Sierra

Some people get a benefit from using a soft cervical collar. It can help to keep your chin from scrunching down.

This night would suggest a trying a minimum of 10 cm. No significant CA events, and OA is still the largest portion of the AHI. I would leave the max at 10.5. You are probably getting pretty close to finding an ideal single pressure.

I think on your ramp you are still in a standard timed ramp. I would suggest switching it to a AutoRamp mode. Then there will be no ramp time to set. It will only stay at the start pressure as long as you are awake -- up to a maximum of 30 minutes.

The central apnea seems to be still there. So, yes I would try a 6 minimum and 7 maximum to see if that helps reduce the CA events. The AutoRamp Start Pressure would have to be reduced to 6 cm, as it cannot be set higher than the minimum pressure. The EPR can stay at 3, but it will not reduce the exhale to less than 4.

I think it is worth a try to see if the CA events could be reduced.

I'm sure the rest of the world will be watching Australia carefully as you move into your winter flu season. So far Australia and New Zealand have had very low infection and death rates compared to the northern hemisphere. It will be interesting to see if there is a spike up during the typical flu season.

COVID Fatality Rates

Without doing any research, my recollection is that apnea basically is temporary closing of the airway -- kind of an on off effect while you are sleeping. Other conditions like COPD or asthma may result in flow resistance to the lungs when there is no apnea. The lungs become less efficient in moving air in and out. I suspect it may be measured by the tidal volume being reduced. That can result in low oxygen. In those cases a BiLevel machine may be more appropriate where it can deliver a much higher pressure on inhale compared to exhale to improve flow. And in the more severe cases it may be necessary to add oxygen, so the same tidal volume of air contains more oxygen.

I think a maximum pressure of 8 cm may be possible, IF you set the EPR to ramp only. When you have your EPR on full time the effective pressure during the night is really the green line on the graph. The effective pressure is not as high as you think it is. The problem with EPR is that it reduces pressure on exhale, but if you have an apnea event the machine will just increase the pressure to compensate. So you have gone full circle. EPR reduces it 1 cm and then the auto function increases it 1 cm or more to stop the apnea, and you are back where you started. If you use the EPR full time you can be getting the worst of both worlds. The EPR reduces the effective pressure, causing more events, and then the Auto function increases pressure which may likely be causing central apnea events. Bad, and more bad!

The idea of using the Auto Ramp is so you can control the EPR so it is only on when you are awake, before you go to sleep. It is not really a ramp but a hold in pressure. If you set the Ramp Start pressure at 7 cm (your can set the Ramp Start the same as your minimum, pressure) and set EPR at 3 cm and for Ramp Only, you will get 7 cm on inhale and 4 cm on exhale which should be very comfortable. When you go to sleep you will have 7 cm on inhale and exhale, but you will be asleep and should not notice it. the way you have your machine set now, you are exhaling against 7 cm or more already.

I noticed that In all your settings in your history, the lowest AHI you averaged was in April 2019 with EPR in ramp only. The pressure settings at that time were probably too high though, and you should be able to get away with less. But I think you would benefit from the Ramp Only EPR.

You are pretty consistently staying under the treatment guideline of 5 for AHI. It seems your most dominant component of the AHI is central apnea. Generally that can be reduced by lowering the pressure. Since your obstructive apnea and hypopnea are low, my thoughts would be to do two things:

1. Lower the minimum pressure to 7, and lower the maximum pressure to 8 cm.
2. Set the EPR to 3 but for ramp only. This will be more comfortable for going to sleep. After you are asleep the EPR is not helping you. It reduces the effective pressure of the CPAP, so it then increases pressure to compensate. When it increases pressure it may be causing the central apneas.
3. Set the machine to auto ramp with a start pressure of 7 cm. Your graph looks like you are not using the ramp or you have it set to a short timed ramp. I find the auto ramp works very well. It essentially holds the pressure at 7 until it detects you are asleep. With the EPR on ramp only it will give you 7 cm on inhale and reduce that to 4 cm on exhale.

I would try that and post again. The hope is that the reduced pressure will reduce the central apnea without increasing the obstructive and hypopnea. The best setting in the end may be to go to a fixed CPAP pressure. However I would not do that until you see how it works with a min of 7 and max of 8.

Starting your ramp out at 4 cm can be a bit low. You may find that is not giving you enough air to breathe freely when going to sleep. I adjust the ramp pressure so it is high enough that it does not feel like it is restricting flow when I breath in deeply.

It looks to me that all the OA events occurred at 9 cm, and almost all of the H events were at 9 cm as well. That certainly suggests 9.5 minimum could be better. The only bit of a concerning factor is that you had two PB, or Periodic Breathing events at 9.5 cm. They can often be related to central apnea events.

I think I would try a 9.5 minimum pressure first to see if the PB or CA's become a problem. Maximum could be lowered to 10.5 or even 10. My concern in trying a flat 10 at this point is that it may cause the PB and CA to emerge. The other issue with going to a flat CPAP single pressure so early is that you do not get a chance to see what relationship there is between the pressure and the type of events you are getting. Also, a minimum of 9.5 may be enough to minimize the OA and H events.

I use the SleepyHead version. I am not sure there are any real improvements in the OSCAR version yet. I have not kept up with the revisions. There are some very minor bugs in the last SleepyHead version, but nothing critical.

I just remembered that before I went to the Swift FX headgear, I cut the P10 straps, overlapped them about an inch, and sewed them up again. It helped quite a bit. It can give you some more life out of the headgear before you buy new. I tried the little pincher clips, but found they did not work well. One of the issues I had with the P10 headgear was that it would catch on my pillow and slip off my head. I would wake up with no mask on...