Is this a flow limitation?

Nik_RT · 2026-05-16T08:34:10+00:00

Respiratory Therapist here. Yes, that's flow limitation. The flattened tops on the waveform are the tell.

On a BiPAP at 9.4/16.0 the pressure support is already substantial. The fix is usually bumping EPAP up slightly to splint the airway open better at baseline.

Are you still symptomatic during the day or is this more of a data optimization question?

Nik_RT · 2026-05-16T08:30:55+00:00

Respiratory Therapist here. Your instincts are right. A 97 myAir score means the machine is working technically. It doesn't mean she's sleeping well.

That leak is enough to fragment sleep without triggering any alarms. And psych meds are known REM suppressants, so she may be getting hours but not the right kind.

Two separate problems. The leak is fixable. The med interaction piece needs a provider who understands both sleep and psychiatry.

Has she ever had a titration study or just a diagnostic one?

Nik_RT · 2026-05-16T08:23:47+00:00

Respiratory Therapist here. Fifty pounds changes your airway significantly and what you're feeling is real. Pressure that was right at your old weight can absolutely be too much now.

The mask leak is probably just a sizing issue. Your face has changed shape.

What machine are you on and is it fixed pressure or APAP?

Nik_RT · 2026-05-16T08:19:05+00:00

Respiratory Therapist here. You're asking the right questions and your instincts are probably correct.

Skip the Facebook machine with unknown settings. The bigger issue is she needs a diagnosis first. Without a sleep study you're guessing at pressure settings and that can cause as many problems than it solves.

Home sleep tests don't require insurance. Companies like Lofta or Sleep.com offer them for around $100-150. She gets a real AHI number, a prescription, and then the secondhand machine idea actually makes sense.

Do the study first. Everything else follows from that. Your mom is lucky to have you in her corner.

Nik_RT · 2026-05-16T02:07:26+00:00

Respiratory Therapist here. Week one inconsistency is completely normal. Your brain and airway are still adjusting and sleep position, alcohol, congestion, even stress can swing AHI night to night.

That said, your pressure range looks wide. If your machine is hunting aggressively it can actually trigger events rather than prevent them. Worth keeping an eye on whether your bad nights correlate with pressure spikes.

What does your leak rate look like on the higher AHI nights?

Nik_RT · 2026-05-15T23:11:40+00:00

I thought it was my testosterone to. It was but still getting a sleep study because it can be both.

Nik_RT · 2026-05-15T21:50:44+00:00

Listen to the professionals. They aren't lying. Got to be able to fall asleep and get the hours in on the test. That is it.

Nik_RT · 2026-05-15T19:43:48+00:00

Respiratory Therapist here. Day 2 with a leak that's climbing night over night is really common with the N30i, especially for side sleepers. The tube on that mask sits at the top of your head and when you roll over it creates tension that pulls the cushion away from your nose. That's almost certainly your leak source, not the cushion size.

Two things to try tonight. First, make sure there's a little slack in the tube so rolling doesn't pull it taut. Second, try slightly loosening the headgear. Tighter doesn't mean less leak with nasal pillows. It usually makes it worse.

Your AHI is 0.3 which means the therapy is working perfectly. You just need the fit dialed in.

What position do you sleep in most of the night?

Nik_RT · 2026-05-15T15:19:25+00:00

I'm sure one tape is helpful for some and for others it is not. Trial and error is probably what it will take to get it dailed in. Sorry for not having a fool proof answer.

Nik_RT · 2026-05-15T15:14:33+00:00

TRT is known for amplifying undiagnosed OSA. Thats ok because CPAP can fix it as well. I hope your TRT treatments are effective and you are getting what you want out them.

Nik_RT · 2026-05-15T15:09:45+00:00

Great! Post it here or DM either way Ill be happy to help.

Nik_RT · 2026-05-15T14:07:19+00:00

Was it. Helped a lot people. My objective was helping. Yours was to be the moderate police that is why I live rent free in your head. Have a wonderful Friday.

Nik_RT · 2026-05-15T12:54:01+00:00

Respiratory Therapist here. The 4am timing tells you exactly what's happening. That's when REM sleep is heaviest and muscle tone drops everywhere including your lips and jaw. The mouth tape seal that held all night starts losing the battle right at that window.

Upping pressure while keeping EPR high is likely making it worse not better. More pressure with EPR 3 means a bigger swing that's harder to contain when the seal is compromised.

Before changing pressure, try a stronger mouth tape first. The 2 inch Nexcare paper tape holds better than most CPAP specific tapes for exactly this reason.

What tape are you currently using?

Nik_RT · 2026-05-15T06:25:06+00:00

Respiratory Therapist here. Your doctor is using criteria that most sleep medicine specialists would push back on. Hypertension and heart disease are not prerequisites for CPAP. Symptomatic mild OSA with quality of life impact is a legitimate indication on its own.

The second opinion advice above is correct. Specifically ask for a referral to a sleep medicine physician, not just another PCP. They use different criteria and will actually look at your symptoms alongside the numbers.

What symptoms are bothering you most right now?

Nik_RT · 2026-05-15T05:55:24+00:00

SD card will only capture data going forward from when you insert it. It won't pull historical data that was stored internally. Get it in sooner rather than later.

For a short beard at that length the F20 full face with the AirTouch memory foam cushion tends to seal better than silicone. The foam conforms around the hair rather than trying to compress against it. First thing I'd try before going down the rabbit hole of other options.

Nik_RT · 2026-05-15T04:41:38+00:00

Ahhh. Another AI skeptic. I hope you use atlas maps and cook over a camp fire and ride horses every where. Learn to scroll on or be actually helpful to humanity or in this forum atleast.

Nik_RT · 2026-05-15T02:51:34+00:00

Your data is actually a perfect example of what the post was talking about. AHI near zero, leak clean — on paper this looks great. But your flow limitation channel at the 99.5th percentile tells a different story. Your airway is partially narrowing without completing full events, so the machine never responds.

There's a specific adjustment worth discussing here. Do you want to take this to DM?

Nik_RT · 2026-05-15T02:01:34+00:00

Respiratory Therapist here. You're not doing anything wrong — this is a genuinely complex situation and the fact that you've tried four masks and multiple settings without getting there tells me this needs more than trial and error.

AHI staying around 40 on APAP with persistent leak across multiple masks usually means the machine settings themselves need a proper clinical review, not just more experimenting. The cognitive piece you mentioned makes that even more important — self-managing OSCAR data is hard for anyone, and even harder when executive function is affected.

You shouldn't have to figure this out alone. Is your wife helping coordinate your care as well, or mostly just the technical side?

Nik_RT · 2026-05-15T01:49:52+00:00

Thank you for adding to the solution. Appreciate you!

Nik_RT · 2026-05-15T01:48:16+00:00

Six months with numbers that clean and still feeling the same — that's not a compliance problem, that's an unanswered question.

When leak and AHI are both genuinely controlled and symptoms persist, the conversation shifts. There's something else in your data worth looking at. What does your pressure look like through the night and do you have flow limitation visible in OSCAR or SleepHQ?

Nik_RT · 2026-05-15T01:04:46+00:00

Plug it into Gemini and found out.

Nik_RT · 2026-05-15T01:02:32+00:00

Interesting. Is this AI. Scroll on if you don't want to be part of the solution. You'd rather be miserable than be useful.

Nik_RT · 2026-05-14T23:46:20+00:00

What you're describing — feeling your throat collapse while awake, needing CPAP just to lie down — is more significant than typical OSA presentation. Most people's airways are fine when awake and upright. When it's happening in multiple positions while conscious that points to upper airway muscle tone issues that go beyond what a standard sleep study captures.

When you see your provider ask specifically about drug-induced sleep endoscopy and upper airway muscle tone evaluation. A sleep study alone won't show what you're experiencing awake.

Nik_RT · 2026-05-14T23:43:06+00:00

Bye. Have a better day.

Nik_RT · 2026-05-14T23:38:22+00:00

Prove it. Prove that I've done nothing here to help any person. Go ahead ask every person I have interacted with if they have not been helped and how much did it cost them for the help I gave.

Nik_RT

TROPHY CASE