CA (cluster?) events not reducing

[T818]

I tried changing EPR 3 , 2, 1 but still its high. Also tried going up & down by 1cm pressure. 
Flow limit goes up if I reduce EPR & CA seems to go up if I increase EPR.
Its been more than a month of continuous usage after 2 years break.

1st sleep study in 2018 showed, 1 CA, 3 OA, 25 HA, 4 Mixed
2nd in 2022 May showed, 14 CA, 16 OA, 118 HA, 2 Mixed
3rd in 2022 Oct showed, 9 CA, 46 OA (They didnt seem much qualified. i have seen multiple mistakes in their report)

[Shad0Wolf]

Looks like the 13th was your best/longest. Those clusters appear to be happening when the pressure was starting out low and got better after ramping up to about 10. I was looking at the data on the left (95%) numbers. I might would adjust the pressures to that, so , 10 and 9 and turning the ramp feature off. Or reducing it. It looks like it may be set to start around 7 and after about 45min go to 10. Its hard to tell all the way zoomed out but that is where I would concentrate.

[T818]

Hi,
95% is almost 9 now with nasal mask n30i. Earlier attached reports were 10.

My pressure settings is now Min 7, Max 9 with new nasal mask n30i. Earlier Max was 10 with dremwear full face mask. I reduced Max to 9 with nasal mask as I was having serious bloating and burps which didnt happen with full face mask with max pressure 10 which has reduced now so that I dont keep waking up
I have tried with EPR 1 & 2 & 3. with EPR 1 flow rate goes up like around 0.15. with EPR 3, CA goes up to 30+ events.

I have attached few reports while using n30i, Min 7, Max 9, EPR 1 & 2. Ramp is always off. I will try Min 9, Max 10, EPR 2 tonight.

[T818]

closer looks at the CA with mask pressure.

[Sleeprider]

I'm seeing flow limitation leading to arousal, followed by CA. I think the CA event is junk resulting from a change in position or the arousal from the respiratory effort related arousal (RERA). I think you need higher EPR at 2 or 3 and a higher minimum pressure at 8.0.

[T818]

Last night I set Min to 9, Max 10, EPR 2. there were 6 HA, 45 CA. Usually what I have seen is, if EPR is increased, CA is increased. Should I ignore these CAs?
Please let me know if need to adjust the pressure/EPR.
I still feel sleepy. Also foggy/dizzy, weak memory etc are there. Also I am sleeping long hours. After being on PAP for 9 hrs, I slept 4 more hours without. someone suggested me to see a neurologist to check if I have hypersomnia. should I do that or wait for optimizing PAP settings?

[Brazen]

Sleeping without your cpap isn't doing you good.
That's 4hrs of your body fighting for the oxygen it needs.

I feel like it would be tough to determine hypersomnia when your sleep apnea is not fully treated.
Plus, at least here, the standard treatment for hypersomnia is strong stimulate drugs which come with a whole list of likely side effects (eg: REM disruption, cardiac stress, etc).

Give Sleeprider and the other experts a little time to try to help optimize your treatment. 

Even if you have more than sleep apnea going on, it's still important to get your sleep apnea treatment right.
Breathing is basic -- treating disordered sleep breathing is essential.

[Sleeprider]

Thanks for trying the revised settings that I was aware might increase events, of course we had to know. The increase in EPR and pressure moved event toward centrals, which is more convincing that the problem here is indeed the central apnea aspect of your sleep disordered breathing identified in the sleep studies, emerging with therapy. At this point, you have two choices. We can attempt to optimize CPAP to minimize central apnea and hypopnea while still controlling obstructive events, or refer you back to your doctor for an ASV titration. CPAP does not treat central events, but most insurance requires you to fail CPAP and BiPAP before they will reimburse for a bilevel with backup rate (E0471) like ASV. The fact you have central apnea with CPAP therapy and that CA was identified as a component in your diagnostic tests shows you do have complex sleep apnea and should probably move to an appropriate therapy.

The alternative is to identify the lowest fixed pressure with no EPR that adequately treats obstructive events and does not stimulate the alternating hyperventilation/hypoventilation typical of someone with an unstable apneic threshold, or complex apnea. This approach should maintain an AHI of 2-3 but may never feel completely satisfying, while ASV would probably result in an AHI less than 1 and after an adjustment period should be comfortable and restful. The caveat is that a low "optimized" AHI on CPAP will probably disqualify you from being reimbursed or demonstrating medical necessity for the ASV. Your choice is not easy.

[T818]

I live in Bangladesh. This kind of diagnosis treatment are difficult here as doctors, technicians are not that qualified in this field. Also my insurance doesn't cover sleep related issues. I am paying all treatment costs on my own.

Lets continue with this machine for now with optimized setting and see how I feel. If dont feel good than will purchase ASV. But I am not sure ASV titration is available here in my country. So far I have seen that in the sleep clinics.

Please suggest how should I set the pressure settings. I have attached 3 reports from last month using fixed pressure. 2 of them are EPR=off & 1 report with EPR=1

[T818]

Sleeping without your cpap isn't doing you good.
That's 4hrs of your body fighting for the oxygen it needs.

I feel like it would be tough to determine hypersomnia when your sleep apnea is not fully treated.
Plus, at least here, the standard treatment for hypersomnia is strong stimulate drugs which come with a whole list of likely side effects (eg: REM disruption, cardiac stress, etc).

Give Sleeprider and the other experts a little time to try to help optimize your treatment. 

Even if you have more than sleep apnea going on, it's still important to get your sleep apnea treatment right.
Breathing is basic -- treating disordered sleep breathing is essential.

Brazen, 
thanks. will use cpap as long as I sleep. and hypersomnia check up on a hold for now. things seem to be a little bit complicated. hope will get the best possible outcome.