Help with poor sleep, hypopneas and centrals

Slpd89 · Post by **Slpd89** » Tue Sep 01, 2026 8:01 am

If I were to summarize the last 8 months of CPAP treatment I would describe it as absolute hell. I was completely abandoned by my sleep clinic. I was graduated to my primary care physician to manage my condition once my AHI was below 5 at my 3 mo compliance visit - even though I told them the only reason my AHI was lower was because I am waking up constantly throughout the night and am much more tired than I was pre CPAP. I was given a 5-15 pressure range and a thumbs up. My primary care physician has no idea how to help me and I have had to take matters into my own hands. No matter how many times I complained about leaks, centrals, multiple wakes, and aerophagia I was told my pressure was fine and to “just keep trying”. DME just keeps shipping me masks, but are no help with fitting or tips for leaks.

Masks I’ve tried :

Resmed N20 and N30 - terrible mouth leaks even with chin support. N20 made the bridge of my nose bleed. Cheeks fill up like a chipmunk even when my mouth is closed or taped.

Resmed F20 and F&P vitera - Bridge of the nose is bleeding raw and I leak out of the bottom of the mask with jaw drop

Resmed f40 an F&P Evora hybrids. F40 was a floppy and leaky joke. Evora feels pretty dialed and shows the least detectable leaks when I wear a cervical collar. I’m out of mask swaps again so sticking with the Evora for now.

I lowered my max pressure to 10.2 (which I can still barely mange) and I honed in on my set up to minimize leaks. Any pressure above 10.2 increases my aerophagia, hypopneas and centrals. No obstructives anymore. These are the lowest numbers and leaks I have ever had over the past 8 months. I attached two nights of lower AHI readings that are still leaving me exhausted. Should I lower my pressure any more? My centrals, leaks and wakes all seem to be around a pressure of 10 most nights.

I’ve ready about several options to fix this.
1.) trying a lower fixed pressure and titrating up until my numbers improve
2.) possibly increasing my max pressure to 11 and also increasing EPR to one

Any advice would be welcome. Thank you!

zonker · Post by **zonker** » Tue Sep 01, 2026 11:33 am

Slpd89 wrote: ↑
Tue Sep 01, 2026 8:01 am
If I were to summarize the last 8 months of CPAP treatment I would describe it as absolute hell.

welcome to the zoo! sorry your having a hard time. dunno if it's comforting to you or not, but the majority of us had trouble at the beginning so we're here to help.

mostly what we need is data from you. not everyone uses the same machine or mask.

i suggest you start by reading this-

viewtopic/t172378/StickyIf-you-want-CPA ... Gquot.html

good luck!

Slpd89 · Post by **Slpd89** » Tue Sep 01, 2026 2:02 pm

Thank you! I just updated my profile, and clips of some OSCAR charts are attached. Any advice would be appreciated!

mlmollenkamp · Post by **mlmollenkamp** » Tue Sep 01, 2026 2:03 pm

Just an observation. You have no obstructive apenas showing. All of your clear airway events seem to happen when the pressure is at or near 10 cm. You may want to try reducing the pressure a little more, .5 cm or less each step to see where the obstructive apenas start again.

Turn off the calendar next time you post, it will allow more information on settings to show. Also show the flow limits. You could reduce the graph height a bit in options to get another graph or two.

Good luck.

Slpd89 · Post by **Slpd89** » Tue Sep 01, 2026 2:21 pm

Awesome, thank you! And thank you for the OSCAR graph tips! I will start with just lowering the pressure a bit and see if my centrals go away and hypopneas stay the same. If that doesn't work, I will post some updated and cleaner OSCAR readings. My other thought is to bring the pressure back up to 11 and then turn EPR on to 1. My sleep clinic is suggesting a Max pressure of 12, and even 14 with EPR turned on. The few nights I tried EPR at 3 I woke up suffocating several times, thinking someone had pulled the air from my lungs. My centrals were even higher with the high EPR...so I am reluctant to try EPR again.

Pugsy · Post by **Pugsy** » Tue Sep 01, 2026 4:52 pm

Those centrals flagged could very well be post arousal centrals and not true asleep centrals.
Meaning the poor sleep quality could be causing awake periods or brief arousals that the machine flags as a central.

Could you zoom in on those flagged centrals to see if you are having brief spikes in the flow rate which could point to an arousal and then a post arousal central flag?

Read this thread to get an idea what I am talking about as well as get an idea how much to zoom in.
viewtopic.php?f=1&t=187767&p=1451526#p1451526

If they are post arousal centrals then really all it means is your sleep quality is less than ideal....now why....that's another question needing another answer.

zonker · Post by **zonker** » Tue Sep 01, 2026 5:31 pm

Slpd89 wrote: ↑
Tue Sep 01, 2026 2:02 pm
Thank you! I just updated my profile, and clips of some OSCAR charts are attached. Any advice would be appreciated!

you are entirely welcome! but your profile didn't update with the machine and mask.

other than that, i will step aside and let my "betters" advise you.

Slpd89 · Post by **Slpd89** » Tue Sep 01, 2026 5:43 pm

I zoomed in on some centrals showing the fluctuation in flow rate for two separate dates. They look pretty similar; do you think this is possibly me waking up? If so, should I consider any pressure adjustments or EPR adjustments for comfort, since they are happening at or near the highest peaks of pressure during my therapy?

zonker · Post by **zonker** » Tue Sep 01, 2026 5:57 pm

Slpd89 wrote: ↑
Tue Sep 01, 2026 2:21 pm
My other thought is to bring the pressure back up to 11 and then turn EPR on to 1. My sleep clinic is suggesting a Max pressure of 12, and even 14 with EPR turned on.

another tip: when making a change in your settings (and i'm glad you know how to do that) make ONE change at a time and stick with for 2-3 nights. why? because it takes a bit of time for our brains to adjust.

Pugsy · Post by **Pugsy** » Tue Sep 01, 2026 6:25 pm

Those 2 examples look more like post arousal to my eye anyway....especially the second image because there is a clear big gulp of air right before the cessation of breathing. Then it looks like you went right back to sleep fairly quickly. The first image is a bit harder to evaluate because we don't see all that much breathing before the flagging but definitely after the flags it looks like you were NOT sound asleep so I tend to lean towards the slight irregular breathing shown before the flags as an indication of arousal.

Now there are a few people who find that EPR can actually trigger centrals....real asleep centrals but usually when that happens we see a LOT more central flagging where the person is definitely asleep. This is NOT something that is very common at all and there's nothing miraculous about that 10 cm pressure point perhaps triggering centrals either. Centrals can happen with as little as 5 cm pressure. It's not just higher pressures.

Now if you told me that you were sleeping soundly and you regularly saw centrals I might be more concerned but you admit to poor sleep quality so.....I would suggest that you perhaps make a change in something that makes this therapy more comfortable for you in hopes that more comfort will translate into improved sleep quality. The whole idea is to improve on sleep quality.

And do make only one change at a time if at all possible. When you make multiple changes in something you don't know which change may have caused whatever result (good or bad) and sometimes it's kinda important to know which did what.

Slpd89 · Post by **Slpd89** » Tue Sep 01, 2026 6:46 pm

This is all so helpful. I really appreciate all the feedback. So last night I actually slept pretty well. Had quite a few dreams and felt decently rested even with a few wake ups. Centrals stayed about the same and about a .4 increase in hypopneas (AHI was 3.7). Based on all this, if you were to make one change - would you suggest decreasing my max pressure to 9.6 from 10.2? Or, leave it at 10.2 and work on my sleep set up? Or, leave it at 10.2 and turn EPR to 1? I was reading a suggestion to increase max pressure by 1 for every EPR level added, but if you suggest one variable at a time I will stick to that. Assuming these changes are just for comfort. Thank you!

Pugsy · Post by **Pugsy** » Tue Sep 01, 2026 7:16 pm

If it were me I would just change the EPR for comfort and then only worry about increasing the pressure (minimum) to compensate for the slight drop during exhale ONLY if I saw a bunch of OAs crop up because of the drop during exhale. Not everyone needs to increase the pressure when they use EPR so that is sort of an old wives' tale. It's not something that is set in stone....that people need to increase the minimum pressure if they want to use EPR....some people might need to but some people won't need to and I don't see any sense in using more pressure until there is a proven need.

The number of hyponeas you are seeing....not worth even worrying about.

I doubt your centrals are caused by the pressure increases and I doubt that when it (the pressure) wants to top out around 10 ish that the pressure is the cause of the centrals. Also an occasional real asleep central is normal to see.....so an occasional centrals isn't anything to get all worked up over. There are what we call sleep onset centrals that can happen and are entirely normal. They are only a problem when they are so frequent they keep bouncing us out of sleep and causing arousals. When that happens we see normal sleep up to the central flag and THEN we see arousal breathing AFTER the central flag.

I personally like EPR and that's why I use a bilevel machine...I REALLY prefer a 4 cm difference between inhale and exhale and I sleep so much better AND it doesn't or hasn't even triggered any centrals for me. So I use what is more comfortable for me...gotta be comfortable first and foremost to be able to sleep the best. Now I sometimes will see a handful of centrals but they are always related to arousals because I don't sleep so great but that's because I am old and have really, really bad arthritis going on and the pain wakes me up.
I have discovered over many years that any AHI I might have is always at least 75% post arousal flagging.

BTW remembering dreams and/or a lot of dreaming means your sleep isn't all that good. We don't remember dreams unless we wake up during them or right at the end of a dream and we can dream in any sleep stage not just REM....and it's normal to wake briefly after the end of a REM cycle. It's only a problem if we have trouble going right back to sleep.
Also we may or may not remember the arousals we might have. It all depends on how quickly we go back to sleep.

Slpd89 · Post by **Slpd89** » Tue Sep 01, 2026 7:51 pm

Very thoughtful response. I’m honestly feeling better just from all the feedback. My sleep nurse practitioner never even saw me face to face and just gas lights me if I reach out with questions. This all means so much to me thank you. I will leave my pressure range as is and turn EPR to 1. I’ll get a good chunk of data before I report back!

zonker · Post by **zonker** » Wed Sep 02, 2026 1:07 pm

Slpd89 wrote: ↑
Tue Sep 01, 2026 7:51 pm
My sleep nurse practitioner never even saw me face to face and just gas lights me if I reach out with questions.

this is not at all unusual and it's another reason we're here.

Slpd89 · Post by **Slpd89** » Thu Sep 03, 2026 4:14 pm

OK, so these are the past two nights where I left the pressure at 7.4-10.2, but added EPR1. I would say I slept much worse with frequent wakes and about doubled my CAs ( I understand these may just be wakes). Sept 1 was much better than Sept 2 based on how I felt throughout the day. I also notice sinus headaches when I use any amount of EPR. Assuming I am at a good therapeutic pressure based on my lack of obstructives and small number of hypopneas, would it be safe to say that I am just an extremely pressure change sensitive patient? Maybe I would benefit from narrowing my pressure range to say 7.6-9.6 and removing EPR? Maybe even moving to a constant pressure around 9 at some point?

Help with poor sleep, hypopneas and centrals

Help with poor sleep, hypopneas and centrals

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Re: Help with poor sleep, hypopneas and centrals

Re: Help with poor sleep, hypopneas and centrals

Re: Help with poor sleep, hypopneas and centrals

Re: Help with poor sleep, hypopneas and centrals

Re: Help with poor sleep, hypopneas and centrals

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