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RE: 2.5 months into using CPAP, looking for possible adjustment recconendations.
This is interesting! My charts look a lot like the original poster's charts. My "official" Resmed 11 came set with the level prescribed by my sleep studies, at CPAP and at 8 cm, which did not work for me at all after spending many months with a second-hand Resmed 10. That one had been set to APAP with a range of 7.4 to 15, IIRC, and EPR at 3.
Currently my settings are APAP with 8 to 13 cm, EPR at 1. I worked myself down from EPR 3. Results are variable, with some nights great and under 1 AHI. But I also get a lot of nights in the 3 to 4 AHI range and wake with a headache. I looked through months of my charts in OSCAR and arrived at about 9.5 for my 95% pressure average.
Tonight I'm going to try an adjustment - I'm now set to CPAP at 9.4, with EPR at 2.
I read them along with other papers, and the landscape has not become clearer. In short, both APAP and CPAP have advantages and disadvantages. The choice depends on the patient's situation and condition.
My main concern about these reports is that the methodology is not available. The approach we suggest today, APAP, can differ significantly from those used in the older references. I understood that the study from 2002 concluded that the APAP pressure adjustment causes micro-arousals, which disturb sleep. However, the first advice we deliver on this forum to patients who obtain an APAP machine in a factory setting is to increase the minimum pressure to close to 95% percentile pressure. Incidentally, this is the CPAP pressure recommended. Was this protocol included in the above-referenced study? I do not think so.
Nevertheless, it is an important topic to consider carefully because we advise members.
For instance, during the 25 years, I switched from CPAP to APAP and BIPAP, and I have had a positive experience. At the same time, others in this forum advocate CPAP over APAP.
I trust I will have some time to read papers and start an independent thread about this CPAP vs. APAP story.
RE: 2.5 months into using CPAP, looking for possible adjustment recconendations.
I prefer apap, as cpap is limited to one setting. A person's needs can change during the night. Cpaps keep a person at roughly the highest pressure they ever need, while an apap allows lower pressure when the high pressure is not needed, making them more comfortable to use. For people who are sensitive to pressure changes, one can use an apap set for a smaller pressure difference.
RE: 2.5 months into using CPAP, looking for possible adjustment recconendations.
Here are my resutlts from the most recent 3 nights. My central apneas have increased above what has been the normal for me. I think that might be due to the epr also increasing. I posted in the forum a few months ago about this issue. My flow limits do seem to have lessened interesting enough.
RE: 2.5 months into using CPAP, looking for possible adjustment recconendations.
Where you are at is a balancing between the flow limits and centrals. I would try moving the EPR down for a few days and see if that helps. As you move down the EPR check the centrals and flow limits, that is what you are trying to get the balance, you are trying to achieve to be the best for you. It may be you will need to get to the place where you have EPR 0 but you will have to decide where it needs to be set for you. And if the O and H events go up you will need to raise the min to fight those.
RE: 2.5 months into using CPAP, looking for possible adjustment recconendations.
It means that the benefit, i.e., the FL reduction, gradually decreases with increasing pressure. There is a pressure above which the FL is no longer reduced despite further pressure increase.
Here is a hypothetical example: you have a 0.1 FL reduction when you increase the pressure from 5 to 9 cm, then a 0.03 FL reduction when you increase it from 9 to 13 cm, a 0.01 decrease when you increase it from 13 to 17 cm, and a zero FL reduction when you increase it from 17 to 21 cm.
