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[Treatment] Advice on pressure and conquering RERAs/CAs - Printable Version

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Advice on pressure and conquering RERAs/CAs - REMChaser - 10-06-2024

Hi all! First time poster, longtime reader. I’d like to thank everyone here for the info they have shared over the years. The wealth of information has been invaluable since I started my CPAP journey in June of this year.

While I have become more acclimated to therapy in that time, I am still missing that elusive consistent, restful sleep. I have experienced this high quality sleep exactly twice since going on CPAP and it was life changing. I was almost a different person. And I have been chasing that feeling ever since.

My biggest issues appear to be RERAs and CA events. I can get my CAs pretty consistently under 2 when I am in my current 7.6 - 10.2 pressure range (with 3 EPR), but that results in higher RERAs. From what I understand the way to tackle RERAs is higher pressure, but when I crank up the pressure, my CAs spike. Feels a bit like chicken and the egg. My body has gotten much better at handling mouth leaking, which prevented higher pressures earlier on, so it could just be that I am not giving my body enough time to adjust. The combination of RERAs and CA is leading to very fragmented sleep. I wake up at least once in the middle of the night and have trouble falling back asleep. In case it matters, I am taking Trazodone each night as prescribed by my doctor. I take a half dosage before crawling into bed and then a 1/4 dosage in the middle of the night to help me fall back asleep.

The most “successful” pressure ranges in terms of the raw data were 7.0 - 9.4 and 7.6 - 10.2

A recent discovery is that I probably am suffering from positional apnea. I use a weird ergonomic pillow that is raised and has a scoped out middle for my neck and head that helps tackle neck pain. I fall asleep on my back, but my partner frequently finds me sleeping on my side, so I must be a pretty active sleeper. I am going to try a flatter pillow this evening.

Any other ideas or suggestions here would be much appreciated. Here are a handful of Oscar charts that I hope will provide clarity. Thanks in advance!! 

Sleep-well

Advice on pressure - REMChaser - 10-07-2024

Hi all,

I was wondering if I could get a second set of eyes on my current machine configuration. The way I am interpreting the data, it seems like I would benefit from increasing the pressure. But just want to make sure I am headed in the right direction as I have been feeling a little like a dog chasing his own tail.

Here are my OSCAR charts from the past couple of nights. Thanks in advance!

RE: Advice on pressure and conquering RERAs/CAs - G. Szabo - 10-07-2024

Hopefully, you can reduce the positional issues with a different pillow. 
You need higher pressure because you hit the maximum pressure ceiling. As you reported, higher pressure can increase CAs. Therefore, you should reduce EPR simultaneously. 
I would try a minimum of 9 cm and a maximum of 12 cm with EPR 1 or 2.

RE: Advice on pressure and conquering RERAs/CAs - REMChaser - 10-07-2024

Really appreciate you taking a look! That kind of aligns with what I have been thinking as well. I'll give that a whirl and follow up in this thread in a couple of days.

RE: Advice on pressure and conquering RERAs/CAs - OpalRose - 10-07-2024

Hello REMChaser,

I've merged the two threads you started, as it's much easier for those that wish to advise to see your history in one thread.  Going forward, please use this thread for your therapy questions and charts.

Thanks!   Smile

RE: Advice on pressure and conquering RERAs/CAs - Crimson Nape - 10-07-2024

Your Daily charts are displayed in a less than optimal configuration.  Please follow the steps below to help us see your data.
  1. Go to File > Preferences > Appearance
    1. Set Graph Settings > Graph to about 130.
    2. In the Fonts section, set Application, Graph Text, and Graph Titles to a size of 8.
    3. Select "OK" (lower right) to save and exit.
  2. In your Daily Screen, increase the width of the left side, so each entry only uses one line and no text wrap.  This is achieved by sliding the vertical separation bar to the right using your mouse.  This will provide more information to be displayed and will not reduce the graphs enough to affect their reading.

  3. Use the F12 key to take the screenshot.  This will minimize the calendar, which is taking up valuable screen area.  
After getting new screenshots, please post them here.  All we need are the Daily screenshots.
- Red

RE: Advice on pressure and conquering RERAs/CAs - REMChaser - 10-07-2024

Thanks Opal! 

I apologize Crimson, here are my corrected charts. Hope these are a little easier to read. I understand now why you like these settings, very crisp layout

RE: Advice on pressure and conquering RERAs/CAs - Crimson Nape - 10-07-2024

No apologies are needed.  You are learning.  Your chart displays are looking much better.  You may wish to play further with the graph height.  Based on your monitor's resolution, I would try maybe a 115 pixel size.  If it isn't to your liking, you can always go back to a larger size, or even smaller.  Just don't get carried away.  5 or 6 graphs displayed is good enough.
- Red

RE: Advice on pressure and conquering RERAs/CAs - G. Szabo - 10-07-2024

Your high flow limits, which are visible now, confirm your pressure increase needs.

RE: Advice on pressure and conquering RERAs/CAs - REMChaser - 10-08-2024

Thought I would post a small update. Reducing the EPR to 1 and raising the pressure really killed off those RERA arousals, which is great to see. Flow limit looks a little bit better too. It was a tough night of sleep, but I know my body is just adjusting. 

I'll probably try mouth taping tonight to see if that can help with the leaks. 

Looks like I am hitting the top of that pressure range, but those peaks seem to coincide with leaking events, so I don't think that it warrants a pressure increase yet.

Thanks for the advice G! Going to stay the course now for a little to see what happens once my body adjusts.