How to resolve this issue?

Hey guys, I have lurked here occasionally but when someone on reddit recommended I go here for better advice, I figured I would give it a shot. I will say some of the advice on reddit did help, as my machine was never zero'd in. I was on the factory settings of 4-20 cm for over a year. For the sake of time, PAP therapy wasn't working, which was no surprise as the pressures were too low. I eventually upped my pressures to around 8-12 cm APAP with and EPR of 3. Well nothing felt better after months, I felt worse even. I never investigated further because my AHI was low (my original sleep study was an AHI of 5 and RDI of 15). A user asked to see my flow rate despite Oscar saying I had little to no significant flow limitations. The user began to point out all these unregistered events, flow limits and RERA's. Come to find out these machines miss a lot, especially RERA's. Now. I don't know how correct this user was, but him and two others recommended a bi level machine. However another user recommended I just needed more PAP pressure. So I ordered a bi level and figured in the meantime I would just use the APAP as a CPAP with no EPR. Low and behold, my sleep improved. Stopped waking up as much, lower AHI and felt a bit better in the morning. However, my flow limits jumped up a lot and I still had the same issues(I dont think EPR was the issue, but APAP). All through the night I had weird breathing that always lead to an arousal. From looking at my chart, this was every 10 to 30 minutes at the most. I figure some of these are just me moving at night, or REM, but they happen constantly and are always preceded by flow limits, even if the machine didnt mark it as a flow limit. I figure I got my EPAP (sorry if im using this term wrong) at the right value to stop my OSA events, but when I upped my pressure the next night in hopes of tackling flow limits, I slept worse (though not as bad as on APAP) and had an insignificant amount of centrals, but had some flagged RERA's and hypopneas, etc. I figure that I may need more IPAP, and my EPAP is good (Once again may be using those wrong as I am not on BiPAP, I just mean the exhale pressure seems good but may need more inhale). I am going to try a pressure of 12 tonight with EPR of 3, as my best night sleep was on a fixed pressure, no APAP or EPR at a pressure of 8.4 cm, however, same breathing issues and number of arousals. Im am hoping I just need more IPAP and my EPAP is good and this will resolve my flow limits. If EPR isnt enough then I hope PS is enough on the Bi-level I ordered. I am still very symptomatic despite my low AHI. I know my issue is likely tied to sleep as a psych eval was insignificant and blood work insignificant as far as a cause for my intense brain fog, excessive yawning, sleepiness and fatigue. I had random nights throughout the years where I would sleep great and felt normal again. Im guessing even a broken clock is right twice a day, as my pressures were in such a wide range due to factory settings being unchanged during that time. Sadly I didnt have an SD card at the time either. I am posting an imgur link below. Once again, most of the night, every 5 to 30 minutes, I wake up, which is preceded by flow limitations. Do I need more pressure? Do I need EPR or PS (kinda the same IK). Would love some insight, thanks in advance.

https://imgur.com/a/i4Uuzz4

Nice website, but where's the Cpap link?

Btw, you said you lowered the pressures (plural), but by lowering the max, you could be capping how high the min. wants to go - it's the one to raise when needed, but unless there's a good reason not to do it, leave the max at 20 and see what happens.

Sorry, CPAP link? I dont understand. I turned off APAP (Which is what helped, for some reason) so I dont have a max. I turned down max and APAP because I think it kept going up and up reacting to events and was waking me up instead of helping anything. Lankylefty did a video on the subject and found that it applies to me, in both symptoms and data. I dont think it sits well with me.

Some people do seem to do better with fixed pressures instead of auto adjusting. Auto adjusting isn't for everyone.

So how come you shared an auto adjusting report instead of a fixed pressure report?

Ardeo77 wrote: ↑

Mon Jul 17, 2023 12:27 pm

I think it kept going up and up reacting to events and was waking me up instead of helping anything.

Ever think that maybe the cause of the wake ups was maybe related to what the machine was trying to kill??????
And not so much the changing pressures?
Just a thought.

BTW please make use of the new paragraph feature when you type.....huge solid blocks of text are very hard to read and comprehend.

I posted some with CPAP and some with APAP if you look at photo description, I posted both to show comparison. I get the same events regardless, but the APAP mode is reactive and not proactive. So I assume raising pressure would help. What I know is that since I turned off APAP, I feel an actual improvement for once, albeit small. However my flow limits increased so perhaps APAP helped some, but since it raises both EPAP and IPAP, I think the auto may be causing an issue by raising min pressure to high. Not sure.

Ardeo77 wrote: ↑

Mon Jul 17, 2023 12:27 pm

I turned down max and APAP because I think it kept going up and up reacting to events and was waking me up

The *events* wake you up, they also drive pressure increases, then people blame the machine trying to do it's job on being waked up.

Do you take any medications of any kind (even OTC)? If so, what?

Do you have any other physical or mental health issues going on that might impact sleep quality?

Sorry....I didn't scroll down to see the gazillion snippets or other reports.

Thats great and all but I tried APAP for years and when I turn it off I feel better, my data is different as well. Im not here to argue APAP, with it I have arousals and flow limits, I do without. What I am asking is how to address the issue at hand. With APAP on I have higher AHI and worse sleep, I wake up more too pee and dont feel good. I am trying to figure out if I should try Bi level or keep trying to fix my issues through increasing CPAP pressure.

Also pugsy i already said I looked at other health avenues and its all clear, you didnt read and you wont look at my data. If youre not going to be helpful, and honestly I feel like everyone here is being very unwelcoming, ill go elsewhere. I dont want to respond anymore to you.

Okay. I won't bother you any more with my questions....and FWIW I did look at ALL your images of your reports.

Have a nice day.

I'm one of those who do better on fixed pressure.
Apparently, your fixed pressure is still a bit too low.
Compare it to the info on your APAP nights: In the first image, https://i.imgur.com/uro7QSN.png you're spending half the night at a pressure higher than 9.72. On the second image, https://i.imgur.com/CQkHLBs.png you're spending half the night at a pressure higher than 10.16. That mean the pressure you chose for fixed is too low, and the machine can't respond to the flow limitations that happen every now and then and wake you.

Stick to fixed, but trying raising it some more, gradually.

If you can benefit from the higher fixed pressure, based on present data, I see no reason for a Bi-Level machine: you seem to need neither its higher possible pressures, nor its higher pressure relief.

Another thing worth trying: Think of your fixed pressure and the pressure you are now capable of breathing out against comfortably and consider that the minimum pressure you should achieve with EPR. So you could try raising your pressure a whole step (1 cm / water) while adding and EPR of 1. Flow limitations happen when you inhale, and may indicate the fixed pressure you chose it still a bit too low.

Very interesting, thank you. I will try getting the pressure up and getting more used to the exhale pressure. I found one night when I got my constant pressure to about 9.4, I had more centrals so i dropped back down. But honestly they were very insignficant and probably sleep/wake junk. My AHI was like 0.7. I will try this and update the thread. Thank you again

A lot of people disagree with lankylefty about apap.
One size does NOT fit all.
We are all different.
For me, single pressure was pure misery.

Hey ozij, I changed my pressures last night to incorporate EPR and my flow limits (at least on the bar) nearly disappeared, also slept a a decent bit better. I figure this could be from the higher pressures however. Also I still have a decent amount of flow limits but it seems I do have less arousals; they still fairly frequent. If you have any insights, please let me know. Also thanks again

(7/17/23)
https://imgur.com/a/R7w6jfN

Ardeo77 wrote: ↑

Tue Jul 18, 2023 9:04 am

Hey ozij, I changed my pressures last night to incorporate EPR and my flow limits (at least on the bar) nearly disappeared, also slept a a decent bit better. I figure this could be from the higher pressures however. Also I still have a decent amount of flow limits but it seems I do have less arousals; they still fairly frequent. If you have any insights, please let me know. Also thanks again

(7/17/23)
https://imgur.com/a/R7w6jfN

For 95% of the time, your flow limitations are scaled as 0. In other words, nothing is obstructing the flow for your breathing.
Stick to the present setting for about a week, and keep a log of how you feel.
Don't focus on those little squiggles that appear every now and then -- and rarely, at that -- the mean nothing in the larger context of better sleep and - as far as I can see a negligible amount of flow limitations and a very low AHI and less arousals.
Next time, when you post, let us see the whole night.
Our sleep varies from night to night - let's how it goes for a week.

Will do. I woke up a lot last night still but it seemed tied to leaks. My mask fits well but the hose disconnects at the pivot. Every-time a leak sprung up I woke up harshly. I think the settings im on are working pretty well, but leaks are causing issues. I try not to focus on squiggles to much and moreso on big spikes where I wake up or dont breathe for lengths at a time. I figure ive been sleeping poorly for a while and likely need to give it more time. Thanks again