Second attemp at therapy

[Jonkier]

Two more nights data.

Night 1 - pressures 8min 10max EPR fulltime 3.

Couple of hours. Subjectively bad sleep as usual with plenty of awakenings, burping, general aerophagia.

Night 2 - automode but 9min and 9max (fixed) EPR fulltime 3.

2 stints with a long period in between without mask. Airsense 10 flagged CSR for about 15 mins (in image 14.05.24 B). Is this legit, or just periodic breathing. Something interesting about this...lastnight was the first night I have turned onto my left side and fell asleep with the mask on. This is due to wife seeing me when facing left so I always sleep on right so she doesnt see me with the massive mask and hose sticking off my head. I know, let the ego go. I'm pretty sure this CSR corresponds to being on my left, but can't be certain. Lots of centrals in the CSR period. In my at-home sleep study I showed about 9 total centrals, and about 150 H's, and was diagnosed with OSA (not complex).

Again, subjectively terrible sleep with the usual 53976 arousals/awakenings, and burping. 

I watched this video yesterday, and the 'EPAP is the therapy' really stuck out to me, hence the fixed pressure to avoid overly high IPAP and subsequent aerophagia. Am I wrong with this. It's like i'm battling with the war between having the pressure high enough to 'stint' my airway and provide therapy, and aerophagia. 

If anyone could offer any advice i would be greatly appreciative. I am starting to feel lost with this. Feel like I should go see a sleep specialist but cynically feel like it'll be a waste of time vs reading up on all the great advice and case studies found on here. I'm startung to buy into the idea that this SDB is having a massive effect on me physiologically, emotionally, psychologically. I am up and down with mood, maybe depressed, lethargic and have 0 energy or motivation to do anything, anxious.

Sorry guys, for the rant. Really want this therapy to work.

Best regards,

Jon

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This was the video I watched -

Dr. William Noah - Manipulating the PAP Circuit

https://www.youtube.com/watch?v=EWTzFXNUIZU&t=2050s

[40plus]

That video was intresting. That guy seem to say kinda what lankyleft and some others say that epap should be kept up and one should not use epr.

The strange thing is that if i have no epr i get higher flow limitations and flatter flow rate top combined with more snoring. Fixed pressure of 9 or raised to 15 doesent affect these issues at all but epr does. As soon as i start using epr flow limitations decrease, flow rate tops get rounded instead of flat and i snore less or not at all.

So how come some, incl experienced doctors, say that epr shouldnt for the most part be used while others like people here and my own experimenting show that it is very beneficial?

[Jonkier]

I read some posts yesterday stating that, and I paraphrase, it's the pressure support, or pressure differential that assists when EPR is on. 

I still don't know if I am understanding the concept correctly. More reading I guess.

[Jay51]

I will try to explain a little bit (and anyone can jump in here and correct or help also).  EPAP is the "stent" or "splint" that keeps the airway open. It increases oxygenation (mainly spo2).  With a wide open or nearly wide open airway, it is much easier to breath.  Mainly used for large, obstructive apneas.  

EPR (or PS) can and does decrease flow limitations and other mild resistance.  I have seen it here in many charts when a person starts using EPR, flow limits decrease.  Not in every single case though.  It gives a little extra "umph" or "boost" to each inhale.  And can suction out a little bit more CO2 on the exhale.  People start breathing so much better with EPR, that some develop CA's.  Not all though.  

3 is the max for EPR.  A VAUTO can go 4 or maybe 5 or even more I am not sure.  An ASV can go 5 or more for Pressure support (PS).  When pressure support gets really high, it is being used like a ventilator (to mechanically assist breathing and force inhales).  

Everyone would need to experiment for themselves to figure out their own sweet spot here (straight cpap pressure, or 1, 2, 3, EPR, or even more with a VAUTO or ASV, etc.