[Pressure] Help with settings

[Badatbreathing]

Hello.
  I have an at home sleep study scheduled for the middle of January. For the last 2 weeks I have been renting a CPAP machine (resmed airsense 10), on my own initiative. I do not have a humidifier for it. When I rented it, I was sold a nose mask despite mentioning that my nose is usually clogged. The first 4 nights I used a nose spray to open up my nostrils and was able to use the mask, but it is recommended not to use it for more than 5 days at most, so I went and bought a full face mask (yuwell yf02).
  The machine was set at the pressure range of [5,12], ramp on auto and EPR on 1. After using OSCAR to read my data I have slowly upped the pressure to 15. As you can see bellow, the AHI and leaks are fairly low, but Flow limitation appears to be high. Note that my mask seems to be a size too big (L instead of M) so I have to really tighten it to avoid leaks on higher pressures. Initially I would wake up in the middle of the night due to leaks.
  What changes to my settings do you recommend?

[PeaceLoveAndPizza]

Overall things look very good. Well done! Glad you are taking control of your therapy.

I think setting your pressure range to 9-15 with EPR 2 and turning off ramp should make a big difference. Before we address the apnoea’s we need to get the flow limitations under control that are driving the wild pressure swings. A bit of EPR should do that. If EPR of 2 does not handle things, then increasing it to 3 would be the next step.

Once things have settled down a tad, we can see where the events lead. If the hypopnoea’s and obstructive’s continue, we could increase pressure a bit to handle them. I would prefer waiting to get the flow limits managed before addressing the events.

Give that a try and let us know in a day or two how things are going.

[CPAPfriend]

Yeah, I agree. Increase min and dial up EPR 1cm at a time to resolve the flow limits.

[Badatbreathing]

Hello again, and thank you for your replies.
  So, here is my progress:

EPR 1, Pressure (5,15)
   
   

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EPR 2, Pressure (5,15)
   
   

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EPR 2, Pressure (9,17)
   
   

[Badatbreathing]

EPR 3, Pressure (9,17)
   
   

[UnicornRider]

Looking much better.

      I believe you could go :

       Pressure Minimum  11 cmH2O

      Try it there and post back, 

[PeaceLoveAndPizza]

What pressure and EPR setting felt more comfortable? Which gave a good nights sleep? It’s your therapy, so we want to make sure our tweaks are based on settings that work for you.

[Badatbreathing]

So, I have not noticed a big difference between settings. I have some melatonin before bed and it makes it fairly easy to fall asleep. Ever since I started cpap I wake up at least once per night and the past few days I only woke up once so no difference there. The only difference I can think of is that today I was sleepy when I woke up but the feeling quickly subsided once I got off the bed.
I also used a diy mask liner last night. Because of that, i think the mask needed to be less tight to seal properly and thus it was more comfortable.

[Ynot]

You could try maximizing epr, for some reason epr lowers drastically my flow limitations. I'm not quite sure why though. It probably leads to fuller more natural breaths.

[PeaceLoveAndPizza]

BTW, your EPR 1 charts are not at EPR 1.

One more thing to try if you are open to it is setting your pressure to min 11 max 11 EPR 3 (essentially fixed pressure APAP mode). In every chart as your pressure gets driven up by flow limitations, you experience OA and H events. If we fix it at 11 (your median pressure) and add some pressure support with EPR, it may provide a more restful nights sleep.

Otherwise I would stick with a pressure range of 11-14 EPR 3. You could set it 11-17, but the higher the pressure goes the more events you have, so I think capping it for now is a good thing.

Some of your events appear positional, but I’d like to see a few more nights at a pressure before recommending things like a cervical collar or mouth tape.