(09-30-2024, 03:14 PM)CPAPfriend Wrote: hey leonidas,

first order of business is to always zoom in to verify if the CAs are true CAs or just post-arousal CAs, which are quite common. That said, with the limited information you've made available, it's more likely they're true CAs, but always best to confirm.

It's not uncommon for EPR to set on CAs, because increasing pressure support (EPR is essentially pressure support) will increase ventilation (removal of CO2), theoretically speaking, and CO2 is responsible for your drive to breathe.

Aerophagia can be caused by arousals themselves, so it's not necessarily a pressure issue, but the latter is more probable. It's true that you should increment your changes slowly, particularly if you're showing signs of sensitivity, which typically implies you have a low CO2 buffer. This conversation can be a pandora's box, but for now I think there is some lower hanging fruit for you.

Make sure you're breathing through your nose; if you can't, that might be the sign of a greater issue, but nasal breathing results in greater end-tidal CO2 and therefore, in extension, typically less apneic spells. In other words, mouth breathing can exacerbate the consequences of an already thin CO2 reserve. I'm assuming you may have already attempted this, but turning EPR off for now, or at least staying at a fixed setting for it, is advised, as we want to minimize the perturbations and isolate the problem. 

This is kind of obvious, but you're probably still waking up because your pressure is insufficient / not optimized. From a distance, I can see that you still show a lot of dysregulated breathing, and your flow-limit graph shows unresolved obstruction, which is the elephant in the room, but you're right to entertain the idea that it might not be that.