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How to resolve this issue?
#1
How to resolve this issue?
Hey guys, I have lurked here occasionally but when someone on reddit recommended I go here for better advice, I figured I would give it a shot. I will say some of the advice on reddit did help, as my machine was never zero'd in. I was on the factory settings of 4-20 cm for over a year. For the sake of time, PAP therapy wasn't working, which was no surprise as the pressures were too low. I eventually upped my pressures to around 8-12 cm APAP with and EPR of 3. Well nothing felt better after months, I felt worse even. I never investigated further because my AHI was low (my original sleep study was an AHI of 5 and RDI of 15). A user asked to see my flow rate despite Oscar saying I had little to no significant flow limitations. The user began to point out all these unregistered events, flow limits and RERA's. Come to find out these machines miss a lot, especially RERA's. Now. I don't know how correct this user was, but him and two others recommended a bi level machine. However another user recommended I just needed more PAP pressure. So I ordered a bi level and figured in the meantime I would just use the APAP as a CPAP with no EPR. Low and behold, my sleep improved. Stopped waking up as much, lower AHI and felt a bit better in the morning. However, my flow limits jumped up a lot and I still had the same issues(I dont think EPR was the issue, but APAP). All through the night I had weird breathing that always lead to an arousal. From looking at my chart, this was every 10 to 30 minutes at the most. I figure some of these are just me moving at night, or REM, but they happen constantly and are always preceded by flow limits, even if the machine didnt mark it as a flow limit. I figure I got my EPAP (sorry if im using this term wrong) at the right value to stop my OSA events, but when I upped my pressure the next night in hopes of tackling flow limits, I slept worse (though not as bad as on APAP) and had an insignificant amount of centrals, but had some flagged RERA's and hypopneas, etc. I figure that I may need more IPAP, and my EPAP is good (Once again may be using those wrong as I am not on BiPAP, I just mean the exhale pressure seems good but may need more inhale). I am going to try a pressure of 12 tonight with EPR of 3, as my best night sleep was on a fixed pressure, no APAP or EPR at a pressure of 8.4 cm, however, same breathing issues and number of arousals. Im am hoping I just need more IPAP and my EPAP is good and this will resolve my flow limits. If EPR isnt enough then I hope PS is enough on the Bi-level I ordered. I am still very symptomatic despite my low AHI. I know my issue is likely tied to sleep as a psych eval was insignificant and blood work insignificant as far as a cause for my intense brain fog, excessive yawning, sleepiness and fatigue. I had random nights throughout the years where I would sleep great and felt normal again. Im guessing even a broken clock is right twice a day, as my pressures were in such a wide range due to factory settings being unchanged during that time. Sadly I didnt have an SD card at the time either. I am posting an imgur link below. Once again, most of the night, every 5 to 30 minutes, I wake up, which is preceded by flow limitations. Do I need more pressure? Do I need EPR or PS (kinda the same IK). Would love some insight, thanks in advance. 

(I cannot post my Imgur link apparently I need 4 posts first, so I probably wont get any help now that I think about it. I guess ill post 3 pictures but I dont think its sums things up enough.)
   

(also idk why the flow rate picture is posted below but im a goober and dont know how to change it, many more pictures are posted in the link above)


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