[Symptoms] Insufficient deep sleep

[eriks]

I'll try just about anything the next days and weeks, so we'll know.

[eriks]

    Results from a night with pressure range 11-17 and EPR level 2.

My interpretation is that the max pressure is now high enough (it's never reached), but the low limitations are still there. Maybe increasing the minimum pressure even more will help, possibly with a ramp if that doesn't get me sleeping comfortably.

If I compare with other days: flow limitations has decreased a bit, but compare to a week ago and further, it's not better. So although it's little data to draw conclusions, it looks like the higher EPR (in combination with other settings) actually increases the flow limitations rather than decrease them.

[Geer1]

Imo your conclusion is half correct. Higher EPR appears to caused more flow limitation but where your conclusion is probably wrong is that it probably isn't the EPR (pressure difference between EPAP and IPAP) that is making the flow limitations worse but rather the lower EPAP you have been using because of how these Autoset machines are programmed.

Obstructive apnea/hypopnea/restriction caused by collapses or partial collapses of airways is the main thing CPAP is meant to treat. The primary form of treatment is the constant supply of pressure to help support and keep the airway from collapsing. The key thing to know about this treatment is that EPAP (lowest pressure that occurs during exhalation) is the constant pressure that helps avoid these collapses. If your EPAP is too low then collapse will occur during the exhale portion of breathing and then IPAP (inhalation pressure) has to try and force the airway back open which is much more difficult than just maintaining an open airway.

This is the issue that appears to be affecting you. The reason that increasing EPR had a negative effect is probably not because of the larger pressure difference between EPAP and IPAP but rather because on these autoset machines the set pressure is IPAP and EPAP = IPAP - EPR. When you increased the EPR by 2 you effectively lowered EPAPmin by 2 which caused your airway to start collapsing more regularly. In order to maintain the same EPAP and avoid collapse you should in theory increase min set pressure the same amount you increase EPR. Originally you were using a min pressure of 10 cm with 0 EPR, to maintain the same EPAP you need min pressure of 12 cm with 2 EPR or 13 cm with 3 EPR. At this latest 11 cm min pressure and 2 EPR you are still operating at a lower EPAPmin then you originally were with EPR off and this is most obvious by looking at median EPAP stat in OSCAR (10.58 vs 12.08 with 0 EPR). You need to first find an effective EPAP before you can see any advantages the higher EPR might be giving you.

The presence of both apnea and hypopnea supports that you have an airway that appears to collapse at times and higher EPAP is what is likely to be the best treatment for this. In your case it sounds like you aren't a fan of the way EPR feels so I would stick with EPR of 2 for now and focus on finding an effective min pressure to prevent collapses.

When posting these daily overview shots it is most important for us to be able to see the flow rate chart. In your case flow limits are also important and leak rate does not appear important so I would just move flow limits up don't worry about posting the leak rate graph. I would be curious to see a few 3-5 minute examples showing some of the apnea/hypopnea. For example a view of the 1:30 hypopnea cluster, 6:45 apnea/hypopnea cluster and 8:30 central apnea cluster.

[eriks]

Hi, I already increased the minumum pressure yesterday and the EPR is now at two. I had a terrible night (probably due to other causes), so it won't give good data. I'll try again tonight.

I did notice though, halfway through the night, that my nasal cavities where very sensitive as was my throat, making me a bit nauseous. But later on the feeling became less prominent. So it seems to me I've reached the upper maximum pressure level that can be used. Which is not a big problem I think, as the graphs now stay below the max.

I'll report in a few days.

[xaid]

I do have the same problem, guys, where my AHI is low but my sleep is restless (my smart watch shows 0-20 min deep sleep everynight).

It is obvious my APAP helps with the apnea but not with the sleep comfort. And here are my two questions:
1) What is (EPR) and how can I change it on Philips DreamStation Auto CPAP? Is it the same as A-Flex?
2) Any recommendations on my settings (see the attachment, please)

[Dormeo]

Xaid, it would be a good idea to start you own thread with your chart and questions.