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.

[Dormeo]

As others have said, you would probably benefit from EPR, ideally 3. To get used to it, try setting your machine up outside your bedroom and using it for a few hours during the day or evening while you read or watch TV or use your devices. It feels a little different, but once you're used to it I'm willing to bet you'll like it.

As an aside, if you zoom in on your flow-rate graph, do you see little squiggles around the zero line between breaths? If so, the machine may be in error about the lengths of your inhalations and your exhalations.

[Sleeper49]

Thanks for everyone's help. Have also attached a night of data from 13 Dec 2024. On that night, I was on EPR 3, starting pressure 7, with higher flow limitations and more clear airway + RERA events; different from the 12 Dec 2024 stats I shared earlier.

Will the settings that Sleeprider suggested still work? i.e. CPAP/APAP, min and max at pressure 11, EPR 3.

And one final check: should I gradually transit to these settings, or would it be safe to do so in one night? Am concerned about the knock-on impact on my work in office the next day.

Thank you.

[Dormeo]

Fine to change gradually. I’d still recommend aiming at Sleeprider’s settings, but you can get there as slowly as you want.

[Sleeper49]

Thank much Dormeo. I just took a short nap (30 min) with the new settings (constant pressure at 11, EPR 3), and could see the flow limitation at 95% already drop to 0.04. First time ever it has dropped this low after the past 11 months. Will keep at this for the coming nights.

Could I also seek your advice on the extent that flow limitations could impact recovery from apnea, and slow down the lifting of brain fog and diminish memory recovery? Would appreciate hearing your personal experience, if any. It's been a hard slog trying to keep up at work all these years.    

Beyond adjusting the EPR/pressure settings to reduce flow limitations, if there's nothing more I can do to optimise my recovery, then I'll just sit tight, keep using the machine, and hope for the best in months to come.