[Treatment] New to CPAP, inconsistent results as of late

[Vike3]

Although first time poster I have read a lot of posts on here in the last few months there are some real experts on here.  I just figured out how to get Oscar data and have
been running it for a few weeks and would love to have someone analyze my charts.  I had to paste them as limited to 3 attachments so sorry for that. 

Brief hix:  Home sleep study early April 2024,  15.1 AHI, OSA. (36 on back, 6 on side) Spo2 low was 77 and 30 mins under 90.  Yikes ! 

5/1: Started CPAP Resmed 10 in APAP mode, almost immediately traded OSA for TECSA. Sleep Dr said those will eventually go away. 

June: In lab study as although he didn't want to do one as I had been doing well, I told him I had trouble with sleep duration.  Writeup from that is as follows: 

Since June, have been doing progressively better and got AHI down to an average of under .20 for a while there. 
Then I decided to try some back sleeping as side sleeping was bothering shoulder and hip.  They wen't up a little
but nothing drastic.  Average .5-.6.  I can live with that. They are all centrals and hypopneas/RERS, but mostly CSA.

They say CSA's are consistently inconsistent.  Yep they sure are.   Night before last 1 single CSA, nothing else.
Last night, very different story.  I will say my leak rate was not stellar last night so possibly that plays into it?
I should also add that I upped my EPR from off to 3 initially (to treat aerophagia) now I'm down to 1.  I also increased min pressure from 5 to 6.6
over time as noticed SPO2 average would dip to an average of 94 when pressure that low.  (FYY- 2 PFT tests soince 6/1, both better than normal spirometry) 

Questions: 
1- Will leak rate affect CSA ?
2- Do any of my CSA's resemble OSA ?  
3- I have ramp set at 20 mins to avoid "Sleep junk CSA's" as I definitely get those when falling or especially lying in bed too long upon waking. " 
4- I had previously set range from 6.6 to 11 but then would wake up and see it really close (10.8) so I bumped it to 13 (maybe I can go down again to 11 after seeing these?)

Meds:  Hyroxyzine 25mg before bed, Famatodine 10-20 b4 bed, sometimes 3am melatonin mid sleep, sometimes Lorezepam midsleep (rarely though)
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Can't post charts for some reason.  No idea why.  I only tried to post 3, it wouldn't even take 1 !

[Vike3]

Attachments of charts.  Hopefully they work ! 

   
   
   

[SarcasticDave94]

You have a Ramp that is stealing therapy time, every time you restart therapy. These restarts happen several times a night.

Your minimum pressure can be raised to a minimum of 7, which allows EPR to work a bit better. It will also help reduce Hypopnea and flow limits with at least Min 7, maybe Min 8 will be better.

You also have some moderate but fairly consistent leaks. These need attention to reduce sleep disruption. Going tighter on mask straps will most likely be the wrong answer. If the mask leaks with moderate tension, it's either the wrong size, shape, style for you.

[Vike3]

Thanks.  Yes I am constantly buying mask straps from AMZN (have bulk packages) as they stretch so quickly. That's probably my leak issue.  I will remove the ramp time, increase the Min, someone also told me to lower the max to 9 and see if any OSA's pop up as it's the high pressure liklely causing the CSA's (since I never had an issue pre CPAP with them).

[Deborah K.]

Did your sleep study show a lot of CAs? If not they are treatment-emergent and will lessen on their own as time passes. I think that is likely as one of your nights shows only 1 CA. If they are treatment-emergent I would raise your EPR full time to 3. Some nights your AHI will be a bit higher, but the numbers are less important than keeping your flow limits down.

I would change your pressure to 8 to 13. I do not think you should cap it at 9.