Should I prioritize a lower AHI or reducing flow limits?

[sfr79]

After >1 year on CPAP I'm generally doing well with treatment, but I have what I'm pretty certain are persistent treatment emergent CA's. My prescribed settings are APAP 7-11cm w/ EPR of 3. I typically average an AHI of around 3.0 - 3.5, but every couple weeks I will have 1 or 2 nights where my AHI is 5-10. Nearly all of my AHI every night is CA's.

Earlier this week, I switched to CPAP mode at a fixed 9cm, and I turned EPR off. Like magic, the CA's largely disappeared and I had 3 nights in a row with an AHI between 0.4 - 0.7. However, with fixed pressure and no EPR, my flow limits are higher (95% averaging 0.11 per night, vs a 95% average of 0.5 per night on my old APAP settings). Additionally, my leak rate is up with EPR turned off (95% leaks > 30 with EPR off, averaging 8.4 with my old APAP settings). I can also see a couple periods of tell-tale mouth leaking on my chart each night, and I've woken myself up mouth leaking a couple times, so I'm pretty sure this is what's going on with regards to the leak rate.

In summary, the APAP mode seems to do a better job managing my flow limits, and the reduced effort required to exhale with EPR on 3 reduces my mouth leaks, but switching to CPAP mode and turning off EPR eliminates my CA's and reduces AHI from ~3.25 to 0.5.

I'm considering running CPAP mode tonight, with a slightly higher pressure of 9.4cm (in hopes of better managing flow limits), and turning on EPR of 1 for the full night, to (hopefully) reduce mouth leaking.

Do this sound like a decent plan?

Thanks

[Gideon]

Bsd plan, but only because you are changing multiple parameters at a time.

Keep in mind the goal is not 0 AHI or the elimination of CA event. It's to get a good sound night's sleep

[sfr79]

That's fair Gideon. And you're of course correct regarding the most important goal being the subjective measure of a good night's sleep.

I'm pretty much there on the whole. I doubt  Id be changing anything if I didn't have those occasional excursions into the 6-10 AHI range -- if I can make a few tweaks and eliminate the bulk of my CA without otherwise impacting my treatment or the quality of my sleep, I figure that's worth it.

I'm writing this after just waking up using the new settings from my first post (CPAP @ 9.4, EPR 1) 

My AHI was 1.1, flow limits 0.10, leak rate 14. Having just a little EPR def seemed to help from a comfort standpoint. I didn't wake up myself from exhaling out my mouth, which is an improvement.