Newbie Stumped on CA's / EPR

[Semble]

Hi folks,

I'm another newbie to this PAP universe (just one week into treatment so far), and I am so deeply appreciating all the sharing and generosity on this board – you've already been incredibly helpful to me.

There is one thing in particular I'm hoping to get some extra insight on. I've attached last night's OSCAR data below, and here's my info for context:

• Untreated Sleep Study Results: AHI 21.91 (almost entirely obstructive hypopneas), Central Apnea/Hypopnea Index 0.4, Spontaneous Arousal Index 9.59
  
• Prescribed 5-15 cmH2O (note that there was no treatment/titration during my sleep study, so not sure how much faith I should have in the precision of this prescription)
  
• I'm using an AS11 Autoset with DreamWear nasal pillows
  
• 5-15 cmH20, EPR 3, Response Standard, Ramp Off
  

So, as you can see, my obstructive events and overall AHI are already way down relative to my original sleep study results (hooray!), but CA events are up (last night was actually the lowest they've been since starting treatment; on previous nights they've been as high as 8.52/hour). Reading this board, I learned that PAP treatment can cause CA events by way of overly efficient breathing leading to sub-apneic threshold CO2 levels, and that the first thing to try would be to lower EPR. So I tried EPR off, EPR 1, and EPR 2, but for some reason all of these made it so difficult for me to exhale that I was constantly waking up needing to blow air out of my mouth, to the point that I couldn't even make it through one full night without giving up and switching back to EPR 3. I left the regular pressure range set to 5-15 for all of these trials, by the way.

I'm wondering if anyone has any suggestions on this, or anything else at all you may notice in my data and/or settings. I'm happy to provide zoom-in's or any other info you may need. Thank you so much!!

[Gideon]

For the most part you are not getting the EPR=3 so changes as follows just to even things up over the night.

Set Min=7
And keep EPR=3.
I think you could handle EPR=2 if it was a}lied for the full night but I'd rather see you where you have said you are comfortable at 3

[Semble]

For the most part you are not getting the EPR=3 so changes as follows just to even things up over the night.  

Set Min=7
And keep EPR=3.
I think you could handle EPR=2 if it was a}lied for the full night but I'd rather see you where you have said you are comfortable at 3

Thank you for the suggestion – makes sense. I tried this change last night and the results are attached. Do you reckon there are any other adjustments I should try for now, or maybe I should just give it more time as-is?

[Gideon]

At this point changed need to be comfort based. Other than a bit of mouth breathing I see nothing much.

Keep an eye on the centrals, if you see a significant change in AHI look at the centrals first.

Use this for several days then try EPR=2. Without first looking at your numbers which feels better, EPR=3 or EPR=2. This is purely subjective. Let us know. And always let us know what is bothering you

[Semble]

Roger that, will do!