[CPAP] jdougc - Therapy Assistance

[G. Szabo]

I trust you had some bad dreams not related to your treatment. 

Although some might say you are fine because your FL is 0.02 and AHI is below 1, you might be able to tune these further down with some additional tweaking if you want. Hence, I suggest repeating the AUTO titration to see your optimized pressure indicated by the instrument. Leave the instrument in the AUTO regime and increase the pressure max to 11.2 cm.
 
In my personal experience, humidity 2 with hose temperature 26 is too dry. You might want to consider a humidity 3 or 4 setting.

[jdougc]

G. Szabo,
Thanks for looking over my charts again, again and again! I will repeat the APAP regime and increase the pressure max to 11.2 cm as you suggested. 
I don't have a dry mouth or dry nostrils, but I will increase my humidity to 3. I have a humidifier on my furnace so our house is not very dry. I didn't use the cpap machine humidifier at all during the late summer and early fall as it can be very humid here.

[jdougc]

G. Szabo,
Thanks for looking over my charts.
Not sure why, but I could not relax with these settings. After I lowered the max pressure and lowered the humidity back to 2, I was able to fall asleep easily. The pillow cushion is newer, as is the soft cervical collar. Maybe I am still getting used to them. I cried out again at 3:23 AM, haha.
I attached the 1st part of the night separately.
   
   

[G. Szabo]

You might belong to people who do not tolerate pressure adjustments or EPR. 
 
Your flow limit has improved with your last setting; hence, I believe you can settle for a while with the following settings and observe your feelings.
Mode: APAP
MIn  & MAx pressures: 10.6 cm
EPR off

It would be best to observe the flow limit value in addition to your feelings. You can fine-tune and optimize the above pressure setting by increasing/decreasing it in 0.2 cm steps.

[jdougc]

G. Szabo,
I might indeed be one of those that are not tolerent of pressure adjustments. I have been on cpap mode without EPR or what other companies call it, since 2018.
0.2 cm steps, as you suggest might work for me.  I will try that next week after I settle in with these changes.
I do think that apap could be a great tool for some.
Thanks for your time and help, stay safe.

[G. Szabo]

To clarify, APAP with the same min/max pressure is identical to CPAP with the same pressure. You improved because of the increased pressure. 
The only advantage of APAP, in this case, is that you will need fewer steps to re-check your settings by temporarily allowing a slightly increased Inhalation pressure and letting the instrument find the optimum.

[jdougc]

G. Szabo,

I think I am ready to tackle lowering my Flow Limitations. I have slowly increased my pressure to 11 cm and will go to 11.2 or 11.4 tonight on fixed CPAP. Any ideas would be helpful?
   
   
   

[G. Szabo]

EPR is the most potent FL reduction tool. It is unfortunate that you did  not tolerate it well at lower pressures. The last time you tried, it was at a CPAP pressure 10.6. Once you reach the 11.6 cm CPAP pressure, it would be worth trying EPR=1 again.
Be prepared that there might be some  negotiation window between increased CAs and decreased FLs.

[jdougc]

G. Szabo,
Thanks again for the reply.
I think I have got more comfortable with my new soft cervical collar and the P10 cushion. I made a note to check, next week or later, when my pressure hits 10.6cm, after slowly increasing, to turn on EPR to 1. We will see how it goes.