Finding the perfect setting for me.

Hello everyone. This is my first post in this forum, and I’m writing because I need your help.

A bit about me: I’m 23 years old with mild to moderate sleep apnea. I was diagnosed and given a ResMed AirSense 11 (with a ResMed P10 mask) 16 days ago, and I’m now trying to find the right settings for my treatment. However, it’s been much harder than I expected after watching several YouTube videos about CPAP settings.

I’m really unsure about what’s good for me and what I should change. When I first got the CPAP, my APAP pressure was set to 4–16. After doing some research online, I quickly found that it would be better to narrow the pressure range. So I changed it to 6–16, but I could still see that my pressure was most of the time around 8, 9, 10. Therefore, I adjusted it to 7–10.

My EPR was initially set to 1, but after reading a bit, it sounded like EPR could help with flow limitations, so I increased it to 2. However, I don’t really feel like I can see any major improvements in my data on OSCAR. I can see that as I’ve increased the minimum pressure and EPR, my central apneas have increased, but from what I read, many say that central apneas apparently aren’t as bad as people think.

Overall, I think my leak rate has been good. However, there’s a small twist: when I turned off EPR (my CPAP provider recommended it), my leak rate increased significantly, and my flow limitations also increased. So I think I have to conclude that EPR has a positive effect on me, even though many experts say EPR is bad because EPAP pressure is very important.

Now my question to all of you CPAP users: what would you do if you were me? Should I increase EPR to 3 or lower it to 1? And should my pressure go up or down? I’m very unsure, especially because I’m not seeing major changes in AHI or flow rate/flow limitations.

I also think it could be because I’ve changed my settings too quickly, so my body hasn’t had time to adjust, and therefore I haven’t been able to conclude much.

P.S. I can see that my apneas mainly occur during my REM sleep, which is apparently very normal. However, I feel like my breathing is very unstable during REM sleep, even when there are no flow limitations. Maybe this is completely normal—I don’t know.

I have uploaded my oscars data picture under attachments (I hope you can see them)

Here is a link to all the pictures of oscars: The link is via imgur.com
https://imgur.com/a/CNQbXwJ

Need more information.

How are you sleeping?
How are you feeling?
Exactly what is it you want to improve upon? Why?

Do you take any meds of any kind (even recreational drugs). If so, what?

Are you having any nasal congestion at night?

Thank you very much for your answer and I would be happy to elaborate. First of all, I do not take any medication. The reason I am writing is simply because I want to optimize my data and settings so that I can get the best results. I can certainly feel the positive effect since I started CPAP, but it goes up and down a bit (not a linear progression). However, I have in no way had any problems getting used to CPAP. I don't think about it at all and easily sleep 8+ hours with the mask on and I am also very unaffected whether the pressure is 4 or 10. I have shared three different nights on sleep hq with you, which you can look at. That would be a great help. I am very unsure about what is good as many experts contradict each other and I therefore have difficulty navigating.

https://sleephq.com/public/26a84bb9-f51 ... 04db5d9acb
https://sleephq.com/public/ab1c1dee-c7c ... 54fee84a6d
https://sleephq.com/public/972e561c-c96 ... af3897135f

As I suspected the bulk of your flagged events (all of them including centrals) are all related to arousals...even your central flags follow obvious awake breathing. Using EPR isn't causing a problem with centrals in your case. All this hooplah about centrals and EPR causing them is really blown way out of proportion. Yeah, EPR can cause centrals to pop up in some people but it's actually a very small percentage of people who have a problem with EPR and centrals forming.

More worrisome for me is that your flow rate has evidence of a lot of awake or not sound asleep breathing....tells me that you aren't sleeping very soundly for a good chunk of the night.

If you see yourself hitting that max of 10 very often or very prolonged you might think about increasing that max setting just a little.
Use whatever EPR setting you simply like the best.

Please take the time to answer all my questions.
I don't see answers to all of them. Thank you.

Whatever settings you end up with....don't go changing things unless the results are horrible. There is a lot of truth to that "Give it time" admonition because your body needs time to adjust and every time you go changing something your brain and body has to start all over again.
Keep a setting for at least 1 week preferably 2 weeks and keep a log of how you feel and how you would rate your sleep quality.

To answer your first question, I have no problems with nasal congestion at any time. I don't know if there is anything else you would like to know, but could you please tell me how to improve my sleep? You mention that I have a lot of arousals and that my sleep quality is not that good, but how do I improve this? Is this something that will improve as I get more used to the treatment or do I need to change something in the settings. What would you do if you were me?

Mathis wrote: ↑

Sun Mar 22, 2026 3:34 pm

You mention that I have a lot of arousals and that my sleep quality is not that good, but how do I improve this?

How to improve on the sleep quality is going to be difficult because we have no way to know what is causing the arousals with any certainty. I would rather have been able to tell you "you need so and so pressure setting so that you can sleep better" but I just don't see anything glaring and standing up screaming "fix me better" and you will sleep and feel better.

Instead I try to glean answers to questions I have that might point to feeling and sleeping better....that's why all the nosy questions.

Your flow rate looks jagged and ragged and lots of big gulps which makes me think "poor sleep quality" and you haven't said "but I feel great and feel like I am sleeping soundly" ....so I assume that my thoughts were correct.

It's a common complaint though from people new to cpap. They want to slap the mask on and turn the machine on and go to bed and from the first night and feel like superman/superwoman. We all want that but it's rare that we end up achieving those goals.
Lord knows I have first hand experience along those lines....but I didn't get it and in fact still can't say that my sleep quality is good.
It will be coming on 16 years that I have been on cpap...and I already know my sleep quality is in the toilet but it has nothing to do with the mask or machine or my settings. I have other issues messing with my sleep that the machine simply can't do anything about.
I am coming on 74 years of age and my body is eat up with arthritis and I have considerable pain that messes with my sleep.

Mathis wrote: ↑

Sun Mar 22, 2026 3:34 pm

What would you do if you were me?

I already told you what I would do....pick a setting and use it for at least a week or so. Gotta start somewhere getting your body adjusted to all this stuff going on.

The bulk of your AHI is arousal related so your current settings are doing a good job and there's no urgent need to change anything but you do need to give your body/brain ample time to become adjusted to the therapy.

Now why you aren't sleeping so soundly or long enough.....I have no way to know the why.
Medication side effects are a common cause but you don't report any medications.
Age related pain and/or other health issues are also common cause of poor sleep...but you are young and unlikely to have those other issues....but I could be wrong.

You know that patience pill I suggested you be taking.....get a big bottle of them You will likely need them.

What caused you to go get the sleep study anyway? What symptoms were you having to cause you to look at OSA?
Have any of those symptoms reduced????

I had quite a few symptoms such as fatigue, headaches, bad mood, many times on the toilet at night, poor physical recovery and then just a feeling of never being rested. That's how I went and had it for a couple of years before my little brother discovered that I was gasping for air when I slept. The reason I didn't 100% answer whether I sleep well is simply because I didn't think it was supposed to suddenly sleep perfectly after two weeks with CPAP. As I understand it takes longer for the body to get used to it and thus also improve the symptoms. Yes, I have clearly had a positive effect of CPAP so far. I sleep more stably, recover better, have a better mood, am clearer in the head and a little less tired. However, it is my understanding that it takes longer for the body to recover and I am therefore not complaining about the improvements I have already seen as it should get even better with time. No, I don't feel that I necessarily sleep really deeply like I did before sleep apnea, but it is the right step on the way. However, I am very concerned when you say that you cannot know what is the cause of the many arousals as if you expect them to never get better. As I said, I do not take any medication or have any other disease or condition other than sleep apnea. I do not know if I also have UARS but that is just speculation. I hope it will get better with time and when my body gets used to the cpap and the settings since I have 100% changed my settings too much and too quickly. That was also the reason why I wrote here to begin with: to find out what was most optimal for me so that I did not have to change my settings all the time.

Mathis wrote: ↑

Wed Mar 25, 2026 5:07 am

However, I am very concerned when you say that you cannot know what is the cause of the many arousals as if you expect them to never get better.

I didn't say that those arousals would never improve or reduce the occurrence. I just said that we don't have any way to know for sure what the cause might be.....and to fix any problem it's kinda important to figure out the cause....and it's not easy and even if we know the cause it isn't always an easy thing to fix.

The machine only measures air flow or breathing....it has zero way to even know if we are asleep or awake or even semi awake.
We can glean some potentially useful information as to sleep status by evaluating the flow rate/breathing but it's at best an educated guess.

Below is and example I like to use of awake vs asleep breathing that shows fairly clearly the difference in how the flow rate looks but it has no way to tell me what caused the awakening. It could have simply been a normal end of REM sleep stage awakening but it could also have been pain or even the cat jumping on me or the hell cat that I have that likes to just scream all night (and all day) that caused it.

I circled the asleep breathing in red. Note that the flow rate when asleep is very regular and rhythmic....and the awake or post arousal breathing is very irregular. Anything flagged when not asleep is arousal related and not apnea related.



and the same time frame but zoomed out a bit so you can see a larger segment and get a better idea what I mean.

You might have 2 problems......a sleep apnea problem that the machine has adequately dealt with
but you might have another problem which is just a sleep problem totally unrelated to your apnea issues.

Might also be that you simply need to give your body and brain more time to adjust to this new way of sleeping..

When you asked if I was taking any medication, I thought you meant some really hardcore medication. Before I was diagnosed with sleep apnea, I had depression for which I still take medication (I'm in the process of tapering off now). I take both bupropion (wellbutrin), trintellix and acutane. I also think it has something to do with my brain and body getting used to it. My body has always had a bit longer to get used to things, especially when it comes to my sleep, which I'm very sensitive to. This could be jet lag after traveling, for example. I'm also considering having a DISE study done at some point to see if I'm a candidate for surgery. Maybe this could help too. In any case, I have a bit of a hard time seeing that I should suddenly have another sleep problem at the same time as sleep apnea, since my sleep before all this was perfect.

Mathis wrote: ↑

Wed Mar 25, 2026 11:29 am

Before I was diagnosed with sleep apnea, I had depression for which I still take medication (I'm in the process of tapering off now). I take both bupropion (wellbutrin), trintellix and acutane.

The very medications I was wondering about because they are all well known to mess with sleep itself.

Funny thing about sleep apnea....its symptoms can mimic depressive symptoms and often once someone gets off those meds a lot of the depressive symptoms go away and the person feels a lot better mentally and physically.

Research the side effects for those meds. They are a lot more "hard core" than you might think.

I am well aware that the symptoms of sleep apnea can resemble those of depression and that is 100% my case. Unfortunately, my doctor recommended that I start taking it before we could even prove that sleep apnea was the cause of it all. I was therefore put on these medications that were supposed to help with my cognition, mood and energy. I read a lot about them being able to negatively affect one's sleep but only thought it could cause problems falling asleep which was not the case for me. Regardless, I have just started to taper off of it because I never felt anything positive from the medication anyway. I am a little curious if you have ever experienced medication like the one I take having a negative effect on people's sleep (I am mostly thinking of CPAP patients).

Mathis wrote: ↑

Wed Mar 25, 2026 1:42 pm

I am a little curious if you have ever experienced medication like the one I take having a negative effect on people's sleep (I am mostly thinking of CPAP patients).

Yes. That's why my first question to people having trouble sleeping (either falling asleep which is called sleep onset insomnia or sleep maintenance insomnia which is when we have trouble staying asleep) is the medication question.
It's extremely common complaint or problem when taking any type of mood altering medication.