Could I be doing better with my CPAP

[Refkt]

Hello to those who may be able to help 

I was diagnosed with Mild Sleep Apnoea in 2020 after several years of severe symptoms. Below I have provided my initial sleep study results. I commenced a trial on CPAP (ResMed Airsense 10 Auto) where they made some adjustments on some of my follow up appointments. I did notice some improvements in my symptoms and subsequently purchased my own machine - ResMed AirSense 10 for her. 

I have tried varying combinations of masks however due to being a mouth breather and having a slight skin allergy to silicon I am currently using a ResMed AirFit F20 Full face with the foam cushions. I did like the P30i pillows in terms of the air tube connection being at the top and the minimal equipment around the face and head, but due to mouth breathing and the silicon irritating the inside of my nostrils, it didn't work for me. I thoroughly dislike the cushion style masks. 

I have also attached last nights OSCAR data and the last months graphs.
 
Even though my sleep study AHI indicated I was a mild case, with severe symptoms at 7.4 I would really like to try and see if I can get my long term average as close to zero as possible. 

Accendotal evidence seems to suggest my lowest AHI seems to come along after a night of at least 3-4 drinks (I drink - maybe 1-2 glasses of wine once a week with dinner and once a month any more drinks than this). 

Current settings include min 6, max 20, ERP = 3, 45 min ramp time. 

Typically a side sleeper, otherwise on my back (some nights both sides and back as I toss and turn) - usually bunching my pillow so my head is resting on the edge and the mask/hose hanging off. 

Keeping in mind I had severe symptoms with a mild case of 7.4, so running between 2 and 3 average indicates I could see some improvement if I can get this to closer to zero, it is hard for me to pinpoint if the residual symptoms are as a result of the sleep apnoea, another chronic medical condition (endometriosis - which many suffers indicate fatigue etc) or the inconsistent nature of my sometimes/sometimes not shift work schedule (given at my worst symptoms pre diagnosis, I was in a role with no shift work). 

Is there anything you could suggest that will help me get my AHI closer to 0 consistently? 

Thank you in advance


           

[staceyburke]

Your numbers are ok.  In your sleep study the centrals were about equal to your obstructive apneas.  This machine will not treat centrals but yours are not high so I don't think that is a worry.  However, what I am going to suggest as pressure could cause more and if they do you should take the EPR down from 3.

What is EPR?  It is exhale pressure relief.  Now some quick facts on how to use EPR.  EPR makes the exhale value less so you do not have to work as hard to expel the air.  For example min 8 and EPR 3 would give you an inhale of 8 and an exhale of 5. (min-EPR=exhale)  The min is the inhale.

Now the absolute lowest a pap machine can go is 4 so your setting of min 6 - EPR3 can not be 3 because the lowest the machine can go is 4.  You have to move up the min so the EPR will be able to work.

my suggestions
Min 8
EPR 3 full time (not just on ramp)
Turn off the ramp. - While using the ramp you are not getting any therapy and your events are not counted.

Now Centrals are not regular - one night you will have several and the next night none.  Because of this you need to try for a couple days and see how you FEEL and if you have an increase in centrals.

[Sleeprider]

I'm thinking you could try settings of 7 to 12 cm pressure with EPR 2 and perhaps curtail both obstructive and centrals.