Please help with pressures

Good evening everyone.
I tried posting this thread on ApneaBoard and didn't get much help so I was hoping that you guys might be able to steer me in the right direction.
I haven't had Aerophagia in a few days since turning on EPR to 1 and updating pressures to 8.6-11.4 cm (after I had aero, I tried EPR 3 and 2 on 7-11.4 cm).
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Going to be copy and pasting some stuff from my other post (linked above) for context:

I have been trying to get my pressure settings right for a while now on my Resmed AirSense 11 Autoset. Basically I have been tightening up the min and max range from the default 4-20 cm range because near the beginning the pressure changes were waking me up. I have asked my DME and first sleep doctor for pressure help months ago, didn't get any response. Same from my second sleep doctor (did new patient consult last month on 7/30/25 after someone referred me). I will have to look for another sleep doctor because the first one I saw only seems interested in selling sleep studies and the second one seems like he doesn't want to spend any time helping me with pressures (if his office doesn't even respond to voice mails what is the point?).

Started CPAP on 2/16/25 (had my SD card in ever since my first night), was doing pretty well at the beginning of May 2025 (when I finally felt settled on the mask for me), but from June to July I had constant aerophagia (waking up in the middle of the night just to burp, stomach bloated when waking up, acid reflux). Note, I did start taking Zepbound for sleep apnea on 5/12/25.

I haven't tried stuff like mouth tape or anything.

I use the Philips Dreamwear cushion mask with small cushions and small frame.

I've tried a bunch of other masks too (X30i, F40, N30i, Evora, F20, Dreamwear Full), but this Philips Cushion is the only one that works for me (medium frame doesn't work, has to be small apparently).

I switch to my side at least once a night (usually prefer back) and I usually get air blowing in my face (though this Philips one is the "least worst option" currently). I have read that this particular Philips frame has high pressure compared to other cushions like the N30i because it doesn't not have as big of a relief valve.

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I have messed around with the min and max range and then started getting aero. Tried EPR at 1, 2, 3 as well as lowered max pressure and when that didn't work, lowering min pressures seemed to lessen the severity of the bloating/burps.

While I can tolerate EPR on 1 and 2, it is noticeably harder to fall asleep with it on 3. While awake I do prefer EPR off (breathing feels kind of weird with it on).

I was doing fine with EPR off, but I do know that when my min and max pressures were the same (11.8 cm on 6/8), that was a bad experience.


The biggest issue I am having right now is that I am sleeping between 9 hours - over 12 hours and feeling very tired when waking up. I know back in May I was sleeping like 8 - 8.5 hours and feeling well rested... I would like to try and get that feeling back. Please let me know if I can post anything else because it seems like I am hitting the 3 attachment limit here.

I'm not a doctor, or even one of the people with the most expertise. But here are my thoughts. You have very few apnea events, none are obstructive in the charts you sent. It is very unlikely that any sort of setting changes are going to do much. I think your pressure range looks appropriate, its not flat topping on the maximum setting, and the minimum is reasonable. EPR is typically set for comfort, its usually not a factor in the effectiveness of the therapy, although there are some exceptions. Set EPR to what ever is the most comfortable and gives you the best quality sleep. It seems to me you have so few events it's not likely that apnea is what's causing your current fatigue.
I don't know what your sleep study showed, or your initial diagnosis was, but if it were me I'd go back to the sleep doctor and tell them how you feel. Don't stop until you've been helped. I've been under treatment for about 20 years, I wish I'd pressed my doctor more early on.

Hey mlmollenkamp, thanks for the response. I was thinking the fatigue had to do with my pressures (I have always had an AHI below 3 once on my CPAP) because I had that week or two in May when I was waking up daily feeling very refreshed. The only thing that happened since then is I started getting aerophagia and then the pressures went out of wack. I attached my sleep study results (using 3% oxi desaturation) as I figured that is more sensitive than the 4% oxi desaturation. I am going on vacation tomorrow until Friday 9/5 so I won't have access to OSCAR, but I will be bringing my CPAP! So I can only try different pressures (and not post future OSCAR screenshots) after tomorrow morning. Thanks!

Tried turning off EPR yesterday, same pressures. Stomach feels weird this morning. Like nausea. Not exactly bloated, but feel like I want to burp. I think this may be related to pressures. Am supposed to take Zepbound today though. Did get one last OSCAR until I am back on Friday night from vacation.