Time for Adjustment, drop EPR or raise pressure?

[OpalRose]

The flow limitations would indicate you need a slightly higher pressure.
Also, as long as you are comfortable with EPR set to off, then I think that's a good move to keep clear airways in check.

You are going about it the right way...by raising minimum pressure slowly.

[PoolQ]

"felt starved for air at 4 and 5" I found for me that I needed 5.6 as a minimum. Set the pressure, put the mask on with air going, lay down and relax, breathe normally and see if you get that feeling-if you do up it a little until you can breathe without feeling starved. This is not therapy adjustment it is just getting enough air.

Then sleep with it and make sure you have not jammed up you numbers, doubt you will, but always check.

The waiting a week or two or more is to keep you from whiplashing yourself, you need time to adjust to this stuff, but IMHO not enough air is not something to get used to-pressure in all its forms yes, lack of air no.

[AshSF]

Since your pressure needs are below 10, I would suggest you try a constant pressure of 9cm with EPR at same level. Do this for 10 days and evaluate.

In APAP mode, resmed is very aggressive with pressure changes and they may be messing with your sleep architecture. Consequently, your AHI/RDI numbers may look good but you still feel like crap in the morning.

[holden4th]

Interesting point. My settings are only a few points higher. Would the less aggressive Respironics 60 series algorithm work better in this case?

[Sleepster]

I have been at this setting for the past several weeks and my numbers (with a few exceptions) have been around 1 or less. While my sleep has been OK, I feel it should be better.

Take a very close look at your leak graphs. If you see extended chunks of time where the leak rate is elevated, that could indicate mouth-leaking. That alone is enough to ruin a night's sleep. The remedy is a chin strap, and if that doesn't work, a full face mask.

My flow limits seem to be a bit to many and since things improved (both numbers and sleep quality) last time I made changes, I am contemplating another change. EPR to off, or a pressure hike from 6 to 6.5.

There's no harm in trying either of those things. What is your 95th percentile pressure, and your median pressure? Your range of 6 to 16 is pretty wide. If the numbers indicate that you need a pressure significantly higher than 6 to stop flow limitations then it could be that an even larger pressure hike is needed.

I have graphed my AHI by month and run a least squares line for the last four months. Each month the line is downward sloping and below the previous month so I know things are improving.

This shows you're adapting. That's awesome!

[monkeyfeathers]

I am actually having a similar conflict. When I started my DR Auto I did not realize that the flex setting would drop me so low below my minimum pressure. So I raised my min by a half and dropped my flex by 1 and was much better. I almost wish that flex/epr had a ramp feature in and of itself or limited to times the pressure increases during times of need. My need for it kicks in around 9.5. Live and learn.

[Rcgop]

I am actually having a similar conflict. When I started my DR Auto I did not realize that the flex setting would drop me so low below my minimum pressure. So I raised my min by a half and dropped my flex by 1 and was much better. I almost wish that flex/epr had a ramp feature in and of itself or limited to times the pressure increases during times of need. My need for it kicks in around 9.5. Live and learn.

I may rethink the ramp off, EPR/Flex off, but for now just raise the pressure. Very slowly and take my time. My max pressure never gets over 10, so I can let the auto set be my ramp.