95% pressure steadily going up- should I be concerned?

[Vike3]

Been on CPAP for about 7 mos now.  For my in lab study and for most of the earlier months even though my AHI was a lot higher, my 95% pressure was around 9.2 or thereabouts.  Now it is over 10.   There could be some explanations for this but wondering if going from EPR 0 to EPR 1 could be the primary cause ?  My AHI was lower at EPR off but Aerophagia was an issue.   Also my leak rate is a little worse (gotta figure out how to tighten these nose mask straps better. I had been using the one that went over mouth and under the nose and although I like the nasal one better the fuller face/partial face was easier to keep tight.)   Other potential changes, I've gained a few lbs and have been doing more back sleeping than in the past as the constant side sleeping causes shoulder and even left side leg pain.  I do have chin strap, cervical collar.   Here's my stats if that helps.  My centrals have gone up slightly with the EPR at 1 vs 0 and have also had nights where it has been all hypopneas (are they usually obstructive or central?)  RERA's lately as I have been stuffed up with a cold and have had some issues in the last few months with nasal stuffiness where one nostril blocked a lot.      

[staceyburke]

We really can't say much without data - OSCAR Daily view with the charts that are in my signature.  That is what we use to help people, the summery does little in telling us WHY something is or is not happening.

[Vike3]

Thanks. I have those for sure, but unfortunately I don't have them from back when it was pre- EPR adjustment when it was EPR off. I just started with Oscar in September and by that time EPR was at 1 so not sure I have good "comparsion" charts in that regard. Does turning the EPR on in and of itself cause the 95% pressure to rise ? I really could have asked the questions without the summary chart, I posted that to show the increase. Median/average total pressure really didn't change much but the 95% did.

[staceyburke]

The main causes are Central (which some times they have  real mind of their own.  Pressure to low.  No epr used.

[Vike3]

        OK I am posting 2 charts, 1 with higher 95% pressure from a few days ago and one from 11/18 where it was lower.   Interestingly the one with the lower pressure was higher AHI. 
I also forgot to mention that I did raise my pressure from 5 to 6.6 which may also have played a role, but don't forget went from EPR 0 (at that 5) to EPR 1 at 6.6 so that may offset it.

If nobody knows the answer to my question it's fine I will be seeing my sleep Dr on the 19th and I can ask him whether raising the EPR also raises the 95% pressure or not or whether it doesn't have anthing to do with it.

[G. Szabo]

When you increase the EPR, your expiratory pressure decreases parallelly. Some people's airways collapse or narrow due to the lost supporting pressure (it also depends on the pressure level); hence, the very first part of the inspiration period becomes more difficult. The instrument realizes this via the increased flow limitation in the inhalation period and compensates it by increasing the pressure. This is the answer to your question.

However, people are different. For example, I have not experienced this phenomenon.  

As for your OSCAR:
You would benefit from EPR=3 full time and minimum pressure 9 cm setting.

[Vike3]

Thank you for the detailed explanation and gives me a ton of solace actually as I thought there might be something wrong with my lungs or soft pallate muscles. 
(Despite more testing in the last year than any human could possibly go through proving otherwise each and every time...very long story with a happy ending thank God)  

I worry about the centrals with the proposal of 9 and 3 but I'm game for anything.  I guess in a way it's not far off of what I have now 
in terms of overall net effect  (6.6-1= 5.6 vs 9-3= 6 so pretty close )  I know in my in lab she moved me up to 8 and I left there feeling great but not sure what if anything
she did with the EPR ?  

Sleep Dr decided not to have me change them despite my success at the higher level, but I have since been messing with them anyway.

[SarcasticDave94]

With EPR 3 full time and min pressure at 9 that puts you close to 6 much like you are now. It might even feel much different, but the EPR 3 will act just like a more expensive bilevel with PS 3. Give it a shot. If it doesn't work out, post an OSCAR chart with the attempt. We'll find something else to trial that works out.

[Vike3]

Well I gave it a shot.  One of the best flow limits I have ever seen, if not the best at .04.   Clearly I have to get the leak issue figured out as everything was going great until that happened and likely caused the first central,  the other centrals were definitely sleep wake junk.   Flow rate a lot more consistent as well.  You can tell the 9 was more than I needed in the middle part of the sleep so my average pressure will obviously be higher.  No idea what woke me up the first time.  Not seeing any instrument related reason as nothing happening around that time.   The leak issue has to do with the struggles I am having with the nasal mask straps.  When I put a brand new one on it's fine.  Then it starts to expand and I can never get the right tension.  Last night it seemed to be too tight as it was hurting my nostrils, yet there were leaks.   That part I gotta get figured out as this report would have looked a lot better without that having happened.

[G. Szabo]

I suggest you turn the ramp off.