Pressure Settings - Is This As Good As It Gets for Me?

[esleepie]

Started PAP therapy in March and I'm wondering if there's anything I could do to improve my results. See attached photos.

TL;DR
I was diagnosed in February with severe OSA. Overall AHI of 63.3, supine AHI of 85. Oxygen Desaturation Index (ODI) of 59.4/hr. Minimum o2 sat of 57% and 145 minutes at SpO2 less than 89%.

I received my Resmed Airsense 11 in March and was prescribed APAP at 8-14cm. They said I could come back for a full titration study at a later date if I so desired and/or if i have troubles with the prescribed pressures. I may eventually take them up on that, but for now, I have been reading and absorbing as much as I can and would like to make adjustments from home.

I initially had difficulty breathing against the pressure and had a lot of CA's because of it. My AHI was 5 to 7 each night. Way better than without CPAP, but I still felt horrible and was ripping off my mask and throwing it across the room each night. It took a week and multiple calls to my DME provider to get a call back and still they didn't offer much help. "Just get used to it."

I added EPR at 2. That helped, but I still felt suffocated trying to exhale against pressure and the CA's continued. I turned EPR up to 3 and almost all of the CA's went away, but I still see them at pressures over 11. I discovered that at pressures below 10, I had a lot of OA's continuing to occur and AHI was still high. I adjusted up to a minimum of 10, max 14. 

This is where I want to turn it over to you and see what you think I should do. I did try some other things, but nothing seemed to provide anything consistent. It seems like my OA's don't get controlled until around 12, but CA's start in the upper 10's. 

I am hoping for some guidance here but if all else fails, I'll set up that appointment for a titration study and try to find the time to attend.

[esleepie]

I made some changes last night because I noticed that I don't ever really hit the max pressure and most nights top out in the mid-12's. So I think I may drop it down 0.2 at a time from here and watch to see. Also noticed that breathing seems most stable around 10.5 to 11.5. 

Starting to wonder if maybe fixed at 11 or 12 might be best for me? Thoughts?

[gainerfull]

How do you feel the next morning after sleeping with these settings?

[esleepie]

Still pretty tired. I've had a few random nights over the last couple months where AHI was below 1 and those nights I actually felt pretty good. I just haven't been able to pinpoint what exactly it was about those nights that kept in the AHI so low.

[gainerfull]

While you wait for someone to recommend changes I'd recommend looking into how you can improve your leak rates as they're pretty high. Once you've got your 95% leak rate as close to zero as you're able you'll be well set up for pressure change recommendations. It doesn't seem like your current minimum pressure is compensating for your obstructive apnea but I'll let someone more experienced weigh in on what the setting change should be.

[OpalRose]

Starting to wonder if maybe fixed at 11 or 12 might be best for me? Thoughts?

The Epap is what sprints the airway open to control Obstructives. Most of your apnea are Obstructives.

Try Cpap mode with 11.6cm. Set EPR at 2cm. This gives you an Epap of 9.6, which should control the Obstructives.

[esleepie]

While you wait for someone to recommend changes I'd recommend looking into how you can improve your leak rates as they're pretty high. 

It doesn't seem like your current minimum pressure is compensating for your obstructive apnea

I've been working on the leaks and you're right, the obstructive apnea needs higher pressure. The problem has been that higher pressure translates to strings of centrals and the pressure then fluctuates all over. That's why I'm thinking I may need fixed.

The Epap is what sprints the airway open to control Obstructives.  Most of your apnea are Obstructives.  

Try Cpap mode with 11.6cm.  Set EPR at 2cm.  This gives you an Epap of 9.6, which should control the Obstructives.

Thanks Opal. I will try that tonight.

[esleepie]

Here's last night's chart.

[OpalRose]

How did you sleep while using straight pressure?  Did you feel that was enough pressure?  

Your numbers are decent and if you're comfortable, stay with these settings for awhile, or.....
You can raise your minimum pressure in small increments to see if the Obstructives will lessen, without causing an increase in CA's.  Although, the CA's are not that high either.

If you choose to increase your pressure, move it to 12cm.

[esleepie]

Thank you Opal. Now that I'm a little more awake and have had some coffee, here are my thoughts... I tend to have more centrals on EPR2 than on 3. I added a zoom here and it looks to me like there's an unmarked central at about 4:28am. There are several of them like this through the night. I have experienced these type of occurrences while awake and it feels like my lungs get tired of pushing out against pressure, I inhale deeply, and then hold it for a while. I don't intend to do it, t's subconscious. Also, I can tolerate higher pressures with EPR3. I know that's because it lowers the overall average, but it does a better job of controlling the centrals. Somewhere in this pressure range of about 12, I start having equal occurrences of centrals and obstructives. These are just my observations. I'm no professional, so I will take whatever advice you give and try whatever settings you think might help. Just sharing information I think may be helpful in your consideration.