[Treatment] Trying to improve my numbers

[Lex2101]

Hello everyone.

I'm a bit stuck. How would you go about to improve these numbers?
I'm currently using a nasal cushion mask.

[Sleeprider]

With 9-17 pressure and EPR 3 on your S9 Autoset, you are experiencing a relatively high obstructive apnea rate, and some incidental centrals. I'm going to focus on the obstructive events since that is what your machine can do, and if we can get those under control, then we can go back and see what remains of the centrals. Your median therapy pressure is about 11.6 in both of these charts, so your minimum pressure of 9.0 seems to fall short most of the time. The pattern of apnea suggests that obstructive events become more likely below 11 cm and seem to abate by the time you reach 15 cm. I think a higher minimum pressure is a logical, common-sense change you should consider. Note that with 11 cm pressure, your actual delivered EPAP is still only 8.0 cm, and that is probably the crux of the problem. My own experience with a Vauto puts my minimum pressure at 13/9 cm (IPAP/EPAP). It is not unresonable then to recommend a minimum pressure of 11/8 to 12/9 to you to help cut these obstructive events. I don't think you need any changes to maximum pressure, and you seem to benefit from EPR to reduce flow limits. We may review your EPR setting in the context of central events later.

You need to be aware that your obstructive events are clustered, sometimes with events occurring within seconds of each other. This is an indication of a sleep position that causes the airway to obstruct, generally by chin-tucking. The use of extra pillows or sleeping inclined should be avoided. We sometimes suggest a soft cervical collar to prevent sleep position from causing a bend in the cervical airway which leads to obstruction. At this point, I just want you to be aware of the potential for positional apnea and try the higher pressure. There is a wiki on Optimizing Therapy in my signature links that discusses the positional apnea, and other sections deal with centrals. Give it a look.