Flow limits and sometimes RERAs

[spacemustard]

Hey Everyone,

I've been on CPAP for 2+ years and until recently was using a range of 6-8.4 but found that I was getting aerophagia/arousals from pressure jumping up and down as I experienced flow limitation.

To try to improve my flow limitations and decrease arousals from pressure swings, last week I set my EPR to 3 and started to gradually increase my minimum pressure and decreased my max pressure. Over the last few days I've brought my minimum pressure up and max pressure down so that they are now both at 7.4 with EPR=3. I now am having some nights where I have 0.0 AHI and some nights where I have several RERAs and Clear Airways flagged. My flow limit is also showing as very high some of the time which is the opposite of what I would have expected from increasing EPR from 1->3.


Here's one of the "good" nights.

0_0_night_overview.gif (389.24 KiB) Viewed 336 times

And here is last night where I have a number of RERAs and a few (false?) Centrals.

rera_night_overview.gif (430.27 KiB) Viewed 336 times

Here are some zooms on a few of the events.

rera_zoom_1.gif (413.7 KiB) Viewed 336 times

If some nights I have 0.0 AHI and some nights I have RERAs and CAs should I try increasing my pressure? I get aerophagia easily so if I do increase pressure I would want to do it slowly. I sleep in lots of different positions so it's possible that the 0.0 nights I'm spending more of my time on my side or stomach instead of my back?

[Pugsy]

RERAs are a symptom of potentially having arousals related to some sort of airway issue. All it means is the breathing looks like the breathing when a person has had some sort of arousal from some sort of airway disturbance. It's a symptom...not the cause.
Now why the cause...million dollar question.

CAs/centrals....could be awake/arousal related irregularity in breathing getting flagged. It's a cessation of breathing which lasts at least 10 seconds or more. Hold your breath for 10 seconds. That's essentially a 10 second central apnea.
More pressure will NOT fix or prevent central apneas...either the awake false positives or the real asleep central apneas.
So even if you didn't have aerophagia issues with higher pressures we wouldn't tell you to increase the pressure in an effort to reduce centrals apneas...it simply wouldn't work anyway.

It is normal to have a handful of centrals that are real asleep centrals. Not a big deal. Everyone can have a few here or there and it doesn't mean anything nor does anything need to be done about them.

[Miss Emerita]

How do you feel during the day? By the numbers you are doing well, so the "subjective" facts are especially important.

About the flow limitations: do you experience nasal congestion? Sometimes FLs are caused by swelling in the nose rather than in the tissues a little lower down in the airway. The EPR would probably not address FL caused by nasal swelling. As an experiment, you might try using Flonase about an hour before bedtime. It takes a couple of weeks to kick in, so you'd want to give it at least that much time to see if it made a difference.

[spacemustard]

Thank you both for the information. Very helpful to keep building my understanding of how all these concepts fit together!

I do feel much better this week than before these settings changes. If this is the best I can get for now it’s definitely better than before but I’m definitely open to any ideas if there are still other options to explore.

I do use Flonase for nasal congestion 2x every day. My ENT suggested turbinate reduction since I do have constrained airways all year round and I get sinus infections regularly. I won’t be able to book that procedure until after the pandemic is over.

I can try clearing out my nose a little more before bed to see if that helps at all.

Thank you!