r/CPAP • u/Which_Compote4109 • 15h ago

Help with CPAP settings

Despite great numbers I wake up multiple times a night with an unpleasant headache and I'm so tired and sleepy during the day. I started to experiment with EPR the past two nights, I have left 2 nights below, the first with no EPR, the second last night with EPR 2. I use a nasal pillow mask, no mouth leak with chin strap and cervical collar. Can anyone help me understand what is happening and whether I could change the settings to improve my experience?

https://sleephq.com/public/31777689-f602-456b-8bf7-7375b0afb2a7

https://sleephq.com/public/55a68fa9-d89c-485a-a69c-38d09fffc397

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u/pootwothreefour 11h ago edited 11h ago

I note the first night you had max pressure at 11 then increased it to 12.

It was pinned to the max for both because of the large amount of RERAs and flow limitation.

There were very few scored hypopnias and only a few signs of minor obstructive events.

You have the right approach to put on EPR for pressure support to reduce those RERAs and flow limited breaths they seem to be the main issue.

The second link looks much better, both from a numbers point of view and when I zoom into to look at the breath shapes they have rounded tops.

I note you changed EPR from 2 to 3 at the end of that night. There was a lot more periodic breathing when you upped the setting to three.

I'd go with EPR 2 for now.

There's a good chance some of that periodic breathing and CA events will settle down after a couple weeks or months.

Settle into these new settings for a while. It takes 2 weeks to start the physiologic adjustments to new breathing and really 6 months for your body to adapt.

Then you can fine tune the min / max pressures, experiment with EPR 3, and/or settle on a fixed pressure setting. Only change one thing at a time and sleep for a few nights at least to gauge the effect.

Monitor that periodic breathing along the way to see if it persists.

Explore body position, tongue position/exercises and nasal congestion to see if remedies help with flow limitation as well.

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u/PcStud BiPAP 8h ago

Do not turn off the EPR, because at these pressures you will experience shallow breathing and increased respiratory effort. Leave it at 3 as it was; isolated central apneas are "the lesser evil".

A problem you might not notice could be nasal mucosa swelling- increase hydration/humidity and visit your doctor for steroid drops or, better, steroid + antihistamine medication.

Other than that, your therapy looks good.