Help reviewing my sleep data - Can it get any better?

[YMK94]

Hi all,

Looking for recommendations to achieve better sleep. While I definitely feel more alert and less groggy in the mornings after having used my CPAP for 5 days now, I still feel sleepy and tired in the afternoons and want to make sure my CPAP settings are optimal for my use case. My current setup:

- Resmed AirSense 11: 4-20cm Pressure Range
- AirFit P10 Nasal Pillows w/ Mouth tape: Found this to be more comfortable than a full face mask since I'm a mouth breather
- Sleep position: Back on relatively flat pillow. Had the lowest AHI in this position according to my sleep study

Attached is my OSCAR data of my most recent and best night of sleep with the above setup. Looking through a few threads, something tells me my flow limitations might be the issue? But not exactly sure..

[Deborah K.]

I see a few things that should help you.

1.  Turn ramp off if you can tolerate not using it.  If not, set it for a shorter time.  You get virtually no therapy during ramp, and if you get up during the night ramp runs again each time you return to bed, so work towards turning it off.

2.  Your flow limits are rather high.  Set EPR full-time, at setting 3.  This will lower the flow limits and make your breathing more comfortable.

3.  Set your pressure range at 7-11.  You are beginning at a pressure that is meant for small children.  Also, you don't seem to need high pressures, so topping it at 11 should be comfortable for now.

4.  Your charts are set up okay, but we need to see to the very bottom of the flow limits on the first page.  The other two pages are not necessary unless someone asks to see something from them.

Best of luck!  

[Phaleronic]

I think the charts look good even on the default titration pressure they put you on, but seeing that your 99 percent pressure is 7.68cm I would raise min pressure to 6cm (leave EPR on 1) and lower max pressure to 11cm, this will help with comfort. You don't need EPR at 3 since it requires a higher minimum pressure and you're doing very well already.

Welcome to the forum YMK94!

[YMK94]

Thank you both for the feedback! I'm going to try both recommendations in stages, assess how I feel, and report back here.

Stage 1: 6-11cm, EPR full-time at setting 1, Ramp off
Stage 2: 7-11cm, EPR full-time at setting 3, Ramp off

I've also attached an updated OSCAR chart that shows my flow limits on the first page.

Appreciate the help!

[YMK94]

First night at Stage 1: 6-11cm, EPR full-time at 1, and Ramp off went pretty well. While I didn't get much sleep due to nose pillow irritation, breathing was very comfortable, even though my minimum pressure had increased, and my OSCAR data seems to show decreased flow limits too. 

Going to try Stage 2: 7-11cm, EPR full-time at 3, and Ramp off tonight!

[YMK94]

First night trying Stage 2: 7-11cm, EPR full-time at setting 3, Ramp off. While I didn't mind the increased pressure at 7cm, the night before at 6cm was definitely more comfortable.

Is it safe to say my optimal settings are somewhere between 6-7cm, and EPR at 1-3?

Is it worth trying a full face mask (F20) and to see how it compares to nasal pillows w/ mouth tape?

Any other recommendations given my OSCAR data?

[Deborah K.]

You never drop back to 7 and you do go several points higher, so I think you should stay at your present settings for now.  Once you are accustomed to these settings, you may want to raise your starting pressure to 8 because you presently never drop back to 7.  As to EPR, don't drop it, but use whichever number regularly keeps your flow limits the lowest.

There is no intrinsic advantage to a full-face mask over a pillows mask.  Full-face masks leak the most, nasal masks leak less, and pillows masks leak the least.  If you are comfortable with your present setup, stick with it.