Headaches and Clear Airways following high pressure (OSCAR data)

[Sleepblitz]

Hi all!
I'm new to CPAP, I've been using ResMed Airsense 10 for a few months, and I'm struggling with some issues I believe are related to pressure. I was hoping someone could help me make sense of my OSCAR values and maybe share if they have a similar experience.

1. Since I started, I've experienced constant headaches and sometimes drowsiness, which I read could be a side effect of high pressure.
My provider originally set the max pressure to 7. When I lowered it to 5 or 6, that also lowered the intensity of my headaches (I still get them somewhat); however, the pressure graph almost always seems to reach the maximum, even when I tried setting a higher pressure (8). Additionally, the higher pressure also came with more intense headaches.

When I used the machine I often wake up tired and with a slight headache; on the one hand I don't have that many untreated obstructive events using the lower settings, but on the other hand looking at OSCAR it looks to me like I should be using a higher pressure regardless; only higher that to increase the issues.

2. I also noticed multiple CA events, which I read they could be caused by either high pressure or EPR, so I turned EPR off and lowered the pressure, but that didn't seem to change their occurrence. I don't know if I should be concerned or not, or if they're related to my headaches / drowsiness at all.

This is pretty weird. I'm not sure why this happens, since in my previous attempts at these values with other machines went fine (I had a long trial-and-error period using a few other machines, which I didn't choose for several reasons). It might also be the case that these symptoms will simply go away with time, I don't know. 

I was hoping someone more experienced could take a look at my graphs and see if there might be some other cause. Any help will be appreciated.

[jdougc]

Welcome, many of your issues can be related to this: "I'm new to CPAP, I've been using ResMed Airsense 10 for a few months"
Please attach a few graphs with the higher pressure, but hide the calendar and the event pie graph, it is more important to see the stats and settings.
Your minimum pressure is very, very low, something that won't help your therapy and you see that as you hit the max pressure so often. Also you have many flow limits which might be causing your issues, turning EPR back on will help with this, but EPR will not be effective under 7 CM or pressure. So raise your minimum pressure.
The CAs can be related to being new to cpap therapy, unless you had CAs on your sleep study. Please attach a copy of that sleep study with you info redacted.

[SarcasticDave94]

I'm not sure what is causing your headaches. It may be the currently not effective therapy.

Not being offensive, but 7 or less pressure is quite low. In your case, it's too low.

You can see the flow limits, the busy FL activity needs addressed. You will want to lower the FL, which are like Apnea but not timed, typically represent about a 50 percent airway obstruction. To act on these, it will require higher pressure, better with EPR too. If you use min pressure 7, then EPR 3 full time can be added in.

These flow limits, besides the CA, are your biggest issue. I believe if you address the FL, therapy gets better results.

I would try pressures 7-15, EPR 3 full time, no Ramp.

Yes, currently, your Central Apnea/clear airway/CA can be an issue. As mentioned, if the CA were not a big issue on your sleep study, then they will be labeled treatment emergent, and will diminish with more time on CPAP.

[Expat31]

Also disactivate the calendar and pie chart, so we can see all of your settings that are partly obscured.
Also the snore graph is of no practical use, disactivate.

Also agree minimum pressure is too low, increasing this 7 or 8 would help reduce hypopneas and obstructives.

I would suggest maximum to 10, so we can get an idea where the pressure wants to go.

Agree, restoring the EPR to 3 will be more comfortable, and in addition will reduce flow limitations.

At this stage, I would not worry too much about central apneas. Often they reduce significantly once your settings are properly optimised.

It looks like you have ramp on?  During ramp time, you get little therapy benefit.

Let's see where these adjustments go.

[Sleepblitz]

Here's two days where pressure was set to a 7.6 (I wrongly mentioned 8), I hope I got the layout right. I assumed from the flow rate pressure was too low and tried to raise it, but the following headache was so bad I had to revert the settings.

The study summary doesn't mentioned CA by name that I can tell. I attached it although it isn't very accurate IMO, I slept very little and very poorly in the lab.

Could the headache be associated with the poor flow limitation? If EPR helps at higher pressures, should I try to raise both pressure and EPR and see if that helps?

Edit: Following the other replies as well, I'll give it a try - I'll set the pressure & WPR higher than before and hope for the best. I'm very new to reading these charts but I have to agree this pressure isn't really doing much for me. I'm very hesitant about it due to the above experiences but I'll give it a go and see how it feels.

[PeaceLoveAndPizza]

As Dave said, try the following to give a good baseline to use for any future adjustments.


Mode APAP
Min pressure 7
Max pressure 15
EPR 3 full-time
No ramp

Once you have a few nights post a chart or two. Folks can help adjust from there.

[SarcasticDave94]

Mask leaking and moderate patterns of what appears to be Positional Apnea are something to take a look at.