OSCAR Data - Low AHI but still not feeling great, and are these real OA events?

[THEVGE]

I am a bit surprised people are positive about these flow limitations. I still see a lot of them (flat tops), I would not be happy with this. I would still advise increasing pressure and try to get used to EPR 3.

I also would stop using the ramp, unless you absolutely need to.

[G. Szabo]

I am a bit surprised people are positive about these flow limitations. I still see a lot of them (flat tops), I would not be happy with this. I would still advise increasing pressure and try to get used to EPR 3.

Perhaps you have noticed the recent arguments on this thread and several others about EPR and other settings. I think the overwhelming majority of experienced users suggest (based on their positive experience) a high EPR setting as long as it does not interfere with CA. However, there are some who notoriously want to eliminate it. 

In my opinion, this back-and-forth argument has reached a level that hurts inexperienced members who become confused and also hurts this forum's reputation. Hence, I stopped delivering suggestions about EPR (and some other settings) when I saw the same people repeatedly showing up and contradicting them because it made the thread look like a football stadium, which we should avoid. Instead, once I made my point somewhere up in a thread and got these counterarguments, I just dropped the case and trusted that the less experienced member seeking advice sooner or later would figure out which suggestion made more sense in their case.         

[THEVGE]

Thanks for elaborating. I was not aware of what you wrote but I do notice I recently feel an urge to counter-argument quite often so maybe that is what you wrote as well.

That being said, I understand everybody is different and everybody has different and often anecdotal experiences.

In that respect all shared experience is helpful. Like I shared my opinion on this threads data based on my personal experience.

[Santino]

Thanks, THEVGE and G. Szabo. Getting differing views on the best course of action definitely can be a bit disorienting, but I very much appreciate all the input in any case. Speaking for myself, it is most helpful when folks explain the reasoning for their suggestions, though I'm sure that is difficult and time-consuming given the number of people seeking help on this board!

I bumped the pressure up slightly to 9 the last two nights, with EPR still at 2. Yesterday I felt great, today not as much. Perhaps because I had pretty bad leaks last night.

I'm still dealing with some occasional dull head pain during the day that I suspect might be related to the mask straps on my neck, which in turn is causing me to go slower than I might otherwise go in terms of bumping up the pressure, because I feel like I'd then have to tighten the straps tighter and risk more headaches. I bought mask strap covers that perhaps will help. Or who knows, maybe it is something else causing the head pain.

My data from the previous two nights is attached. THEVGE and G. Szabo, your feeling is that EPR 3 would help improve those flow limits? If I did increase to EPR 3, should I also increase pressure somewhat, given the lower EPAP, or is there a case to be made that increasing to EPR 3 alone will help, given that the cervical collar seems to have solved the OAs? If alternatively I stick with EPR 2 for now, would you suggest that I increase pressure?

[THEVGE]

My opinion: your structural leak is terrible, you need to fix that first. It destroys your therapy. Flow limitations are present continuous, but with a leak it is unclear how bad they really are. The absolute number is not that high (0,13) but for me that is already high.

Either way, for me it is clear pressure needs to go up. If you decide to use EPR 3 you also need to increase your IPAP with 1 (compared to EPR 2). But I expect, even with EPR 3, your EPAP and IPAP need to increase still

[G. Szabo]

I agree with the above comments on leaks. 

Higher EPR makes breathing easier and makes you feel better. It reduces FLs and Aerophagia. It helps with the leaks. It is advisable unless it permanently increases CAs. All professional respirators use some kind of EPR. Even the widely available commercial bipap machines can go higher than EPR 3 because it has a serious treatment benefit, and it is not some feature we just want to throw into the garbage because some YouTube expert says so.

Therefore, I always suggest using a high EPR setting and optimizing your treatment under this condition. Now that you have already reached some level of optimization, it is logical to ask for a simultaneous pressure adjustment with the increased EPR.

I suggest the EPR=3 setting. However, let's change one parameter at a time and not touch the pressure yet. Perhaps it will not be needed. The FLs will tell you.

[Phaleronic]

Thanks, THEVGE and G. Szabo. Getting differing views on the best course of action definitely can be a bit disorienting, but I very much appreciate all the input in any case. Speaking for myself, it is most helpful when folks explain the reasoning for their suggestions, though I'm sure that is difficult and time-consuming given the number of people seeking help on this board!

I bumped the pressure up slightly to 9 the last two nights, with EPR still at 2. Yesterday I felt great, today not as much. Perhaps because I had pretty bad leaks last night.

I'm still dealing with some occasional dull head pain during the day that I suspect might be related to the mask straps on my neck, which in turn is causing me to go slower than I might otherwise go in terms of bumping up the pressure, because I feel like I'd then have to tighten the straps tighter and risk more headaches. I bought mask strap covers that perhaps will help. Or who knows, maybe it is something else causing the head pain.

My data from the previous two nights is attached. THEVGE and G. Szabo, your feeling is that EPR 3 would help improve those flow limits? If I did increase to EPR 3, should I also increase pressure somewhat, given the lower EPAP, or is there a case to be made that increasing to EPR 3 alone will help, given that the cervical collar seems to have solved the OAs? If alternatively I stick with EPR 2 for now, would you suggest that I increase pressure?

Hi Santino,

You have minimal flow limits, so they are of no concern here.  EPR fulltime does not help in any way with apnea control or arousals/microarousals, that is why you should please begin turning it down gradually, with the goal of turning it off. Also, higher EPR makes people feel worse (in my own personal use with this system, and with others I've helped on forums outside of this one-it is also a resmed issue with their algorithm, so if you try another machine that is not resmed and use this form of EPR (reslex/Flex/SoftPap) you will feel better)

[Santino]

Thank you all very much for your detailed thoughts, I really appreciate it. I will focus in the short term on addressing the leak issue. I’ve had a tough time getting my F40 mask to both simultaneously be relatively leak-free while also not feel like the straps are overly tight.

Given the diametrically opposed opinions on EPR, I guess I’ll have to experiment more and see what feels best. If it does help with flow limits (even if mine aren’t that bad to begin with) as many suggest, then it seems like it’d in theory help with RERAs. I feel like I’ve solved the apnea issue at my current settings with the cervical collar, but I think I’m still dealing with RERAs.

[SeePak]

Santino.

Your leaks are mouth breathing fairly certain of that.
You see that in your charts when the leak rate goes up flattens out and the flow rate Narrows your chart shows that.
Mouth breathing is being talked about a lot recently and it affects your therapy as well as your body chemistry the only way to get rid of that with the full face mask which you're using is to change to a nasal mask and tape your mouth.
There are various ways of doing that you could try myotape which allows the mouth to open as necessary if pressure builds up and has to come out your mouth which is called mouth puffing.

Hopefully we have provided good descriptions of the reasoning for why we have said what we have in our various posts with you.
Please let me know where things are not clear?