[Pressure] Large pressure swings

[Kdsjr]

I'm coming up on two months using CPAP. I had an AHI of 13 at my sleep study with lots of hypopneas throughout the night. Since starting therapy, I haven't really felt much better. I'm definitely dreaming FAR more than I did before which seems like a positive step, but Im still tired throughout the day. Looking at my OSCAR data, I see that my pressures are just all over the place all night. I've tried slightly increasing the pressure to 11 (from 10). I didn't feel much of a difference but I noticed that my 95% and median numbers increased correspondingly. Are there any other steps I should consider trying to hone in on an ideal pressure or range?

           

[OpalRose]

The Flow Limitations is what drives the pressure to the maximum set. We like to see that 95% FL number around <5, preferably 3. Using EPR usually helps bring that number down.

So let's try this:

Minimum pressure - 8 cm
Maximum pressure - 10 cm
EPR - 2

Hopefully this will stop the pressure swings with a narrow pressure range and bring the flow limitation down by using EPR.

Try this for a few days and repost. We may need adjustments.

Question: Did your sleep study show any central apnea?

[Kdsjr]

Thank you so much!! I will try these settings for a few days to see how they feel. Thanks again for your advice!

[Kdsjr]

After a few days on EPR of 2 I found that my flow limits were decreasing. I tried increasing EPR to 3 to see if the trend continued and it also seems to have had a positive impact on my overall flow limits. I'm finding that my flow limits haven't gone away though and still seem to be causing jumps in my pressure. Would changing from APAP to CPAP mode cause any problems? I'm wondering if forcing a constant pressure would be even better. I've felt just slightly better on the days that I've bumped up EPR, but I'm still not feeling great. I've attached all the charts from my OSCAR data from last night.            

[OpalRose]

Using cpap mode may be the answer, but let's try this first. Change the RESPONSE from Standard to Soft for a few days.

If that doesn't help, then change to Cpap mode with a pressure set at 9cm, EPR 3.

[Kdsjr]

So I think I've tried all the options suggested and haven't seen any changes. I've tried CPAP mode at both 8.6 and 9.6 with both feeling about the same. I also tried Autoset for Her since I read that it dealt with flow limits better. It seemed to have the opposite effect for me, actually causing them to increase. I've also tried the soft response and it didn't have any noticeable affect. In reading through the wiki, I've noticed that my breathing pattern resembles one of the inspiratory flow limited patterns (pattern 6). This seems to be consistent on every single night. A screen shot of this is attached below.

I've also had an appointment with my primary care doctor and they didn't seem to know what to do. They recommended i make an appointment with my dentist for a MAD and they also said they'd send my charts to a sleep specialist to review. i've noticed that my jaw does droop while sleeping so I'm hopeful that the MAD may help, but I've also started sleeping with a soft cervical collar. Would a BiPaP potentially be a better option for me or are there some other settings I could try? 
           

[OpalRose]

With the changes suggested, these charts are a big improvement over what you originally posted.

We look at the 95% flow limit.  Your recent graphs show .02 and zero 95% flow limits.

The one day that your reading was .05 was due to dropping the minimum pressure below 7.  

Leaks rates are really low.  Pressure swings have been corrected.
The few CA's are nothing to worry over.  Your results are very good.  

So it's how you feel that counts.  You haven't been on therapy very long, and for some, it just takes longer to adjust.  

Maybe take a look at Sleep Hygiene:

https://www.apneaboard.com/wiki/index.ph...Sleep_tips