Periodic Breathing Strategies?

[mark.apnea]

I've been on CPAP therapy since last Nov.  Recently, I've noticed a rash of several sustained stretches periodic breathing, along with several hypopnea and central apneas during these stretches.  I have seen a few nights with CSR events logged by my Airsense 11.  I have had zero obstructive events for months.  I just requested a referral to a pulmonary office as I have had ZERO review and assessment of the efficacy of my cpap therapy since starting last Nov.  They estimate a couple weeks to get this scheduled. 

I'm a side sleeper and wear an evora hybrid full face mask.  I do flipflop from side to side several times per night.  Minor leakage has been an ongoing thing - "farting" from around my cheeks which wakes me up.  I've made many adjustments, looser and tighter, w no significant improvement.  I've become much more consistent avoiding mouth breathing.

I recently reduced EPR from 3, then 2, then 1 over the course of a couple weeks hopefully to reduce CAs, no discomfort with this change.  I also increased min pressure from 7 to 8 in the last week.  I've had a bit of a dry cough/tickle the past week due to a dry airway/throat - I've intermittently stopped using the humidifier this summer as its been quite humid.  I see pressure spikes from these snorting & coughing fits.  I will resume fulltime humidifier use starting tonite.

Are there any strategies to help reduce the CAs and these stretches of periodic breathing?

I've attached last nights OSCAR data along with a zoomed-in view of the periodic events:

   

   

[PeaceLoveAndPizza]

CA’s are not a major issue at the moment, the hypopnoea’s need to be dealt with first. You have positional apnoea caused by chin-tucking or similar positioning causing obstructions in the airway. Try a flatter pillow, soft cervical collar, wedge pillow, or other contraption that helps keep the airway open.

For settings, try EPR=2 to help reduce the FL’s. 

How did you end up with that pressure range? Have you tried titrating and seeing where things land? If not consider trying:

Mode APAP
Min pressure 7
Max pressure 15
EPR 2 full-time
No ramp

This process will allow you to see where things land. We can sometimes over-pressurise ourselves if not working through the titration process. I am not a fan of guessing at what is the proper pressure. I much prefer approaching it as logically as possible.

[mark.apnea]

Sorry, late to reply. Thanks for your response.

As an exclusive side sleeper, would position apnea be a thing to consider.  I cannot imagine how it would be possible to "chin tuck" while on my side.  I tried last night and even actively/consciously trying to chin tuck, it seemed quite difficult to accomplish.  

Any other ideas to reduce these periodic breathing events?

As you note, my CAs seem better controlled than before. As was suggested, reducing EPR slowly seems to have. effective .   

The many hypopnoeas seem to be my current challenge to reduce or control.

What might be effective changes, pressure, EPR?

As you suggested,

Mode APAP
Min pressure 7
Max pressure 15
EPR 2 full-time
No ramp

Is very close to my current settings.  I'll tweek slightly as you note

BTW,  the pulmonary office left a msg to call to schedule an appt.  That was quick!
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