Advice for No REM / Frequent Wake Ups / New User

[sleepy4466]

I'd like to some help adjusting my CPAP to overcome a few issues. I just discovered both this community and am really excited to learn from you all (I love online communities dedicated to self-improvement and open source software!!). I've attached screenshots from my OSCAR data from last night and can upload any other data that's helpful.

In summary, here's the issue:

• I've had some kind of sleep obstruction for some unknown number of years and it causes pretty acute fogginess and afternoon sleepiness

• I'm still adjusting to my CPAP, a Philips Respironics System One (60 Series) RemStar Auto with A-Flex, which I've tried probably about 8 or so times

• My major issue is lack of REM sleep. According to multiple wearables, I often get less than 30 minutes a night. While wearing the CPAP my oura ring says I get less than 10 minutes of REM and I usually feel much worse in the morning after CPAP. I frequently wake up at night, more than usual with the CPAP

• I got a full face mask off of Amazon, but it feels like it doesn't leak too much at night

• I hope I posted correctly. I've been reading the forum. Please let me know if I can make this post better. Thanks so much for your help, I am (so so) looking forward to finally getting a good night's sleep

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[slowriter]

You need more pressure.

See how the pressure graph shows it's cut off at the top? Raise max to 20 to give your machine more room to work.

And notice how your median pressure figure for the night is ~9, and the 95% about ~10? Raise your min pressure to, say, 9 (or 8, per pugsy below).

[Pugsy]

Welcome to the forum.

Please review this thread for image/graph formatting. Less work for you and us if you get everything in one screen shot.
viewtopic/t158560/How-to-post-images-for-review.html

I mention this for future image posting.

I don't know if a better optimization of your therapy will fix your REM issues but it desperately needs to be fixed anyway so lets start there.

Why are you limiting the maximum pressure? The machine wants to go higher and needs to go higher to better prevent the airway from collapsing.
You are having way too many obstructive related apnea events and each one of those could easily cause you an arousal and interrupt the sleep cycle and then you get to start all over in your progression to REM stage and you rarely get there because the apnea events happen and wake you up before you get there....nasty cycle.

You need to better prevent those airway collapses....OAs and hyponeas are related to airway obstructive collapses.
Clear Airway Apneas are central apneas which you simply don't breathe but the airway is open. Having a few of these isn't really a big deal unless they are causing problems. We can't fix them with more pressure anyway so lets set them on the back burner for now.
Maybe a good chunk of yours are related to the OA causing a wake up and then you pause you breathing but that's a byproduct of the original OA and if we better reduce the obstructive stuff then maybe we can also get the centrals reduced as a byproduct.

You probably need more minimum pressure and you for sure need more maximum pressure.
How did you come up with these current settings? Are you comfortable changing your settings yourself?

I suspect that you will need at least 7 or 8 minimum and I have no idea about the maximum.

[sleepy4466]

Thanks so for the reply! I increased my maximum flow and while it stopped hitting a pressure ceiling, my AHI also increased slightly and I got almost zero REM (according to my oura ring). I also feel pretty tired. Here's screenshots. I hope i followed the image guideles this time. I didn't see an option to hide the bar graph in the latest version of OSCAR in the appearance section. Any other suggestions? Maybe some different settings could help? Thanks so much for your help. I so so earger to get a good nights sleep.

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[musculus]

pressure needs to go up. try 10-12 at first?

[Pugsy]

You also need more minimum pressure starting point. The minimum pressure is what does the bulk of the work for holding the airway open and preventing the airway from collapsing.

I suspect at least 7 or 8 cm minimum will be needed. The higher starting point gives the machine a head start for when it needs to go up. It can get to where it needs to be in a more timely manner. These machines can't increase the pressure to where we might need it in the blink of an eye. Instead they can take several minutes to get up to optimal pressure and while it is going up the apnea events happen. These machines don't/can't increase the pressure during an apnea event either. Instead they stop and twiddle their little thumbs until the obstruction has passed and then they slowly continue increasing the pressure.

Using more minimum holds the airway open better in the first place and gives the machine a head start when it needs to increase.
The idea is to prevent the collapse in the first place instead of trying to fix things after they happen.

The pie chart...can be turned off via OSCAR Preferences/Appearance tab.

The dark background makes it a bit difficult to view.
To turn off Dark/Auto Mode:
System Preferences / General / Appearance
Then select the Light Icon

We want the bar graphs on the left side showing AHI and different categories. We don't particularly need the pie chart though but as long as we can see all the statistics on the left side it's not a big deal if the pie chart is there.
Sometimes for some people the pie chart hides some of the statistics which is why we like to turn it off.

So you need more minimum pressure...at least 7 and probably higher. If you can't make a big jump comfortably go up in small increments so that your body can more easily adjust.

[sleepy4466]

Thanks for the all the help so far! It's sooo appreciated. Two things:

1. My tolerance to the CPAP is getting better, in that i get more REM than I used to while wearing it, but it's not any better than I was without it. Here is the latest night. I was fitted for a nose mask and used just that last night instead of the full face mask. Though my AHI is lower, (it was around 10), i'm not getting any more REM and still having lots of awakenings and events during the night recorded by my CPAP as obstructions.

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2. I tried looking in the appearance setting to get rid fo the pie chart and can't find the option. Sorry for not understanding those instructions

Any tips on what I can do next? I increased the minimum and added humidity. Anything else?

[slowriter]

You could use still more min pressure.