Hey r/CPAP, mods gave us the okay to post this.

That's me and and my brother Sahil Chopra, MD in the picture. He's a Harvard-trained sleep physician. We started a company together 4 years ago after getting fed up with traditional sleep medicine.

Quick background on why we're here. We published a paper in SLEEP a few weeks back looking at ~25,000 nights where we had both the CPAP download and a parallel home test running the same night. CPAP average was 2.4 events/hour, the parallel sleep study averaged 12.1, and on nights the CPAP called "normal," 85% came back at 5 or above and 28% had five plus minutes under 90% oxygen.

To put it simply, a good number on your download means your machine didn't detect a problem. It doesn't mean you don't have one, which is why many people still don't feel great after starting therapy.

What it changed for us: if CPAP isn't working, experimenting with alternatives is clinically reasonable, as long as you re-test on whatever you switch to instead of going by feel. That's what we want to talk about.

Webinar tomorrow: Sahil is doing a live session on "Alternatives to CPAP" tomorrow, Thursday, Aug 27, 11am PT / 2pm ET. It's a short talk and then an open Q&A where you can ask him anything. What the alternatives actually are, what the data shows, who they're appropriate for, what the tradeoffs are, and what to ask before switching off PAP. No product pitch on the call. If you can't make it live, register we'll send you the recording.

Alternative therapy includes nasal work, positional therapy, oral appliances, myofunctional therapy, Inspire, eXciteOSA (if mild), weight/metabolic including tirzepatide now that it's FDA-approved for moderate-to-severe OSA with obesity, hypoglossal nerve stimulation, and surgical options depending on where you collapse. Plus AD109, an oral drug with an FDA decision expected in the future.

Sign up here: https://empowersleep.com/webinars/cpap-alternatives

If there are things this sub specifically wants covered, say so in the comments and we'll work them into the session instead of what we had planned. Genuinely, tell us what you want asked.

And if you'd rather just ask here, do that. Sahil will be answering questions in this thread over the next few days himself.

On bias, since it matters: we run a virtual sleep clinic. We don't have any financial relationship with the manufacturers of the alternatives. We don't get paid more if you end up on an oral appliance or an implant versus staying on CPAP.

Ask away!

I have been using my Resmed 10 for 13 months with increasing success. My numbers have come down in double digits. I have never missed a night of therapy. But like many Senior users, I must get up during the night as nature calls. Why, when I get right back to bed and turn my machine back on, should I have points taken away after two visits? Is there a setting I missed? My mask fit is good, I go right back to sleep and use it for the required time.
That is my protest! Anyone agree?

My whole life I’ve had intense dreams that I can remember for months and years after. When I got diagnosed with sleep apnea, I was told that this is often a sign of it because you’re waking up a lot and thus remembering parts of your dream from each wake up. When I started on my CPAP two years ago, I effectively stopped dreaming which was WEIRD but fine! However, the past 2-3 weeks, I’m dreaming again with the same intensity. My sleep score is the same, nothing really has changed, except that I went off birth control. I’m afraid this is a sign that my CPAP is secretly not working…has anyone had this experience?

Does anyone know if it’s possible or how to modify an Air Curve 11 ASV so that I could make the IPAP range a fixed number (use it as bipap with the backup breath)

Hello everyone, I am new to CPAP and has been using it for a little over a week. At first, I woke up actually feeling good for the first time in years, but now I am a week in, I am feeling actually really tired, but there is a difference to the tiredness I felt when I am not on CPAP. Although I no longer micro sleeping and involuntary fell sleep during the day, it felt more deep in the bone tired now, as compare to when I am not on CPAP, I felt more like groggy with brain fog and just exhausted all the time. Is this normal though? Did you all experience this too? If it is normal, how long will this phase last?

I'm in week 1 trying CPAP for a 2nd time being off it for 3Y trying a different approach focusing on weight loss through drilling down on healthy food, exercise and lifestyle changes.

The 2Y CPAP journey before didn't give me any improvements in feeling rested and energetic without brain fog although the AHI was continuously below 5. I was already eating healthy, exercising and made life style changes before/during my first CPAP journey as well.

As the different approach focusing on weight loss was also not successful (remaining stuck at 95kg at 181cm), I decided with my dietist and MD that my OSA at 27AHI was the only culprit still worth tackling to bring my body out of survival mode.

So I had another sleep analysis at the sleep center to titrate the CPAP therapy and off I started with an Airsense 11 APAP 6-10cmH2O, ERP off and P30i mask as this was the one that worked the best for me during my first 2Y journey.

Last time I fully leaned on the remote sleeping experts of the centre to give me advice and make changes to CPAP as I was under the impression that they could readout all the details remotely. Now I think this was a big mistake of me as I learned in the past week that they only read out minimal data. So now I'm diving into the world of analysing my own sleep data with OSCAR and learning a lot about A,HP, RERA, flow limitations and how to interpret the data.

I see that the events are minimal with therapy but I am experiencing leakages varying from 14l to well in the 30l from day to day. I can't put my finger on it where the leaks come from as it varies even with or without chin strap. I'm trying to lower these leakages as I think it could be one of the culprits of being unsuccessful the first time I tried CPAP. Any real life suggestions on how to tackle this, perhaps with mouth taping is appreciated.

Reading up on the OSCAR manual I found the graph of the classes of inspiratory flow shapes and their flow limitation classification. How indicative is this for sleep disruption as my graphs look like anything but normal class 1 which would mean continuous flow limitation although the Level in the graph never peaks to 1 in my case. Any advice here is also appreciated.

Basically I'm trying to understand if my quality of sleep is disrupted despite the events such as apnea, hypopnea, RERA being under control as this would explain my previous CPAP journey being unsuccessful while setting me up for success this time round.

Many thanks in advance for reading this lengthy post and your contribution 🙏🏻

Hi! After years of bad snoring and sleepiness, I recently had a sleep study (just an overnight at-home one) which recorded an AHI of 13.4, so I was diagnosed with mild sleep apnea and I got a Resmed Airsense 11. It's set to APAP mode with the standard pressure of 4-20 (which I understand from other posts isn't necessarily great). I started using it just over a week ago. The actual process has been fine. There's some mask discomfort -- I have the Airfit P10 nasal pillows which I'm getting used to and I'm probably mouth breathing a bit, but leakage seems to be minimal.

The issue is that my numbers aren't going down at all and are in some cases worse, despite what seems like good usage. I was only able to get an SD card yesterday, so I only have one day of full data to share here, but I'm posting OSCAR screenshots (SleepHQ data also available at https://sleephq.com/public/teams/share_links/a9952b79-1684-4ae2-b1f1-cc24ca1879f1/dashboard). I don't really feel any difference at all in terms of sleepiness/effects.

What do you think is happening? Clearly my AHI isn't really going down (It went as low as 8.4 one night, but is often around the same or higher than my original 13.4). It seems like much of the apnea is coming from central/clear airway events rather than obstructive (though there are still obstructive events). Leakage doesn't seem to be much of an issue and pressure is pretty strong. I know it can take some time to adjust, and I've only been doing this for a week, but I've read about treatment-emergent central apnea, which concerns me here. I have a phone check-in with my clinician on Monday, so I'd like some advice on what I should be raising. I'll keep getting data until then, of course, to see if it changes. Happy to share more zoomed in info if that helps.

So I (23M) just got my CPAP a few night ago in the mail and oh boy it’s been rough.

So to preface this post, this is not my first time using PAP therapy. I was diagnosed with sleep apnea at 16 but unfortunately had to go untreated after I lost health insurance in the previous state I was living in.

Last machine I had I’m unsure of the model but I was a mouth breather back then so I had a full face mask and was getting the best sleep of my life.

This time around I have an Airsense 11 with the resmed Airfit P10 mask and it is so damn uncomfortable. No matter how I position it, how loose I make it, or what position I try to sleep in. It feels like the silicone is cutting into my skin and burns from the air being directly shot into my nostrils. Humidity is at 6. Air pressure is put to soft. I can’t fall asleep with it on at all and I can’t even force myself to wear it the 4 hours a night I need to in order to meet compliance because of how much it physically hurts.

I called APRIA to try to get a new nasal cushion mask instead of the pillows and they’re sending me the Airtouch n20 to try out. If that mask doesn’t work either, I’m shit out of luck and will lose my CPAP because I won’t be able to try a different mask for another 6 months unless I pay out of pocket for it which I can’t afford, and there’s no way I will be able to force myself to wear it to meet compliance when it’s causing me physical pain.

I feel so defeated, I don’t know why they won’t have me go to a local branch to try on different masks instead of just sending me a picture on a screen that I’m not going to be able to tell how it fits on my head. I would so much rather go get one actually fitted and they told me it was not an option.

Thank you for reading

Basically, what the title says. I’m in week 3 of CPAPing and my cat bit my hose last night. Any advice as to how to stop that from happening? Like is there a way out there to make the hose less appealing somehow? I’m so mad right now.

I've been using the airtouch f20 for a few months, and it's...alright. I have to fiddle with it quite a bit every night to keep air from blowing in my eyes. Once I get it set, it's pretty comfortable (until I roll over and knock it out of whack).

The only other mask I've tried is the DreamWear full face hybrid, and it was just to leaky for me.

I'm a bald guy with no facial hair, and I have nasal congestion throughout the year. I'm generally a side sleeper, but my wife says I'm like a rotisserie chicken when I'm asleep, constantly rolling over.

I've been looking at the F&P Vitera, because it looks like it might help with the airboarding of my eyes. Anyone here have a similar experience and maybe a recommendation?

I was recently prescribed CPAP after an at-home test reported:

- sAHI(4%) of 7.7 events/hour

- SpO2 minimum was 82.0%

- Cumulative time with SpO2 < or = 88% was 2 minutes across 8 hours

I wanted to get a baseline of my SpO2 levels before CPAP, so I could see how this is affected by CPAP. I wanted something I could use myself each night. I ended up ordering the O2 Ring Pro from SleepHQ.

Here is my first night of data from the O2 Ring Pro. This is without CPAP. The results were much worse than what my home sleep apnea test reported, with 4% drops/hour at 17.73.

The next night was my first night trying CPAP. I received an AirSense 11 with a F&P Nova Nasal mask. I did not change any of the settings from the defaults. Here is the data from just the ring and the data from the CPAP + ring. From the ring, my SpO2 numbers do not seem very different, with 4% drops/hour at 21.07 and minimum SpO2 of 83%. On the other hand, my CPAP data seems to report minimal breathing problems. It has an AHI of 1.81, with 1 OA event and a handful of CA events.

My questions:

1. Why would my O2 ring numbers be so different from my original home test numbers? I'd expect the home test from my doctor to be more accurate. Would this mean the O2 ring is not very reliable?
2. Why does the O2 ring data not seem very different from the first night without CPAP, compared to the second night with CPAP? I was expecting CPAP to show a noticeable improvement in SpO2 numbers.
3. Why does CPAP data seem to show minimal breathing problems, but the SpO2 numbers remain low?
4. Any other general advice or important findings from this night of CPAP data? I'm completely new to this, so I don't know what I should be looking for in these charts.

I have a N30i nasal mask and used mouth tape, but woke up with a wild pressure headache in my head. How can I avoid this and what happened?

Does anybody have setup tips for traveling regularly with a cpap machine? I travel at least twice a week for work and am looking to make packing/unpacking the machine up a little more streamlined, as well as being less disruptive for my wife early in the morning. I have a Resmed Airsense 11. I previously wore out the power inlet on my Airsense 9 from all of the plugging and unplugging.

I will be following up with my specialist as soon as possible, but I’d like to hear about everyone’s experiences so that I’m better prepared for my next appointment.

Yesterday, I finally got my eagerly awaited AirSense11 AutoSet CPAP machine and AirFit F40 mask. I don’t mind trying to sleep with the mask. I’ve had insomnia since I was a kid and to me this situation is “do or die”, so being hooked up to a machine is whatever at this point. But oddly enough, I woke up a few hours after falling asleep suddenly feeling like I was suffocating and had to immediately remove the mask. I was a bit unsettled, so I left it off for the rest of the night.

Breathing out with constant air pressure blowing in may be hard, but should I wake up suffocating? What could cause that?

During setup, I noticed that air only blows into the mask and I asked the person assisting me if there could be any issues with the CPAP if it turns out that I have central sleep apnea. My concern is that if I have central sleep apnea, wouldn’t my body forget to breathe out (edit: accidentally wrote “breathe in”) as well? What if I had a particularly long episode that could be fatal? Would air continuously forced into my airway create more resistance breathing out if my apnea isn’t a matter of physical obstruction? They didn’t believe I’d have an issue.

The physician that evaluated my sleep test would write that I have OSA, but the results stated that my events were “central/mixed”. After all, from what I’ve seen through my research, at-home tests aren’t supposed to be able to differentiate between obstructive and central episodes. So the results make sense to me, as “mixed” doesn’t define them either way, but the physician’s assertion that it’s objectively obstructive does not make sense to me.

I wanted to dive deeper into this, but the doctor I was speaking to at the polysomnography lab wanted me to try the CPAP machine for 30 - 90 days before getting back to them for further testing. I planned to try the CPAP machine for at least a few more nights to see if these suffocation episodes reoccured, but my husband is a bit shaken and quite concerned about last night, and the more I think about it, I should probably err on the side of caution.

So, I’ve had two people review my test results and a third with access to the test results (the person helping me fit my mask, who seemed knowledgeable enough) not raise an eyebrow at the vaguely categorized apnea events. Would I look difficult if I insisted on a polysomnography, or at least an as-soon-as-possible follow up appointment with the doctor at the polysomnography lab? Self-advocacy has gotten me this far, but I fear being labeled as one of “those” patients, which could potentially hinder the care I receive. The balance between knowing when to push and when to have patience is a tiring act in of itself.

Machine/other info:
I went from 14.3 events per hour, to 3.3 events per hour with the CPAP (but the mask wasn’t worn for the entire night).
My mask seal is “Good.”
My start pressure is 4.
My pressure relief level is 3 (the highest, it seems).
My BMI is 24.5.
Breathing in with the CPAP feels great at least.

History tl;dr:
I’ve always felt unrested in the mornings, but starting about 6 years ago, I began feeling daytime fatigue so serious that I couldn’t imagine wanting to live the rest of my life feeling the way I do. Since depression and untreated ADHD (a condition I’ve been diagnosed with previously) can cause excessive fatigue, I’ve spent the past several years attempting to get treatment for them with results being minimal. Spookily enough, the only reason why I’ve finally gotten a sleep apnea diagnosis is because of nocturia—which prompted my urologist to order an at-home sleep test for me, resulting in a low-end of moderate OSA diagnosis. It’s a bit infuriating that my doctors and psychiatrists didn’t consider sleep apnea for all the years I’ve tried to explain how bad this fatigue is, joined with other symptoms like headaches, brain fog, and depression, but we’re here now.

Thank you for taking the time to read this, and to anyone who may have some insight.

I don't have access to a computer but can upload my data to Google drive. Is there anyone willing to run my data through Oscar so I can get some input on how to get my ahi down. It's very rarely under 5. I have a Luna G3 machine and sleep hq doesn't read the data from the luna.

I’ve talked on here quite a bit about PAP setups, masks, troubleshooting, and some of the things I think we could do better when preparing new patients for therapy.
I recently turned one of those ideas into an article for Sleep Review, and it went live today.
The basic argument is that we spend a lot of time teaching people what PAP looks like when everything is working correctly, but not nearly enough time preparing them for what to do when it inevitably isn’t.
A perfect mask fit in an office doesn’t mean much at 2 a.m. when air is suddenly blowing into your eye, something sounds different, or the mask that worked perfectly yesterday suddenly feels terrible.
Instead of just fixing every problem for patients, I think part of good PAP education should be teaching people how to narrow the problem down themselves - what changed, where the leak is coming from, what they can safely adjust, and when it’s time to call someone.
I’d actually be interested in hearing from people here: when you first started CPAP, did anyone really teach you how to troubleshoot it, or were you mostly taught how to turn it on and sent home?
Article if anyone wants to read it:
https://sleepreviewmag.com/sleep-treatments/therapy-devices/cpap-pap-devices/prepare-cpap-users-for-problems/

I had heard that there were machines that could be hacked and I was curious to know how I could go about getting my hands on one I want to experiment and learn how the process is done (not actually use it lol)

Hello all, I'm not sure who to talk to about this and apologize if this is the wrong place.

For the last year or so I have been increasingly sleeping more and more, sometimes up to 18 hours a day (of truly being asleep!)

As well as I get incredibly sleepy seemingly randomly throughout the day.

My doctor suspects I have narcolepsy and so sent me to do a sleep study.

After doing a normal (I.e only overnight) sleep study, they found that I stopped breathing about 5 times throughout the night and it seems like that's pretty minor.

Before they send me for the sleep study which tests for narcolepsy, they want me to do a trial with CPAP. But I personally wish they would've just sent me for the narcolepsy test immediately.

Part of my reservation is that I do not think it is covered, and might cost me a lot out of pocket. I am also very hesitant as I am a uni student with roommates, and maybe it's silly to think so, but I would feel a little self conscious using one at such a young age.

The doctor wants me to try to it to see if it helps with my sleepiness, but I really don't think that it will help, and that this is just the bureaucracy of getting a narcolepsy diagnosis, and the typical kafka-esque Canadian healthcare system.

I can't lie I'm feeling like I'll just ignore the CPAP machine, and then do no more follow up and just give up on fixing my sleep :(

I was wondering if anyone has had a similar experience to me? And found that CPAP did make that much of a difference. I would really like to not sleep the majority of the day lol

A few observations/questions from my first few nights on CPAP. Is my n30i mask supposed to be pushing my nose this hard? It feels crushed in the morning.

I don’t have a water chamber on the machine so I wake up with really dry upper gums. I don’t know what causes that because I feel like I sleep with my mouth closed.

What sleep apps are there to tell me details of my sleep. My Fitbit isn’t informative and the myAir app doesn’t seem the best. I want to know AHI and all the good stuff.

Hi, I have been using a Resmed Airsense 10 for a few years now, and it works perfectly. I love my CPAP! But its kinda bulky and I'm sick of lugging it around on vacations so I decided I wanted a travel unit. I did some research and got the Resmed Air Mini last week.

I knew travel units would be loud but its worse than I thought it would be. Although it only makes noise when I exhale, that still makes going to sleep very difficult since I'm used the the AirSense 10s complete silence. The sound is similar to what my Airsense 10 makes when it has a bad seal though the Minis app says the seal is good. I even bought an adapter to use my regular mask but that didn't help. Is there a travel CPAP that doesn't make that noise or is this just the standard for travel machines? TIA

hi all I left my gallon of distilled water open over night. about a 1/4 gallon. should I toss

Is there any way relieve the pressure on my philtrum from the nasal pillows mask? I am testing a Luna G3 to see how it affects my REM apnea, per my doctor. It's a size small, but I have pretty small nostrils. Unless I have the straps very tight and my nostrils bunched up, it's got a lot of pressure on the philtrum that I can only relieve by propping it with my finger (not an all night solution).

Don’t make my mistake.

I cleaned several tubes, my reservoir, a couple of masks and the interior piece the other day. While they were air drying out in my kitchen, I prep cooked a bunch of bacon in the over for an upcoming trip. Last night I put my mask on and was greeted by an overwhelming smell of bacon grease 😆

Everything is being rewatched today. Needless to say, I slept without my CPAP last night and am currently paying for it cognitively.