Need advise.

[Rarends]

Hi,

I started my cpap therapy on 1-apr-2024. I feel a bit better but am still very tired after 4pm. I had my blood oxygen measured and the values are good, I did this because my values measured with an O2 ring at night were low. I am currently taping my mouth and I am using a nasal pillow mask and the Resmed airsense 11 autoset machine. At this moment my pressure is 11cm with EPR on 1. I keep looking but now I am asking for help from you members what to do. Should I increase the EPR, I also hear that EPR is not recommended? Greetings from the Netherlands.

[Expat31]

Hi, 

Can you repost so we can have a completer view of you results, including stastics and settings. 

Take a screenshot of your Daily screen.
   * For Windows or Linux: Use the F12 key
   * For a Mac: Use Fn+F12

For detailed graph organising, please see here.

The best result will be to have them in order of importance:-
1.Events
2.Flow rate
3.Pressure
4.Leak rate
5.Flow limitations

Also make sure the calendar is excluded as it will obscure the visibility of settings. 

Thanks

[Rarends]

Thank you for your reply. Please find attached a new screenshot.

[Expat31]

Thanks. 

Perfect! 

You certainly have few apnea events, with just a total time duration of 21 secs. Overall your events are well controlled 
 
However there are several problems that need to be dealt with that may help with sleep quality. 

Your  flow limitations are too high at 0.22. They should be no more than 0.1, but ideally 0.5 or less. 

The best way to reduce these is to set  EPR at 3, but be vigilant to see that significant central apneas do not appear as a result. Probably not a problem in your case, as currently you have just one central event. 

You have the ramp on auto, best to turn this off, as during ramp, you receive little therapy benefit. 

Your leak rates are well within limits, but you have some spiking, likely caused by mask movement, perhaps creating sleep disturbance. Check on mask primer. 

Concerning your hypopneas. It looks like you may have a tendancy for positional apnea, as could be some clustering evident in your events and flow graph, well certainly one just before 5am. You could refer back to your sleep study to see if positional apnea was flagged as an issue. 

The last item to consider is that you are on a fixed pressure of 11cms. 

Have you considered APAP, with something like a minimum of 7 and a maximum of 11? 




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[Rarends]

Dear Expat31, thank you very much for your help!!! Much appreciated!
Is your advise when I increase the EPR from 1 to 3 also to increase the pressure? If so to which pressure?

[Expat31]

I think the best option initially is to try min 7, max 11.

The reason for this is hopefully we can establish an average pressure as a starting point. 

It will be interesting to examine any peaks in pressure that may be caused by flow limitations, leaks or  or positional apneas. These types of events do nothing to help therapy, they just cause sleep disruption. 

We will see where this goes.