How to treat my flow limitation?

[accetableplaintain]

I noticed that my AHI stats are good but I am flow limitations which may explain why I still feel tired. 
I'm currently on cpap pressure 7, with EPR 2. 
Should I increase my pressure to 7.4 and decrease EPR to 3?
Or should I decrease my pressure from 7 to 6.6 (although i don't know if it will be enough to stop my obstructive apneas from happening). 

Thank you

[Gideon]

How long have you used CPAP? It can take a while to loose the tired feeling.
I'd bump the EPR up to 3 and see if that makes a difference. Try it for several days and compare it to your EPR=2 feelings.

Set the y-axis on your floe Rate chart to 40+/- for better clarity and no more than 3 minutes to better show the individual waveforms.
Also include the Flow Limit chart and that is an important pressure driver and always include a full nights chart as that helps with context.

[SarcasticDave94]

I'd consider a few things, include a non-zoomed OSCAR shot to enhance our view of overall therapy. With flow limits at Max .25, I think EPR 3 should be better than EPR 2. However, it doesn't tell us your therapy story as to why you're on static CPAP pressure 7. If there's no restriction on using an Auto mode range, that too can help with flow limits. But keep in mind, comfort is King.

If you're comfortable with the night's sleep that this OSCAR data is tied to, you can decide to do nothing as well. Zero Apnea events, zero flow limits, etc. isn't the goal. Events that are low enough to afford you will rested status can be considered good.

[factor]

I noticed that my AHI stats are good but I am flow limitations which may explain why I still feel tired. 
I'm currently on cpap pressure 7, with EPR 2. 
Should I increase my pressure to 7.4 and decrease EPR to 3?
Or should I decrease my pressure from 7 to 6.6 (although i don't know if it will be enough to stop my obstructive apneas from happening). 

Thank you

3.49 hours isn't a lot of sleep either.  Hopefully that isn't all you get normally.

[quiescence at last]

yep. 4 hours is not the goal for how much sleep you get. and your close up shows you are definitely  sleeping in that timeframe.

flow seems to show both flow limitation in inspiration and in exhalation, although may be more prominent in the inhale.

if i were increasing the EPR to 3, i probably would try to bump pressure up to fixed 8.0, or ideally letting the machine do some of the hunting for best setting by doing APAP pressure of 7 to 10 with EPR 3.

be sure to stick it out a one setting for many many nights, especially as your body gets conditioned to the CPAP machine.

QAL

[accetableplaintain]

Hey everyone, 
First off thank you so much to everyone who responded. I really appreciate it. 
I'm sorry for the late response, I just recently moved and was really busy with school so forgot to post here.

The reason I was on static cpap of 7 was because that was what my sleep doc told me to use. I had failed my in lab titration study but when i got the machine at home my sleep doc monitored my data and said you cpap of 7. 

I tried using APAP for the last two weeks or so (6 to 8.4 pressure with epr of 3). I found that I was having a lot of troubling with waking up at night (multiple times). So I've switched back to cpap. I've attached some pictures below. I'm on 7.6 pressure right now from a ramp at 6 with epr of 3. I did wake up 2 times this night although I'm not sure if it was because I was having mouth leak as my mouth tape had gotten loose because of my saliva. 

I'm still feeling tired/brain fog/headache type thing when I wake up. Any thoughts where I should go from here with my flow limitations (which i still seem to be having) and general data? I know someone previously suggested trying out pressure 8 so I can try that with epr 3. 
I could try going back to full face mask if maybe my problem is using nasal + mouth tape, but with my f and p vitera i had so many leaks (probably because of my beard). 
Thank you

[Gideon]

hard to read because of the glare.
Your AHI is great so your doc will be happy.
We look for the 95% Flow Limit number to be under 0.10 and your is.
Flow Limits are treated with Pressure Support or on ResMed CPAPs with EPR so

Set Min Pressure=8
Set EPR=3
this is to work on your "feeling tired/brain fog/headache type thing" Both of these setting should help, if not we bump your pressure up another notch.
With your numbers we look at making you more comfortable and are not looking to chase numbers.
What is bothering you about the flow limits other than the fact they are there?
Try this, do a blind eval of your sleep when you wake up, Don't look at your ResMed's screen, and for sure don't look at OSCAR.
Write down your description of how you slept. This is strictly to keep you "Honest" and uninfluenced by the numbers.
Now you can look at your numbers and OSCAR.

[CorruptAlligator]

That's interesting you have it CPAP mode. I'm starting to think limiting my max further to the point of being closest to constant pressure like CPAP would more beneficial than APAP mode.

I hardly get any OAs anymore, and I see my pressure abruptly rise in response to FL. And it seems to be walking me up.

So, it's not the FL is at issue, but the machine's reaponse to it. I'm considering dropping my max to 10 from 12 (my min is 9), so that pressure doesn't spike so much and disturb my sleep. This is why I can see CPAP mode can be preferrable.

APAP feels like it's more trouble than CPAP with good titration. It's understandable APAP doesn't work for everybody. If one is sensitive to abrupt pressure changes. Resmed algorism with sudden pressure spike in response to FL. So, I understand now when it's really difficult for people to comply or get good sleep durtion due to APAP waking them up.

[accetableplaintain]

thank you so much for your advice. 
Here is my data from pressure 8 epr 3 (ramp of 6.4). 
its usually like this for most nights ive tried it. 
I do feel better in the mornings with pressure 8 epr3 then i did with lower pressures or apap. Although still feeling sleepy throughout the day and wanting to take a nap. 

Any advice on fine tuning my cpap? I was thinking maybe increasing pressure a bit to get rid of the hypopnea or maybe lowering epr to 2 to reduce clear airway events (since maybe thats why I still feel sleepy throughout the day)? Although if i lower epr I might increase my flow limitations which I think I am still having a bit of. 

Thank you

[Gideon]

Since you are feeling better with a fixed pressure of 8 try increasing pressure to 9.
question to you, without viewing the numbers which FEELS better to you, Pressure of 8 or 9.