Newbie Struggling with Leaks and CAs

[Sleepy1979]

My original sleep lab test had 0 obstructive, 0 central, 0 mixed, 30 hypopneas, and 0 RERA (REM RDI of 19) for an AHI of 5. My sleep practitioner is extremely hands off. I adjusted my generic Rx (4-10; 2 EPR) to 7-10 3 EPR.

I've been on CPAP for 3 months now. I alternate between pillows and nasal mask to deal with congestion, runny nose, and not getting enough air. I earnestly tried a cervical collar. I sleep with the head of my bed elevated some 5". I cannot say my sleep is relaxing at all. I have mostly CAs. I have a decent number of leaks. Perhaps my issue is positional? I've given two nights' overviews and a look at one of the CAs. Kind thanks in advance for any time or insight. 

           

[paulag1955]

You could try lowering or turning off EPR to eliminate the central events. Do you have any charts from when your EPR was set to 2? Did you have fewer/any central events then? Also your OSCAR chart shows that your max pressure is 20 but you said your max is 10, so if you meant it to be set at 10, you need to revisit that.

[Sleepy1979]

Thanks much, paulag1955! I am aware that these are fine adjustments in the scheme...

Oops, 2 typos: 5-20 Rx and 7-20 adjusted. 

At 2 EPR, only 6 CAs per night but my flow limitations were exceeding 0.25. The deciding factor was finding exhalation more tolerable at 3 EPR. I could revisit a lower number!

[PeaceLoveAndPizza]

Your main task for now is to get the leaks under control. Whether it is pillows or nasal mask, your leaks look to be mouth leaks given their duration. If you can’t use a soft cervical collar, consider trying mouth tape. If neither of those then get a full-face mask like a ResMed F30 or F&P Evora. Plenty of others to choose from as well.

For pressure, try setting it to 7-12 with EPR 3 full-time. You can also dial back EPR as Paula suggested, but as you noted when you do so your flow limits go up, so pressure will increase accordingly, which means you will likely have to raise the pressure ceiling to 14 or 15. If you change masks we will have to reevaluate.

It is a trade-off with pressure and EPR. You have to figure out what works best for you from a sleep quality perspective.

The CA you zoom in on is a typical arousal. Exhale, followed by movement, then a big gasp of air. As you noted, most of your CAs look positional. 

Again, you need to get the leaks addressed for effective therapy.

[paulag1955]

Yes, this is the trade off that I'm trying to work through as well. How does one weigh apneas/hypopneas/RERAs against high flow limits to determine the best therapy? That is the big question.

[SarcasticDave94]

Agreed with others on lowering EPR on treatment emergent CA combat. You can try EPR 2 without other pressure edits. See how this balances things out and choose which is better. I think it'll end up being EPR 3 giving better comfort and better FL control or EPR 2 and lower CA and less comfort, higher FL. I have predominant CA and COPD, and I've noticed over the years here that others in your situation where the balance between more or less CA is a teeter totter, this side is low the other side goes higher and vice versa. Balance here means overall comfort and rest versus any chart number.

The leaks are probably your number 1 hindrance to good results. Admitted in reference to other events, CA is high but still in the below 5 treated state. My advice to edit EPR down is to help maximize comfort, not necessarily decreasing CA.

[Sleepy1979]

Appreciate the outline of what's important and what's possible. The leaks have gotten progressively worse as I zonk out now, rather than staying liminaly awake all night repositioning the pillows. I'll get a better handle on things with a full face mask. Then I can dive into EPR and pressure ranges. Thanks much to @PeaceLoveandPizza and @SarcasticDave94!