Ghastly Pressure Spikes - Please Help!

[Sleeper49]

    Hello,

I'm 11 months on CPAP (ResMed 10 Airsense for her), with moderate AHI of 21. Managed to get my AHI down to the range of 0 to 0.5 gradually by tweaking settings, dropping the ramp function and increasing my starting pressure to ~8. 

However, I've not been able to eliminate the ghastly pressure spikes, which I'm wondering could cause me to rouse without my knowledge. 

- I still feel there's some residual brain fog and inability to juggle large amounts of detail at work. 
- Flow limitations still hover around 0.14 (95%) and 0.30 (99.5%). 

This is what I've tried so far:

- I've been told I should try to increase my starting pressure to ~10, close to my median, or even higher to 12-13 (95%). However, I'm unable to push my starting pressure to more than 8.6, as it causes me to burp by reflex and makes me unable to fall asleep easily. The aerophagia is deeply uncomfortable.
- Tried using EPR earlier but it made me feel worse the next day.

Any suggestions on how I can: (i) reduce the pressure spikes (which I'm told suggests my APAP is trying to catch up with my body's lack of oxygen); (ii) reduce flow limitations?

Thanks!

[staceyburke]

welcome to the board...  You said you tried EPR but it made you feel worse.  And the reason your pressure is having spikes is you are not using EPR.  Flow Limits are quite high and the ResMed increases pressure when it finds FL to stop them from becoming O or H events.  Flow limits are apnea just like an O or H events the difference an event has to last 10 seconds to be considered an O or H.

So what I would suggest that you try these settings and see how you do.

Min 8
max 15
EPR Full time
EPR 3

Give it one night and post tomorrow.

[Sleeper49]

Thank you! I've a snapshot from a previous night when I used EPR 3, with min pressure 7.0 max pressure 15.0. 

While the pressure curve was less spiky, it was quite a horrible experience upon waking up, with lots of brain fog. I hear you, but am very reluctant to retry EPR, because when I did so, my exhalations (both the duration and the amount of air) became very short relative to my inhalations. I felt slightly breathless when waking up, and wasnt mentally awake enough to keep up with the demands of the day.

And also, when I added EPR, I had clear airway apnea events (when before there was none) and a number of hypopneas too.

   

[SarcasticDave94]

EPR may increase clear airway for a time when you first start therapy.

Your earlier chart looks better than the older one, probably due to the min pressure 8 versus 7.

You may want to try EPR again set to full time. Try EPR 1, see what it does. Then try EPR 2 and compare. Then try EPR 3, again compare. Choose which is comfortable and lower flow limits the most. They're both probably going to be found at the same setting.

[staceyburke]

According to the left panel and event chart you had 0 centrals.  As Dave said move the min to 8.  Do as you wish with the EPR but all EPR does is lower your exhale pressure and allows to to breath more normally.  It can cause some more central apnea (again you had none, they were all Oa) but it looks like you will be fine using it.

[Sleeprider]

With EPR 3, your median pressure was 10.1/7.1 cm and the 95% pressure was 11.7/8.7 (inhale/exhale). Based on how you felt, I think you might be happier with fixed effective pressure. Give EPR another chance because it substantially resolved flow limits and did not significantly change respiratory volume or rate. It does take some getting used to. Anyway, it looks like a fixed pressure of 11.0 should be effective with EPR 3, resulting in 11/8 pressure. To get that either use CPAP mode or in Autoset mode, Minimum 11, Maximum 11, EPR on, Setting 3. Ramp is your choice, but don't start less than 7.0 cm.