Oscar screenshot. Can anyone advise whats next?

[legrunt]

Hi guys.  With regards to my aerophagia/gerd/LPR chronic cough, I am trying to titrate my pressures to be as low as possible, while still maintaining a good quality of sleep.
(aren't we all?)

So this is the lowest I have been in over a year.
Can anyone suggest if I have gone too low?  Or is there room to reduce further?
EPR at 3, is that ok?  Or should I reduce it?

Any advice is greatly appreciated.

Derek

   

[OpalRose]

Besides the normal things that folk try when suffering with Gerd, like sleeping on left side, with head elevated and watching what you eat and drink before bed...

Your chart looks fairly decent.  Are your Gerd symptoms under control with current settings?  Are you sleeping well?  Those are the key questions.  

You can keep titrating by lowering pressure a little at a time and observe.  If you see an increase in apnea, then you can always move the settings back.

As far as EPR, you have Flow Limitations and Hypopnea, so EPR is needed to help with that.
However, you can try EPR at 2 and see if there is any difference in sleep quality, Gerd symptoms, and/or increase in apnea.  

Don't change EPR and pressure settings together.  Only make one change at a time and make note how you feel.

[legrunt]

Thank you.

GERD is under control, but I have to rely on Nexium to reduce the acid in my stomach.  I tried weaning off Nexium over the course of 2 weeks, but the cough returned quite badly.
Coughing in this day and age... sigh... 

I reduced EPR to 2 last night, leaving the pressure settings unchanged.  AHI seems to be better, but I had a bit more gas in my guts this morning.
I might try EPR 2 again tonight, but lowering the max pressure by 0.2 again.

   

[OpalRose]

Probably a good idea to lower the max pressure a little at a time. You may also get to a point where you may want to try Cpap mode instead of auto.

You should also consider that you may be mouth breathing even with the full face mask and swallowing air.

[legrunt]

You should also consider that you may be mouth breathing even with the full face mask and swallowing air.

Oh? Didn't consider that.  How would one go about determining mouth breathing with a full face mask?

[OpalRose]

Look at the leak graph. Spikes peaks are usually mask movement. Flat tops in the graph usually signify mouth breathing.

Your overall leak rate is low, but consistent during the night.

[legrunt]

Look at the leak graph.  Spikes peaks are usually mask movement.  Flat tops in the graph usually signify mouth breathing.

Your overall leak rate is low, but consistent during the night.

Thanks for that...
However, I don't understand how the machine would differentiate between mouth breathing and regular nose breathing if the mask is a full face mask?

Looking at my leak graph, there are definitely spikes where I reached in to scratch my nose...  But does the overall low consistent leak rate merit a closer look?
I notice the venting in the F20 series masks are much higher compared to a phillips dreamwear hybrid or nasal mask... With those, I always felt slightly out of breath from rebreathing.  Was even contemplating drilling more venting holes in the mouth piece... But when I switched over to the f20, no such feeling.  Would that extra (maybe perceived) venting in the f20 cause a leak to be misidentified?

[OpalRose]

Your leak rate is low overall, and does not affect your data.
The only time to take a second look at a lower leak rate (caused by mask movement) is if it's disruptive to sleep.

[legrunt]

Righto... Thanks so much!

[legrunt]

Based on the attached screenshot, you reckon I have gone too low?