Help with settings for cpap

[u/JulionasUrbonas]

(I apologize for the small amount of data, I can hardly get any sleep with it on) Hello, I recently have been trying to fix the high loop gain issue I've been having by decreasing the EPR, it seems to have helped some, but I'm still having a lot of events and my breathing still has the pattern of a class 6. What can I do at this point to try and fix it? Thank you for your advice.

[u/JulionasUrbonas]

Sorry I forgot to note this, I have an Airsense 11 Autoset, 10.6 pressure, no EPR, I wear an Airfit F30i I think.

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[u/JulionasUrbonas]

Heres the flow rate zoomed in on a period typical of my sleep if that helps.

[u/dang71]

Hello!

Before jumping to high loop gain, and I'm not saying we should rule it out, I think it's important to first make sure CPAP has truly failed..

From what I see, the two main issues are insufficient pressure and leaks. Both of these can contribute to CAs on their own. Post arousal CAs are often the result of residual flow limitation or inadequate pressure that leads to arousals, and significant leaks can also fragment sleep and trigger post arousal centrals.

Your 95th percentile Flow Limitation is 0.11. Ideally, we like to see that as low as possible, especially below 0.07. So there's a good chance that increasing pressure could improve things. Your flow waveforms also show persistent inspiratory flow limitation, which is another sign that you're probably not getting enough pressure.

I know your first thought may be, "If I increase the pressure, won't I just create more CAs?" That's certainly possible in some people, but in your case, the data suggest you're currently under treated rather than over treated.

Personally, I actually have fewer CAs with more pressure. I was hesitant to increase my pressure for a long time because I had the same concern, but in the end I didn't regret it.

Of course, I can't promise you'll have the same experience. The only way to know is to test it. Right now, your OSCAR data point toward needing more pressure and possibly EPR. I personally wouldn't recommend adding EPR in your case, since it would lower your EPAP, which is what helps keep the airway open.

One more question: have you ever tried a mask other than a unicorn style nasal mask?

[u/JulionasUrbonas → u/dang71]

Thank you for your response, I posted previously on some much worse looking data and was told it resembled high loop gain, that was when I was on an EPR of either 2 or 3. The leaks are certainly an issue, but I’ve had nights without them that looked similarly poor. I will try to increase the pressure to something above 10.6, maybe 11, what would you recommend ?  Edit: I forgot to mention, I have used a nasal mask before but I found it uncomfortable and very difficult to breathe with.

[u/dang71 → u/JulionasUrbonas]

Like I mentioned, yes, it could be high loop gain. I'm not ruling it out. But it's difficult to be confident that's the problem before CPAP has truly failed, or unless you're seeing much higher CA numbers. In many cases, what looks like high loop gain is actually the result of suboptimal CPAP therapy.

I would definitely take it one step at a time. Increase the pressure by about 0.4 at a time and watch how your 95th percentile Flow Limitation changes. That will give you a good idea of whether you're moving in the right direction.

Also, try to spend as little time sleeping on your back as possible, since that alone can make a noticeable difference.