[CPAP] Need help with settings -- feels like I keep making it worse

[Colbatros]

I've been using CPAP for about 3 years now, only ever had an appointment with a pneumologist 3 months after starting therapy so he could fill out my private health insurance forms, and that was it. I was never 100% satisfied with the CPAP, but at least it was an improvement from before. About a month ago, I started using OSCAR + SleepHQ to track my sleep and have been using some suggestions from Reddit on how to tweak my settings, but it feels like I'm just making it worse every time I make any changes. 

Starting settings were;

• Min: 4cm
  
• Max: 16cm
  
• EPR: 3cm
  

Last night's settings;

• Min: 11cm
  
• Max: 13cm
  
• EPR: 2cm
  

Equipment:

• Machine: Resmed AirSense 11
  
• Mask: F&P Brevida Nose Cushion (in small) with F&P Pilairo Q Adjustable Headgear
  

Even with a better overall AHI score than before I started making changes, I feel more tired than before. I wake up throughout the night, which used to never happen before, my eyes are back to being puffy just as they were before I started CPAP. I just keep upping the minimum pressure to get closer to my median until it gets so high, the slightest increase in the night wakes me up. Any EPR lower than 2 has me leaking through my mouth, something that had never happened in the 3 years I've been using my machine. Any help would help at this point, I really do feel like I'm at my wits' end and just wanna go back to sleeping better. Attaching last night's OSCAR chart. My account is too new to post links but I also have my data uploaded to SleepHQ.

[jdougc]

Welcome to the forum,
Only the post the following unless asked for other charts"
Events Flags
Flow rate 
Leak rate
Flow Limits

Are you changing the filter and cleaning the exhaust port holes on you mask?

Can your post a copy of your sleep report with your info redacted?

You are having mouth leaks that are affecting you therapy, the flat line leaks. 
They would be ok for a full face mask, but pillow masks are more sensitive to these leaks, IMO
Consider using 2x5 strips of athletic tape or a somnoseal device to seal mouth leaks.

Have you changed any medications recently? 
Are there any new physical issues?

[Expat31]

@Colbatros

Quick Tips...

Curl your lips inwards before affixing tape. Gives you a double seal. Only way I have found that holds with high pressures.

Also you may need to up your minimum pressure to clean up the obstructives.. perhaps.

[Deborah K.]

Actually, your chart is just right. It has the five items we need to see.

You would do well to change your pressure range to 10.6 to 15, based on your median pressure and your chart.

[Colbatros]

Welcome to the forum,
Only the post the following unless asked for other charts"
Events Flags
Flow rate 
Leak rate
Flow Limits

Are you changing the filter and cleaning the exhaust port holes on you mask?

Can your post a copy of your sleep report with your info redacted?

You are having mouth leaks that are affecting you therapy, the flat line leaks. 
They would be ok for a full face mask, but pillow masks are more sensitive to these leaks, IMO
Consider using 2x5 strips of athletic tape or a somnoseal device to seal mouth leaks.

Have you changed any medications recently? 
Are there any new physical issues?

Attached my sleep study results from 2023!
No new medications recently, I changed antidepressants last year (now on Viibryd) and it did impact my sleep at first, but I eventually got used to it and could easily sleep through the night. Only recent change in health is that I started working out proper since over a month ago. 

I can give mouth tape another try, I was using KT tape for some time but was finding it hard to get used to it. The air would still try to escape through my mouth, but instead of leaking it'd give me puffy cheeks. 

@Colbatros

Quick Tips...

Curl your lips inwards before affixing tape. Gives you a double seal. Only way I have found that holds with high pressures.

Also you may need to up your minimum pressure to clean up the obstructives.. perhaps.

I'm down to give that a try! For sure I'm thinking the pressure needs to go up to prevent the OAs.

Actually, your chart is just right.  It has the five items we need to see.

You would do well to change your pressure range to 10.6 to 15, based on your median pressure and your chart.

I'll try those settings, should I keep EPR on? Lower EPR seems to lead to more FLs which the machine attempts to fix by upping the pressure, eventually waking me up. EPR 2 is the least I can tolerate, with EPR 3 feeling the best for me, especially at higher pressures.

How close to my median should I stay? For a while, I was trying to keep my min pressure as close to my median as possible, but it kept leading to higher and higher medians (I think because the higher pressure was causing more CAs?)

[Deborah K.]

Feel free to use EPR 3 if that feels better.