[Pressure] New to CPAP - Need help with pressure settings (ResMed 10 AutoSet)

[PressurisedPete]

Hello everyone. I was diagnosed with OSA around 3 months ago. I'm 33, normal build and not overweight so it came as quite a shock. However I've struggled with excessive daytime fatigue for years.

I did hospital lab study and it came back with AHI 31. I then did a separate at-home study (set up by a technician) that came back with AHI 10.1 (and also showed my blood oxygen fell to 86%). Both of them flagged hypopneas as the cause.

For some reason my original healthcare provider encouraged me to set a very high pressure (min 14, max 20) and it was causing me a lot of discomfort. I then sought a second opinion with a different provider who thought these settings were crazy and recommended min 4, max 15 and I'm now feeling better most days. But many days I still feel awful and can barely function.

I'm attaching some screenshots from OSCAR. The one with AHI 3.13 was a day I felt great. The one with AHI 2.34 I felt terrible all day.

What would your plan of action be going forward? Many thanks!

Gear: ResMed AirSense 10 AutoSet, F&P Eson 2 nasal mask

[staceyburke]

You have very high flow limits. Flow limits are apnea just the same as O and H events but they asr smaller and not a timed event. You need to bringing them down. They wake you up. 

You need to change a couple of things    

Move min to 8

Set EPR to full time

Set EPR to 3

You will find a very good change how much you sleep and how you feel awake.

[PressurisedPete]

Set EPR to full time

Set EPR to 3

Thank you for your input. What's the logic for increasing EPR? My understanding is that it decreases the overall effective pressure.

[staceyburke]

EPR reduces flow limits and again flow limits are apnea - the same as all apneas (O or H).I have in my signature how apnea is classified. 

Flow limits are not part of the calculation of AHI. Flow limits cause sleep disruptions and make it so people get very little deep restorative sleep.

[Sleepster]

Thank you for your input. What's the logic for increasing EPR? My understanding is that it decreases the overall effective pressure.

I'm not sure what the logic is behind it, but we know it works. It lowers the exhale pressure, called the EPAP, but leaves the inhale pressure, called the IPAP, the same. The difference between IPAP and EPAP is called the pressure support (PS). Increasing the PS is the way to treat flow limitations.

[EddyDee]

Hi Pete
You can find some in-depth discussion about EPR in this thread, although it's quite technical.

BTW, when posting OSCAR screenshots, it's best to organize it as described here.

HTH and good luck!

[PressurisedPete]

Thanks everyone. I've increased my min pressure to 7 and after a few days of gathering data I'll experiment with EPR set to 3.