TechDude15 - Therapy Help

Hello everyone,

First let me preface - as a long time lurker / reader, I want to thank you all for your amazing insights here, wealth of knowledge, and willingness to help in this community.

I was diagnosed with moderate OSA (16 or so AHI) back during the pandemic and was concerned about treatment, I tried to stay compliant but between mask issues, issues getting appointments, and just feeling like crud after using the machine I stopped entirely.

The past few months I have been making a concerted effort to focus on my health, and part of that was getting back on APAP. I have deep-dived into these forums, and have made adjustments to my treatment that on night 1 made me go "OH MY GOD THIS IS WHAT GOOD TREATMENT FEELS LIKE?!" I now am well on my journey towards better health and sleep thanks to y'all! I also have helped a friend adjust his treatment, and he has noticed a SERIOUS improvement in how he is feeling, and his AHI has tanked from ~6 to <1.

With the accolades out of the way, I wanted to post my data here in case anyone had some insights to help me as I now fine-tune my treatment. I will say, from where I was at before to where I am is night and day (SO. MUCH. BETTER.) so I know I am not going to be wildly changing anything.

Attached are before and afters of my initial settings changes (sadly, I was on 04-20cm before but I didn't have an SD card so no detailed data from then). Please see my mask & machine info on my profile.

Right now, my concerns are:

• Flow Limitations - I know that my flow limitations are not super high, ~0.1 I know is livable but would like to improve if I can, as I see they are not necessarily just positional for me

• Pressures - I am looking at bringing my min up a bit, probably up to ~10, as since adjusting that seems to be about just under my median now

• EPR - (scarrrryyy) kidding, but as I tried last night, testing out 10 on my min felt a bit harder to breathe out while resting. This may just be a comfort thing, as seemingly I am not getting crazy CA's overnight so I am clearing CO2/exhaling ok with the treatment. I am considering maybe an EPR of 1 and raising my pressure range (so maybe 10.4-14.4 or so) / or EPR 2 and appropriate pressure adjust, and seeing how I do. I have also considered doing a short ramp from 9 (which I am totally comfortable at) to 10 in 5-10min as I fall asleep

• Hypopneas - the last few nights, I have seen a rash of hypopneas that I can't necessarily explain. Not sure if I need to come up more on my min pressure or if maybe that + EPR would help
  
  If there is anything else y'all want to address/tips/tricks, etc. please let me know! I have made huge strides in leak, quality of sleep, etc.

Are you having any nasal congestion at night?

Pugsy wrote: ↑

Wed Mar 12, 2025 6:48 pm

Are you having any nasal congestion at night?

Nope, not that I can tell!

Okay.....I was wondering because sometimes flow limitations are from nasal congestion and if that was the case you would need to address the nasal congestion in more traditional methods (spray, rinses, oral meds, etc) because more pressure or adding EPR won't help with FLs that are from nasal congestion.

Otherwise the usual way to try to reduce FLs is either adding EPR or more baseline pressure or a combination of both.

My first suggestion.....add EPR set to 3 and see what happens. If you want to have the minimum pressure more close to the 10 cm you were thinking about....give it a try and see if you need to raise that minimum a bit.

If you are worried about using EPR and centrals forming.....it can happen but the chances are really small. Most people won't have that happen. Only a very small percentage of people develop a problem with centrals when starting cpap therapy with or without EPR being used.

Pugsy wrote: ↑

Wed Mar 12, 2025 7:10 pm

Okay.....I was wondering because sometimes flow limitations are from nasal congestion and if that was the case you would need to address the nasal congestion in more traditional methods (spray, rinses, oral meds, etc) because more pressure or adding EPR won't help with FLs that are from nasal congestion.

Otherwise the usual way to try to reduce FLs is either adding EPR or more baseline pressure or a combination of both.

My first suggestion.....add EPR set to 3 and see what happens. If you want to have the minimum pressure more close to the 10 cm you were thinking about....give it a try and see if you need to raise that minimum a bit.

If you are worried about using EPR and centrals forming.....it can happen but the chances are really small. Most people won't have that happen. Only a very small percentage of people develop a problem with centrals when starting cpap therapy with or without EPR being used.

Thanks! Yeah I generally don't have congestion and wake up very clear, so I think it's mainly UAR. I stepped up to EPR of 1 last night, may stay at it a night or two then try bumping again.