Help with Pressure Settings on APAP OSCAR Data Attached

[connectc]

Hi everyone,

I’m looking for advice on optimizing my APAP pressure settings. I’m using a ResMed AirSense 11 in APAP mode, and while my AHI is usually under 1 when I set the range to 11–12 cmH₂O, I’ve been dealing with frequent RERAs and occasional arousals that still leave me feeling unrefreshed in the morning.

Recently, I bumped my max pressure from 12.0 to 12.4, and I did notice that RERAs went down—but at the same time, my AHI increased slightly. I’m still getting a few arousals during the night even though overall numbers look decent.

Current Setup:

Mode: APAP

Pressure Range: 11–12.4 cmH₂O

95% Pressure: consistently hitting 12.4

Median Pressure: ~11.4–11.6

Mask: Nasal pillows

Leak Rate: 0.00–0.02% large leak

Ramp: 5 min

Humidity: 2

Using: V-Com (EPR off), chin strap, and mouth tape

Questions:

Since I’m hitting my max most nights, would it help to raise the max to 13.0 to give the machine more room to work?

Or could that trigger more arousals or discomfort like aerophagia?

Should I raise the minimum pressure a bit (to 11.4 or 11.6) to improve stability?

Any ideas on how to further reduce RERAs and arousals even when AHI is low?

Any input would be appreciated. I feel like I’m close to dialing it in but still not getting fully restful nights. Thanks!

[Pugsy]

Do you have any nasal congestion going on?

[connectc]

Do you have any nasal congestion going on?

Yes I’ve been prescribed Flonase and Allegra by my doctor and recently recommended to start allergy shots. I’ve been using Flonase and Allegra for about two years, but I’ve taken a break from regular use over the past few weeks due to relying on so much medication.

[Pugsy]

Your reports aren't really all that remarkable. Yes, you sometimes kiss the max setting but you don't seem to spend a prolonged period of time up there.

Your Flow Limitation graph is a bit "active" and this could be from flow limitations in the airway (apnea events) OR nasal congestion (or a little of both).
They both show up on the FL graph but the cause and fix for the problem are different. The machine can't tell Airway related FLs or nasal congestion FLs.
You can't fix nasal congestion with more pressure. Pressure doesn't fix nasal congestion.

Here's what a "Non very active FL graph" looks like. Yours isn't horribly horrible but it is considerably active....though I have seen much worse.



Now I don't know (nor have any way to know) if those FLs are causing any arousals or problems but they can because the machine's auto adjusting algorithm is designed to try to kill what it thinks are FLs because FLs can grow up to be full grown OAs.
Only thing is that more pressure won't/can't do anything about those FLs if they are from nasal congestion.

You need to be more aggressive with the traditional ways to try to deal with nasal congestion and see if that helps your sleep quality or not. That would be the rinses, sprays and medications for nasal congestion.

Now if the FLs weren't from nasal congestion then we try more traditional measures like adding EPR or increasing the pressure.

[connectc]

Thanks for the detailed reply really helpful. I haven’t started allergy shots yet, but I was recently recommended to begin treatment.

Given the feedback and my active flow limitation chart, it makes sense that nasal congestion could be contributing. I’ll get back on the nasal routine (Flonase, rinses, etc.) and move forward with starting allergy shots soon. Hopefully that helps settle things down and improves sleep quality without needing to push pressure too high.

I also noticed that my FL chart has never looked like the cleaner example you shared mine always has activity jumping up and down throughout the night, without long stretches of calm. That’s what made me think there may be something ongoing like nasal congestion driving it.

Would it be fair to say that treating the root cause - my allergies - could lower my flow limitations and possibly reduce arousals more effectively than just chasing a sweet spot with pressure settings?

Appreciate all the insight!

[Pugsy]

Would it be fair to say that treating the root cause - my allergies - could lower my flow limitations and possibly reduce arousals more effectively than just chasing a sweet spot with pressure settings?

IF and that's a big IF the nasal congestion is the primary culprit then yes....lowering those flow limitations could possibly reduce the arousals.

If the FLs are indeed mainly related to the nasal congestion then reducing the nasal congestion should help but remember...if that FL graph is coming from the nasal congestion/cavity....there is no sweet spot for pressures because you can't fix nasal congestion at all with more pressure.

It's a big IF I know but there is a chance and it needs to be taken anyway. Might just work. Might not as well but at least you know.