Need help with

[chujew]

Hello guys!
First of all I'll start with a little introduction. I've been diagnosed with mixed apnea (during the sleep test night my AHI was 40 with 2-3 central apneas and couple more hypopneas). My doc titrated me and perscribed with a fixed pressure of 7cm or 6-10cm using auto mode. I'm 3 months into therapy now and I've been using a fixed mode for most of the time since the auto mode was constantly waking me up. Here are some observations I made:
1. All obstructive apneas are gone - this type of apnea does not occur while I'm using CPAP so I'm happy for that.
2. Central apneas occur only when I'm overtired or when I go to sleep far too late. When it happens it's 1-4 events per night and the next night is most often free of central events. Nothing bad here but it happens from time to time. (last photo)
3. Hypopneas - this is fun part. I'm getting a lot of hypopneas. I've read about position hypopneas and I recently started to sleep with soft cervical collar. It helps but not always. Seems it depends on how tight I put my collar (I have really thick neck). If it's too tight hypopneas occur more often and if it's too loose the same happens. But with the right placement of collar i seems to be under control. But I have a feeling that some of my hypopneas might occur due to a fairly low pressure and they could be treated by pressure increase.
4. Flow limitations - I'm getting a significant amount of flow limits (as you can see on the screenshots). And I know about increasing pressure and turning EPR on but I'm worried that central apneas will spike when I'll do that since they occur anyways. Need help on that especially.
Overall I feel a lot better with CPAP than before but I'm still really tired during the day. Not always, but I'm waking up during the night sometimes and it's really annoying and I don't know why it happens. I also get a lot of brain fog and focus problems so I'm sure there are some ways to make my therapy better. If needed I can post more detailed screenshots. Since most of doctors are happy with AHI below 5 adn they don't see a reason to make changes I'm counting on you guys. I'll be grateful for any help.
Stuff I use:
Airsense 10 Autoset
Fixed pressure 7cm
Dreamwear Undernose mask or Dreamwear full face mask (in case I get nasal congestion which sometimes happens for no reason)
           

[Deborah K.]

I suggest that you set your pressures to 7-11 instead of your present static 7.  Your machine will not go higher than you need.  I think you would feel better using EPR set full-time at 3.  This makes your exhale easier which makes breathing easier for most of us.  Don't worry about the CAs right now.  You don't have enough to be concerned with.  Give these settings a try, post a report, and tell us how you feel.

Also, it would be good if you posted Oscar by tapping the F12 key when you have your report onscreen and then posting it to the board. This will format things correctly and include more parts we need to see.

[chujew]

Thank you for your help. I'm going to give it a try tonight. Below, I'm posting Oscar data again in case it gives more useful info (using f12 this time).
               

[Sleeprider]

The only way to know how EPR will affect you is to try it. Fortunately you can always undo that decision if it doesn't work out. I recommend EPR to reduce flow limits and some other events, but if you're sleep is easily disrupted by changing pressure or you get central events with better ventilation, then you have very good therapy without that change. There are no long-term consequences for trying something, but with an event rate less than 1.0, it's not like you need it.

[CPAPfriend]

Yeah, I agree. Just give EPR a try and then post the charts here and let us know how you feel. Remember to change your pressure the same amount as EPR, EPR +1, then pressure +1, etc.

[chujew]

So I did what Deborah K. said (pressure 7-11cm EPR on 3) and this is what happened:
First night I was not able to fall asleep. EPR on 3 felt really weird so I decreased it to 2. I fell asleep, altough it was already 2 am. so I woke up not rested anyway.
I did next night with same settings, it was already better, I fell asleep quickly and had a good night. I woke up fresh and ready to be alive (finally).
Third night I've increased EPR back to 3 and everything went smooth. I fell asleep quickly and I woke up feeling REALLY GOOD. I was really amazed by how good night I had. No CA's or hypopneas occured (even though i was sleeping without cervical collar) so it looks like EPR is not harming my AHI. For the first time during my therapy I could say I've slept the way I should.
Fourth night went a little bit worse. Nothing really bad, I woke up during the night once and I woke up a bit tired in the morning. But this night I went to sleep really exhausted casue I had a long business travel this day. I'm not expecting every night to be as great as the third night with EPR beacuse I'm often travelling and sleeping in hotels etc. so it may have an impact on my sleep quality.
Overall I feel like it's the good direction I'm going with my therapy. My question is what do I do next? Should I stick with these setting for now and see what's going to happen or should I change something? Also a long term question: should I stick with auto mode or should I lean towards increased fixed pressure with EPR?
Again, thanks for all the help you provide guys. 
           

[chujew]

It's me again.
Update on my situation after 2 weeks: I feel really good, better than before. 
Altought I have some questions. Here is a example of what's going on. Sometimes I'm getting 0 events per night with 6,5h of sleep which is a little too short for me, but at the same time I wake up rested and happy and ready to go. The next night I also get 0 events or e.g. 1 central event and similar oscar numbers as the night before, but I wake up less rested with a little foggy brain (below I'm posting oscar charts of the nights I'm referring to). I know each night might be different but do you guys have a clue what could be the reason of this? What can I do to maximize the effects of therapy?
Still using 7-11cm of pressure with EPR on 3.