High mask pressure causing RERA?

[webweaver]

Something I've noticed in my CPAP therapy is that sometimes I wake up when the pressure gets high or there's a large leak. Recently I've been feeling very sleepy during the day and needing extra naps, even though I'm getting 7-8 hours of sleep and my AHI is under 5.

If a large leak occurs, it's typically because the pressure is high, and I'm a side sleeper and might have pushed the mask a little off-center. I can't do nasal pillows because I'm a mouth breather and often feel like I can't get enough air if I try breathing through my nose.

Sometimes I wake up too early in the morning due to the sound and feeling of high pressure, and I wish I could sleep an extra hour but can't get back to sleep since I've been woken up. Other times, it looks like I've gotten enough hours of sleep, but I still feel super sleepy during the day, and when I look in OSCAR, I do see some RERAs or leaks over the night and am wondering if it's simply poor quality sleep, not deep enough sleep. When the max pressure was set lower at 14, my AHI was higher, usually anywhere from 7-18, so I think that this higher pressure is keeping AHI under control.

I've thought about alternatives to CPAP like the Inspire hypoglossal nerve stimulator but I regularly see CAs in OSCAR, and anecdotally people have told me that I sometimes stop breathing in my sleep (which is what prompted me to get a sleep study). Is central apnea a disqualifier for Inspire?

Any suggestions for better quality sleep?

[Gideon]

We can try flattening your pressure chart. That we would do by adding EPR into the mix.

Set EPR=3, Fulltime. If it is too much it can be lowered. You have a few CA events and this may increase them

Set min pressure=7. Note this will bring your EPAP down to a min of 4 so we will be watching your OA events.

Post the results and we will see.

The amount of CA events you have are insignificant and should not disqualify you from Inspire therapy. Inspire only resolves a very specific cause of OSA so you still may not qualify.

[quiescence at last]

Welcome,
CA is not an airway blockage type of breathing halt, and hypoglossal nerve stimulator is meant to keep stimulating the tissue to aid in keeping the airway open.

update: I agree with Gideon on the lack of EPR, I just usually bump up EPR gradually. Have you used a high EPR before?  It may make you feel like the machine is trying to take over (almost forcing an exhale or inhale before you would naturally.

QAL