[Treatment] NHS ResMed Airsense 10 on default settings - room for improvement?

[discobeaver]

Hi everyone, this is my first post here and I'm so glad this forum exists!

I was diagnosed with severe OSA (35 AHI) around a year ago. I have had a ResMed Airsense 10 since October 2024 from the NHS (England) which is on default APAP settings. 4-20 pressure, no EPR (ramp only). I'm getting <1 AHI average and my compliance is perfect. I have a review with them in the coming month but I wanted to see if there was any improvement that could be made. I don't know if this is anxiety/nervous system dysregulation, but I get a massive adrenaline dump every morning when I enter into consciousness/heart palpitations/rapid heart beats. I didn't know if this was to do with my CPAP not being optimised. My Glasgow Index is around the 2.0 mark, so I think I have flow limitations. I wake up not feeling rested, still. Better than I did prior to CPAP but not miraculously better if that makes sense. If it helps I am using the Amara View full face mask which I really like. I have unexplained chronically elevated liver enzymes and venticular ectopic beats, both of which I wonder have come from years of untreated OSA. They haven't improved from around a year of CPAP therapy so I wondered if there were changes that could be made to ensure I was receiving the best treatment with my machine.

I have posted 6 screenshots - 3 from OSCAR and 3 from the Fort Aspen GI tool. These are from random nights in December 2024 and January 2025 (my data hasn't changed since then and I had them on my Mac already)

Screenshots:
imgur.com/a/oTs1es4

I'm still learning about CPAP and OSA but if I could tweak my settings to test ahead of my review with the NHS, I'm hoping that will make our conversation more productive.

Many thanks!

[ejbpesca]

Some use EPR full-time to reduce Flow Limitations.  You can try it at 1, 2, and level 3.

Search cause of flow limitations during sleep to see what may cause it that cannot be addressed by PAP therapy.

Use the Wiki above to learn more about flow limitations and how they are addressed with EPR or a BiLevel machine.

Min. pressure is often raised to near the median pressure but you may like your settings default settings.  Your machine is doing the APAP adjustments well.

[Sleeprider]

The Glasgow index charts are not useful, but the two Oscar’s chars show us what we need to do. 





Change settings to minimum pressure 7.0, maximum pressure 12.0 with EPR on full-time at EPR Setting 3. This is going to stabilize pressure and lower 95% flow limit to near zero. You’ll feel much more comfortable.

[discobeaver]

Both, I’ve just woken up feeling like a different person. I feel incredible. No adrenaline rush on wakeup. I feel positive, optimistic and lightweight. I actually could get out of bed pretty much immediately on wakeup vs needing to spend a few hours in bed while the adrenaline and crippling fatigue subsided. I went to bed before your replies (I went EPR 3 with 7-20 but I’ll cap the upper limit tonight as advised). Going to roll with this for a few days and then check in OSCAR and post my ‘after’ results. Honestly, I cannot thank you enough.

Does this mean I could be better-suited to a BIPAP?

Thank you again.

[discobeaver]

Hey everyone,

So here's an update with the 7-12 range cap and EPR on 3. The earlier night of the two, I didn't feel as good and am I right in thinking that I hit the 12 limit (when I needed more pressure?). The second night (this morning), I felt the best I have done with the CPAP, with maybe that fight or flight feeling upon wakeup being less pronounced.

Do I need to increase my upper pressure range from 12?

   
   

Thanks again!

[ejbpesca]

I see the top OSCAR has a spike to 12 for ≈ 30 minutes and the bottom one does not.  I can't explain why the spike happened except for Flow Limitations going up during that period with no OA events. Sure you can raise the Max pressure at will to find where the APAP goes to find the best lowest Max pressure.

As I adjusted my Min and Max pressures I looked at a week of OSCARs to find where my Max was going on 20 setting then adjusted Max lower to get them closer together.  Once I got my Min pressure up the APAP stopped spiking to 20 and not going above 17 so I lowered it to 18.

This is fine-tuning your machine as opposed to leaving the Max at 20.

[discobeaver]

Makes sense, thank you! The cap at 12 may have been premature then. I’m gonna put the max back to 20 (now with EPR at 3 and min at 7) and monitor. Then, as you say, I’ll dial back the max once I have more data.