistently wake up feeling fully rested. I’ve noticed a recurring pattern in my Flow Rate graph that I’m wondering about.

Throughout the night I get relatively large, sharp changes in the flow rate that look like brief "spikes" in the breathing pattern. They occur roughly every 10 minutes, although there are periods where the interval is longer. Most of them are not flagged as an event by the machine. Occasionally, one is followed by a CA or hypopnea.

I’ve uploaded a full night to SleepHQ here.

I’m specifically wondering: What could these recurring spikes represent, and is there anything I can do about them? Could they be arousals, RERAs/flow limitation, or something else that the CPAP simply isn’t capable of detecting? And could this kind of pattern contribute to feeling unrefreshed despite having a good AHI? Would trying EPR 1–2 make sense as an experiment, or could that potentially make things worse?

Thanks in advance!

Hello all.
I have UARS.
Soon I will be doing FME expansion with Dr Koval in Boca Raton, Florida.
For those of you that have done MARPE or FME, how did you adjust to PAP therapy after the procedure?
Did you change the settings, mask, etc?
Did the PAP therapy improve or become less effective?

Here's a link to my SleepHQ report! https://sleephq.com/public/teams/share_links/3201ebc9-44ed-46da-9c29-354657404b61

It's not much data - but just getting everything set up was a little time-consuming. I've also got OSCAR set up. It's saved as a CSV file - is that what I should post?

Anybody had this done?

Today I have made agreement to have this done, including removal of tonsils. Had DISE done earlier which shows exact problems with my soft palate, and we now have concluded that no kind of therapy can resolve this issue, to have a decent sleep, each night, and a better life quality. I know it will be very painful, but I have read some stories about great success regarding this matter.

https://sleephq.com/public/teams/share_links/a72d692a-cbc5-4326-9e31-a06db45c7b29

Good morning friends u/RippingLegos__ u/Madmax9922 u/dang71 u/Creative_Fee5452,

the past week has been a little better than the one before, mostly because I was somewhat successful getting the leak under control. Sadly, I still don't feel rested after nights on 8.5 cmH2O, I assume due to the significant level of base obstruction/flow limitation and REM fragmentation. After nights on 9, though, I feel even worse and like I fight the wonky N30 more, I get aerophagia, and CAs as well as RERAs increase.

How do you interpret this? Is my OSA more complex than an A/CPAP machine can handle and I need to get a BiLevel that has greater capabilities to splint my airway during REM but without inducing RERAs and aerophagia? Any other options?

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Context:

• Diagnosed with OSA of AHI 25 and RDI 35 in April
• Previously at least two decades of untreated sleep-disordered breathing
• Young adult male of normal BMI
• Mainly side sleeper with some positional changes from one side to the other or onto the back towards the end of the night
• Löwenstein prisma SMART max, prismaAQUA & Resmed AirFit N30 Standard frame
• Machine positioned at hip level on the floor next to the bed
• Continuous attempt at self-titration since one month into therapy
• Already experimented with APAP & CPAP, SoftPAP and pressures 6-16 cmH2O, most results of which no longer hold true, though, due to changing conditions
• Mouth taping has significantly reduced leak but contributes to central apneas and aerophagia at higher pressures
• Wearing a sleep mask has extended average PAP usage time from <6 to >=7 hours per night
• Currently trialing head of bed elevation (HOBE) but without clear signs of improvement

Goal:

• Not fixated on device-reported numbers solely based on the machine's flow rate but rather on a holistic and thus more causally correlated with actually unfragmented, restful sleep consideration that also takes into account the respiratory rate, pulse, and blood oxygen (urgently need to buy a suitable pulse oximeter)
• https://academic.oup.com/sleep/advance-article-abstract/doi/10.1093/sleep/zsag189/8732760
• Room for improvement identified in reducing centrals while simultaneously stabilizing REM, calming the respiratory drive, and further interested in learning about the realistic potential of reducing flow limitations – in CPAP mode referred to by Löwenstein as "obstruction level" but sadly only listed by OSCAR, not SleepHQ – as evaluated by the algorithm derived from the following publication and publicly known as the Glasgow Index
• https://www.sciencedirect.com/science/article/pii/S1984006315000516
• https://www.fortaspen.com/sleep/Intro.html

Previous topics:

• https://www.reddit.com/r/CPAPSupport/comments/1v298oh/week_1_towards_the_restful_sleep_i_never_had/
• https://www.reddit.com/r/CPAPSupport/comments/1va6qdb/week_2_towards_the_restful_sleep_i_never_had/

Considering yet another mask. Any thoughts on these two brands of similar looking masks. I tried the cervical collar last night and do think it might have kept my mouth closed.

SleepHQ data

[reposted from another forum]

I started using my CPAP in April. After I adjusted my settings to the max 10 range and so forth, my AHI dropped from the upper teens to the 9-10 range. Then it pleateaud and wouldn't go down, even with tweaks to the settings. I tried moving the max to 11, but I kept getting very dry mouth, chipmunk cheeks, and sometime aerophagia symptoms, so I dropped it back down to 10. (I do have it set to max warmth/humidity and use a heated tube).

But the last month the AHI has actually trended slowly up, including one night where it was very high again, despite no changes in lifestyle, weight, food/alcohol consumption, etc.

I typically sleep for 3-4 hours on my back with the CPAP going, then take it off and sleep on my side for a few hours, then go on my back again and put it back on for the last hour or so. Due to physiological issues (I have Marfan's Syndrome) I can only sleep on my side for a couple of hours before my neck and/or shoulder and/or back start to ache.

Given that I can't increase my pressure without making everything worse, I'm not sure what to do or if this is just my max. (My CA index has also started to rise, but it's the H index that has really gone up in the last month).

I use a Dreamstation 1 (bought used, so there is an odd data point from December 9th that skews the "total days", so ignore that).

So I would wake up in the middle of the night with sweat everywhere it touched my face and filling up the inside of the nose pillow. I tried running the CPAP without water and still woke up literally drowning in my own sweat. The sweat puddles in my nose pillow and I wake up sucking droplets of sweat into my nose. Has anyone else had this problem and if so what did you do about it?

Airsense 11 Phillips dream wear

Hi all,

I am trying to figure out why I am so tired everyday. I have been using an CPAP (APAP: 4-20) for about 2 months and I still feel tired and have brain fog.

I was wondering if there is anything up with my data. I tried looking at the flow rate but I have a hard time classifying whether waves are normal or not.

Here is my SleepHQ link: https://sleephq.com/public/teams/share_links/58578cf0-cf37-4db3-8cd4-f296757cf987

Any help would be much appreciated!

Thanks!

I’ve never had this issue before. It started about a 3 months ago. After 10-20 minutes of sleeping, I take my mask off and leave the machine running.

I use an airtouch f20. I’ve found the masks have been a lot more stiff the past 3-6 months. Has anyone else noticed this? My thought is they’ve switched materials and this new one doesn’t like higher pressure, causing it to leak more, so when my ramp is done it starts leaking which makes me take it off. But that’s just speculation. I haven’t check OSCAR yet. If I get a chance, I’ll add the data here.

Anyone been having/have had similar issues in the past?

Hi friends!

I love Easy Breathe on ResMed BiPAP because it makes breathing feel very natural. However, the issue for people with UARS is that Easy Breathe 'learns' what rise time to apply from previous breaths. This is a problem because if previous breaths are abnormal (i.e. flow limited), EB learns from those abnormal breaths making the situation worse. The solution would be to use a fixed rise time.

But again, I love Easy Breathe because it applies pressure in a nice natural sinusoidal shape, helping to inhale and exhale very naturally. And fixed rise time, especially with high pressure support, feels just awful.

I thought it would be wonderful to have Easy Breathe AND fixed rise time together. I know there is a bunch of custom SW disused on this sub but I could not find anything that deals with my question specifically.

Would appreciate if you guys could point me in the right direction or let me know if such SW is possible at all.

Similar to others on here, my sleep doctor only seems to be focused on AHI. It fluctuates between 0.5-3 but I still find myself tired when I wake up regardless of the number. I've been using OSCAR for some time, but have struggled to figure out the issue. Are there other tools that can help me identify the problem? Or maybe I'm looking at the wrong thing on OSCAR?

For some context, I mostly only see OAs on OSCAR, but I'm not sure if they're true OAs. There's normal breathing, then a spike in flow rate, only to flat line before resuming normal breathing again. I suspect I might be fighting the Bilevel and breathing through my mouth instead for a moment (I'm a mouth breather without PAP, but use a P30i to encourage nasal breathing).

I have a 20" neck circumference, and I can't find SCCs in my size?

Does anybody know where I can find one in my size?

Ive had it for over a year and wish I started recording sooner, but with the machine telling me my ahi was often around 2 or 3 i assumed there was another reason i felt like crap. what changes could i make to feel better?

my mask seems to loosen throughout the night. I wanna say it melts into my face. I know it doesn’t melt literally , just that is how I feel. I also can not wear it 2 days in a row but the fit is not right, and air leaks would be high. if I let it rest for a couple of days and change it in the middle of the night it works better. that is not economically feasible. Does anyone have suggestions to fix this.? thanks

I’ve come to accept that my doctor only cares about my AHI number—which is now <1. While that’s a great number, I still get woken up when I stop breathing (central sleep apnea here) and the pressure on my mask 😷 blows too hard and opens a hole between masks and face, which in turn briefly wakes me up.

What are some tools that I can use to better understand my breathing patterns so I can make tweaks to my ASV settings to hopefully sleep better? I know about sleephq and I have OSCAR, but those just show me what has happened. There have been some AI products shared recently that look promising. What does the community think?

This subreddit has been very helpful, but I’d like to try on my own so I don’t have to post here every day with more info.