Large Leaks and Clear Airways are High

[Snidder87]

First time posting, so please bear with me here.

I'm trying to get my AHI down even further, preferably around 1. I've been using APAP since early March - but FFM since mid-April. My main problems now tend to be LL and Clear Airway events. After reading through other posts, I'm planning on loosening my straps tonight - I tightened them hoping to reduce leaks, however they increased last night. This morning after my first wake-up alarm and during my "snooze" period I experienced a very long period of Large Leak, so I'm discounting that portion as a fluke or Hose pulling, but still plan to loosen my FFM tonight. If I could just get my CA down, I think it would be a dramatic improvement. I only turned off EPR a couple of nights ago, as a trial/error thing. I think I need to turn it back on to 1 or 2. Can anybody give me further insight? Do I need higher pressure? lower pressure? Etc. any help would be greatly appreciated! Attaching screenshots from OSCAR.

[Jay51]

Welcome to ApneaBoard Snidder87.  Leaks are a problem.  What type of FFM do you use?  Everything else looks ok IMO.  Keep an eye on your CA's.  They could be treatment emergent (go away after a few weeks, etc.) or they could be permanent.  If you are still having a lot of CA's in a couple of weeks, repost and OSCAR again here.  

You are correct in that lowering EPR usually lowers CA's.  The reason is that people ventilate better with a higher EPR (difference between Epap and Ipap).  The downside is that it can washout more CO2 from your system and cause more CA's - the amount of CO2 in your bloodstream (chemoreceptors) is the main driver to breathe.  Go slow.  Take your time.  Record any changes and post here again with OSCAR.

Here is a link for mask help:  Mask Primer

[Sleepy Quixote]

@Snidder87

Like Jay51 said leaks are a big problem and degrade therapy efficacy, the leaks can also wash out co2 causing more CAs than you might have with a good seal. Its a good idea to try to balance that EPR and keep some in the formula. EPR is the primary way to manage Flow Limits. Low Flow Limits = Better sleep.

Keep at it, keep us posted.

I'm betting if you get those leak rates down all your numbers will improve!