[Treatment] Need assistance with improving treatment

[Harmon]

Hello, 

I'm looking for any advice on settings I could try that might help me lower my AHI. I am using a nasal pillow mask (P10) and have used a F30i in the past and am open to trying a new mask or mask type but would prefer to try adjusting settings first. 

I've attached screenshots from last night below. I've taken some time to try to understand the OSCAR data and learn how to read it I'm just not quite there yet. Still waking up feeling groggy and tired and lacking energy during the day. Any suggestions for what I could try? 

Thank you. 

               

[Harmon]

Updating with last night's data. Still looking for recommendations. I increased minimum pressure from 6 to 7 last night. 


   

[Brazen]

I'm not an expert, hopefully one of them can comment on your settings.

In my novice view...
You're getting some mask or mouth leak. The machine can compensate for some leak but too much and it can't do it's job.
Do you have less leak with the F30 mask?

With your current EPR of 3, it takes a minimum of 7cmw for that EPR to work -- the machine can only go as low as 4cmw so the min 7 minus EPR 3 puts you as low as the machine can go.

[Harmon]

The F30 was inconsistent. There were nights I would have large leaks almost all night and other nights that were similar to the amount of leaks I'm experiencing now. Every once in awhile I'd have a night or two where there were virtually no leaks at all with that mask. 

Maybe I do need to continue to explore mask options. 

Good to know about the EPR. Thanks for the info. I'll keep it at a minimum of 7cmw to maximize EPR until I can get more direction based. 

Does anyone else have any thoughts on settings I could try out to try and improve treatment and lower AHI?

[Melman]

EPR can cause central apnea. You may get better results with EPR of 1 or with EPR off. If obstructive events, hypopnea, RERA increase you may need to increase it again. It may take some experimentation with EPR levels to find the right balance.

[mesenteria]

I think your current settings, except for the EPR (which Melman has rightly pointed to), are generally okay.  You aren't topping out near 13 cm, nor are you bottoming out at 6, although it's close there.  

You have a lot of centrals, and they are somewhat associated temporally with the leakage when that happens.  I dunno what comes first, the chicken or the egg, but if your centrals arouse you, and you heave or toss out of alarm, you may be pulling at your hose just enough to displace your mask, or your head gets placed back on your pillow after turn/arousal, and it gets displaced or merely deformed in the new position.

So, I think we need to grapple with those centrals and minimize them.  Your EPR could stand to be reduced to 2, maybe even 1, certainly as a trial for three nights.  Too high an EPR has a history across the PAP population of encouraging centrals.

There is a small appearance in your events record of 'clustering'.  The apnea/hypopnea happen repeatedly for a short period of less than 15 minutes until you get sufficiently annoyed and aroused that you move and correct the tucked chin towards your chest (often when supine).  If this turns out to be the case, we often suggest that a soft foam cervical collar might improve that problem.

[Harmon]

I lowered the EPR down to 2 for about a week. AHI is averaging around 3. I will attach the last three nights here. Any ideas on how I could try to get that number down lower? Still waiting for symptoms to improve. Thanks for the recommendations so far. 


           

[Melman]

try EPR 1