[CPAP] Possible UARS, need to decide if I should switch to bilevel or keep adjusting APAP

[user357]

So a few months ago I had made an initial post on this board discussing adjusting my pressure because I was still feeling absolutely abysmal despite using APAP for close to a year. I'm almost positive at this point that I'm dealing with UARS and I need some help deciding what to do moving forward. Been using OSCAR to track my results and I bumped my minimum starting pressure up to 6 from where it was when I first got my machine at 5. Subjectively, I've felt relatively better after this change but still nowhere close to where I want to be. I feel like my low pressure settings, lower flow limitations while having EPR at 3 and general failure with CPAP have given me an indication that I have UARS. Could I get some advice as to where to go from here? Any settings I could change in regards to APAP? Should I start looking into BiLevel? Attached is a few screenshots from where my pressures have been at for the past few months.

               

[user357]

And the data from after I adjusted minimum pressure to 6. 

               

[Phaleronic]

Hello user357-

I see the pressure fluctuating a bit in those charts, as well as some leakage. I would suggest that you try cpap mode for a week or so with EPR turned down one (to 2), to see if you feel better (as it is typically more comfortable than apap), set CPAP mode to 9cm. Tonight before bed try this mode for 30-45 minutes just to see how it feels

[40plus]

I would advice the same. The pressure settings are very low and maybe you just need more pressure to sleep relaxed. Fixed cpap mode at 9 and epr 2 seems like a good start.

[user357]

Wouldn't that just cause more centrals though? I'm already dealing with a significant amount of them nearly every night despite having none on my sleep study. And would I really need the higher pressure of 9? My 95% seems to only be at around 7 or so most nights. Just trying to understand here. Thank you.

[SarcasticDave94]

The Central Apnea count I'm looking at on your OSCAR charts aren't significant enough to have them dictate compromised Obstructive Apnea therapy. There were about 8-10 CA events per night as I recall. This is minimal.

[user357]

Also I forgot to mention I tried turning EPR down to 2 one night and it was an absolutely horrible experience, much higher flow limits and I felt terrible. If I'm dealing with UARS I'm assuming I need all the PS I can get right? Would it make more sense to leave it at 3? 

   

[SarcasticDave94]

Yes, keep EPR at 3. Intentionally increasing all the other events to avoid a 0.91 CAHI isn't a great idea.