Request for Optimizing CPAP Therapy

[Sleepyboi99]

I appreciate the explanation. I'll try experimenting with the EPR to see what works best for me.

[Sleepyboi99]

Hello all, 

I wanted to give an update on my therapy. Following my review of the replies to this post as well as diving deeper into much of the information on Apnea Board (so incredibly helpful), I made the following changes: 

- Switched to flatter pillow (significantly decreased AHI) 
- EPR 3 → EPR Off 
- Pressure: 5-9 → 5-7

Since making these changes, my AHI has drastically decreased, and I am feeling far less fatigued than I’ve ever felt in my entire life. My AHI in the past six days has been as follows: 

3/19: 3.5
3/20: 2.9
3/21: 3.4
3/22: 3.8
3/23: 4.4
3/24: 4.9

While this has massively improved my quality of life, I noticed that I felt considerably better when my AHI was around 3, so I'd like to see if there are any further optimizations that could be made to my treatment to reach an AHI around there (ideally lower!) more consistently.

I've included a screenshot from my most recent night of sleep with zoomed in SCs of the clear airway events that still seem to be my main problem area. I've been reading a lot about clear airway events and how the flow rate graphs can be used to potentially identify if they are positional or central apneas. Am I correct in my assumption that there seems to be a mix of both? How can this be targetted?

I am also curious if I would benefit in a change in my pressure range or a change to a fixed pressure. 

Regarding the leaks from this night, I typically do not have this much leakage. If my understanding is correct, the leak rate graph suggests that there was excessive leaking from the mouth?

Thank you in advance!

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Attaching additional zoomed in screenshots of the clear airway events from 3/24/25

[SarcasticDave94]

Your occasional nearly 18% of the session large leaks are hindering therapy. Also you only had about 5 hours on therapy. Some flow limits cropped up especially early in the session.

[ejbpesca]

CAs can be such a mystery and you have a significant amount on the last OSCAR post.  Look at your OSCAR reports for a trend of CAs.  I have read that EPR can help reduce CAs.  EPR is a nonoption for me.  My CAs come and go, but not in the amounts you have on the last OSCAR posted. Some feel medications that suppress the nervous system can cause CAs.

Congratulations on feeling better.  I am doing better too by learning to adjust my machine.  I now shoot for < 1.00 AHI which is where I feel better.

Research Central Apneas and/or Clear Airway Apneas to find information on their cause and treatment.

[Sleepyboi99]

Your occasional nearly 18% of the session large leaks are hindering therapy. Also you only had about 5 hours on therapy. Some flow limits cropped up especially early in the session.

This night was a bit of an outlier as I usually don't have large leaks or use the CPAP for as short as I did on this night on a regular basis. My average CPAP therapy usage is 7 hrs and a half for the past 30 days.

---

CAs can be such a mystery and you have a significant amount on the last OSCAR post.  Look at your OSCAR reports for a trend of CAs.  I have read that EPR can help reduce CAs.  EPR is a nonoption for me.  My CAs come and go, but not in the amounts you have on the last OSCAR posted. Some feel medications that suppress the nervous system can cause CAs.

Congratulations on feeling better.  I am doing better too by learning to adjust my machine.  I now shoot for < 1.00 AHI which is where I feel better.

Research Central Apneas and/or Clear Airway Apneas to find information on their cause and treatment.

I have seen a lot of conflicting discussions on the efficacy of EPR for CAs on this board. I used EPR 3 up until two weeks ago when I turned it off completely. CAs seemed to decrease but insignificantly imo. Still doing therapy with it off for the time being.

[Sleepyboi99]

Hi all, 

Wanted to provide another update on my therapy with this screenshot from my most recent night of sleep. Technically within the normal range of sleep apnea AHI, but I still feel like there is much room for improvement based on how I feel after waking up and throughout the day. 

Would appreciate any insights on what could be causing these CAs and what could be done to address them since they seem to be the prevailing issue for me. 

Thank you!

[SarcasticDave94]

Since you had CA on the test, these are not treatment emergent CA. EPR can affect negatively the CA, but note CA are always consistently inconsistent. So the CA can be there despite EPR being off.

0 OA
24 CA

If you're ready to try the next step, the bilevel VAuto may help avoid more CA with extra settings including time controls. Beyond that, you need specialized CA treatment of the ASV.

You're having Central Apnea, they existed during the sleep study. The CPAP cannot treat those.

Your max leaks are close to the redline and will affect your therapy and comfort. No the leaks aren't there always, but they haven't been fully addressed either.

[Sleepyboi99]

Since you had CA on the test, these are not treatment emergent CA. EPR can affect negatively the CA, but note CA are always consistently inconsistent. So the CA can be there despite EPR being off.

0 OA
24 CA

If you're ready to try the next step, the bilevel VAuto may help avoid more CA with extra settings including time controls. Beyond that, you need specialized CA treatment of the ASV.

You're having Central Apnea, they existed during the sleep study. The CPAP cannot treat those.

Your max leaks are close to the redline and will affect your therapy and comfort. No the leaks aren't there always, but they haven't been fully addressed either.

I guess I should reach out to my sleep doctor to talk about those alternative treatments. My only worry is that because my AHI is technically in the normal range, they would argue that my sleep apnea is being adequately treated and deny the need for them...

[SarcasticDave94]

They probably would try that, yes. So you have to counter with your subjective complaint that therapy isn't helpful in getting sleep. Pull up your copy of the sleep study, show it to the doctor as a reminder. Request respectfully to treat the CA shown in the test. And if you've not got one, you will probably need a Titration with bilevel and ASV to have recorded your results with the machine.

[ejbpesca]

I will be asking for a BiLevel Vauto soon on the grounds of:

1. high flow limitations with flat and jagged wave forms
2. APAP EPR raises my AHI drastically so I need a more refined exhale pressure relief

After all these years I think I deserve one. (won't say that)

I will refrain from writing my opinion of those I must deal with to keep my therapy going.  I'll just say it's been lacking in concern.