15cmH2O too Low?

Background: Started therapy about 10 days ago, my at home sleep study had me at 65 AHI with 2 of the 490 events being classified as Central Apneas. My DME supplier (Kadence Healthcare) set me up with a Resmed Airsense 10 Autoset and a Eson 2 Nasal Mask. The NP who consulted with me (over phone b/c of the 'rona) and her team had the machine set to 7 to 15cmH2O with an EPR of 2cmH2). First few days I was trying different techniques to deal with mouth leaks and I settled on 3M Micropore Tape over my mouth which as far as I can tell has fixed the problem (no dry mouth and leaks as reported in OSCAR are much improved). The last several days have me feeling a bit more rested but I'm still relatively tired, taking naps when doing sit down activities (i.e. reading) and generally not feeling like I'm getting the most out of the therapy.

Issue: I'm thinking like my current AHI which has been around 10 for the last 3 nights (11, 8, 9) is due to the machine is not able to provide *enough* pressure(upper limit of 15cmH2O, lower one set to 7cmH2O). The machine is bumping up against the 15cmH2O limit consistently. In addition I feel a bit out of breath when waking and that I am not getting the most out of the therapy. I know it takes sometime but I rather not waste any.

I'm not seeing a lot of people report benefiting with pressures that high (15cmH2O+) or with cases that are very similar to mine (very few central apneas, lots of obstructive apneas). I posted on another forum where a user hypothesized that my problem is not just OSA but could also be my weight (BMI = 50+) causing "obesity hypoventilation syndrome". I'm looking for second opinions before I waste my doctors time with needless tests and forking over $100 for a logging oximeter. I'm pretty sure my doc be OK with me adjusting pressures on my own but will talk that through with her before I do any experiments. I think I'm missing something so I'm post here for the wizards, gurus and sleep nerds to help point me where I should be looking to be a well-informed patient.

Attached are the last 3 days of OSCAR data in what I think is correct format (I corrected the time on the machine yesterday so date may appear wonky).

I agree with you...Personally I would change the settings to 10 min and 20 max.

Hi - not sure if you have the pressures right - the min. is the one that does the work, the max could/should be left at 20 where most have it because as it stands now, it could be keeping the min. from rising when needed, capping it unnecessarily. I'm not that good with graphs, but I did wonder why the max was on the low side... can you raise it for 1=2 nights to see how things go?

I'd go for min 12, max 20.

Yet another perfect example to illustrate why people that lower the max setting without a darn good reason, (yes, including doctors, Godotnyc), don't have a clue what they're doing.

Atterall wrote: ↑

Sat May 16, 2020 2:34 pm

I'm not seeing a lot of people report benefiting with pressures that high (15cmH2O+) or with cases that are very similar to mine (very few central apneas, lots of obstructive apneas).

There are *plenty* of people out there that need 'higher pressures' (some up into the 20s).

Atterall wrote: ↑

Sat May 16, 2020 2:34 pm

I posted on another forum where a user hypothesized that my problem is not just OSA but could also be my weight (BMI = 50+) causing "obesity hypoventilation syndrome"

That user has no idea what they're blabbering about.

OHV doesn't cause obstructive apneas, it causes hypoventilation, ie, low tidal volumes. Go back and tell 'em to look at the words in Obesity Hypoventilation Syndrome and think about their 'advice'.