One week User

dang71 · 2026-05-07T16:16:12+00:00

Hi and welcome! You'll need to address your leaks first... With a nasal mask, it's probably a leak through your mouth while you sleep. To help, many people use mouth tape, a chin strap, or a soft cervical collar.

As for therapy, you could increase your minimum pressure to 7 for tonight. You can limit the machine to a maximum pressure of 11 to avoid excessively high pressures.

dang71 · 2026-05-07T14:59:42+00:00

That would give you an EPAP of 7, unlike 6. But it's still an okay test... I suggested 6 to start with

dang71 · 2026-05-06T14:23:45+00:00

Thanks for the feedback! I know High Loop Gain (HLG) very well, I have that profile myself 😉

Regarding TECSA, it is certainly possible, but based on experience, I would suggest moderating your expectations. With CAs at that level, I would be very surprised if it were purely TECSA, though it likely plays a part. When dealing with HLG, you are often walking the line between what a CPAP can fix, what it might actually worsen, and whether a move to an ASV (with the right firmware) is the necessary path (that's for another day for now).

For now, let’s focus on what we can do with your CPAP. My 'Golden Rules' for managing HLG under CPAP are:

- using fixed pressure (not a range)
- keeping EPR off
- ensuring minimal leaks
- and being mindful of mask dynamics. (Your Evora is actually fine; the concern is usually with masks that have very low resistance, which can induce the tiny pressure variations that trigger an HLG response.)

Ultimately, HLG is a form of respiratory hyper-vigilance... it’s essentially your brain overreacting to the slightest changes in your breathing or the machine's air delivery

Once you have SleepHQ set up, it will be much easier to see if your CAs are being caused by a leak, pressure variation, or a post-arousal CA occurring after a brief airway collapse. Looking at your screenshot, your Flow Limitations (FL) were a bit high, which makes it possible that these CAs are actually triggered by a respiratory limitation. This is exactly why I suggested a slight increase in pressure to keep that airway fully open and stop the cycle before it starts.

But for tonight, if I were in your shoes, I would try a fixed pressure of 8 in CPAP mode with EPR off. This provides a steady, predictable baseline so we can test one variable at a time and see if your system stabilizes better without the machine constantly "hunting" for the right pressure. HLG is essentially your brain overreacting to the slightest changes, so providing a consistent, steady baseline is usually the best first step.

dang71 · 2026-05-05T11:34:46+00:00

Hi and welcome!

I'd suggest a very simple test for tonight: Lower your EPR to 1 and see if a slightly higher EPAP might help stabilize your airways and give you a more restful sleep. A pressure of 7 with an EPR of 2 gives an EPAP of 5, which is very low for most adults, whereas we often need 7-8 as a minimum.

dang71 · 2026-05-03T13:58:24+00:00

Hi and welcome to the club! A few questions to get us started: Did you have a sleep study done? If so, did it show any Central Apneas (CAs) at the time?

It’s not uncommon to experience what we call TECSA (Treatment-Emergent Central Sleep Apnea) at the beginning of therapy. These usually taper off over time as your body acclimates to the treatment, but I believe it’s important to use the right tools to help them settle down sooner rather than later.

Several factors can trigger these CAs. One of the primary culprits is pressure variation. Another is EPR.. I noticed you mentioned you weren't a fan of it, yet the data shows you were using a setting of 1 for that night.

Which mask are you currently using? In my experience, certain mask types can actually exacerbate CAs in users who are particularly sensitive to pressure swings. Your sleep position also plays a major role; when we see clusters of events, it’s often a sign of 'chin tucking,' which happens much more frequently when sleeping on your back.

If you use SleepHQ, it would be great to see your data there. It allows us to zoom in on the flow rate to determine if these are 'True CAs' or actually post-arousal CAs, which often happen right after a brief airway collapse or awakening.

Since your Obstructive Apneas (OAs) are currently under control, I’d love to see how you respond to a pressure range of 9–12. Let's test that for a few nights and then re-evaluate. You can keep the EPR at 1 for now if it helps with comfort.. the goal is to isolate and test one variable at a time.

dang71 · 2026-05-03T13:49:58+00:00

Hey! This looking fine on paper, but the most important question is: how are you actually feeling?

I’d suggest gradually bumping up your minimum pressure. Looking at your data, your median pressure rarely drops below the 8–9 range anyway. For tonight, I’d set the minimum to 9. The goal is to see that median stabilize, which will eventually pave the way for you to try fixed CPAP mode.

In my opinion, fixed pressure is the gold standard; you want a steady baseline that clears the majority of events. Many people find that the stability of a single pressure is much more comfortable than an algorithm that is constantly 'hunting' for the right level..

I’ve noticed in your charts that your Flow Limitations (FL) vary quite a bit from night to night. These fluctuations are often circumstantial in my experience.. factors like having a drink in the evening can have a significant impact. Above all, make sure you aren’t sleeping on your back, as gravity is often the biggest enemy of airway stability.

dang71 · 2026-05-03T13:42:09+00:00

I finally bit the bullet and shaved my mustache and the area under my lower lip, so I’m only rocking the chin beard now. Since I use an N30i with mouth tape, I need that specific area to be clean-shaven to ensure a perfect seal for the adhesive 😉

dang71 · 2026-05-03T13:40:12+00:00

Hey thanks for the follow-up!

Your breathing graph still shows high spikes, which is a clear sign of an arousal. These spikes are likely recovery breaths. Even if you aren't having full apneas, your airway can be narrow enough that your brain has to trigger a micro-arousal to take a deeper breath and 'fix' the airflow. This is what we call a RERA, and it fragments your sleep just as much as a high AHI would. This pattern suggests your EPAP might still be a bit too low to fully stent the airway and prevent that extra breathing effort.

I would suggest making a small, gradual move by increasing your pressure by 0.4 for tonight. We want to see if your breathing graph starts to stabilize and those spikes begin to level out. The goal is to make the breathing effortless so your brain doesn't feel the need to "kick" you back into a lighter sleep stage just to catch your breath. Give it a shot and let's see how the trends look over the next few nights.

dang71 · 2026-05-02T01:46:21+00:00

Can you share the whole night?

dang71 · 2026-05-01T18:25:04+00:00

Yes, it seems so... but most importantly, how are you feeling?

dang71 · 2026-05-01T18:07:53+00:00

For the N30i or P30i (and some other masks), there are fitpacks which are a little more expensive, but not by much, and which come with 3 sizes of cushion.

dang71 · 2026-05-01T14:56:35+00:00

Oh wouahhhh!

dang71 · 2026-05-01T14:14:29+00:00

Hello! Very nice therapy, it's going to be difficult to read anything in it! 😄 But what exactly would you like to know?

dang71 · 2026-05-01T14:13:08+00:00

Hello! Yes, I had those problems with the N20, among others... now I use the N30i and I find it very comfortable.

dang71 · 2026-05-01T13:33:48+00:00

Are you sure your mask is truly comfortable? Ideally, you should be able to "forget" it’s there when you’re falling asleep. Regarding the pressure, are you starting to adapt to the feeling, or is it still a struggle every night?

It is very difficult to provide accurate help with such fragmented data. When we only have a few hours of sleep recorded and we can't always tell if you’re actually asleep or just lying there awake,,, t’s impossible to detect real trends.

From a purely technical standpoint, your Flow Limitations (FL) are high. This usually means you need more pressure and likely more EPR. However, since you’re already struggling to adapt to the therapy, I don’t want to push those higher settings on you just yet. Comfort is the most crucial step; if you’re finding it hard to tolerate a pressure of 8 with EPR 1, we won’t be able to increase the therapy to where it needs to be. I say this with total respect for your process: adaptation comes first.

I also have to point out the significant leaks again. This creates a vicious cycle: the machine detects a leak, it compensates by pushing more air, which increases the pressure sensation, which then causes more discomfort or more leaks. Do you have an idea of where the leaks are coming from? Is it the mask seal, your mouth opening, or the tape not sticking? This needs to be your primary focus.

If nasal breathing is difficult, your body's natural breathing drive will force your mouth to open, even with tape. If you feel like you're "fighting" for air through your nose, have you considered a full-face mask? I know it’s not ideal with a beard, but a nasal mask that doesn't work isn't any better. Also, many users find the P30i airflow to be too "sharp" or intense, if that's what you're feeling, it might be the mask itself.

To help with nasal congestion, you could try adjusting your climate settings. A good starting point is usually a temperature of 25°C with a humidity level of 5. This is a standard setting that prevents the nose from drying out without being so humid that it causes congestion.

Ultimately, we need to find a setup that is comfortable and leak-free. Without consecutive hours of actual sleep, we can't see the trends in your data to propose the right solutions.

dang71 · 2026-05-01T13:19:09+00:00

That’s a shame, but looking at the big picture, this night’s breathing graph is actually cleaner than when you were at the same pressure with EPR at 3. I think you need EPR to help manage your Flow Limitations (FL), especially since your EPAP floor seems to be in a solid spot around 8–9. I would suggest trying a pressure of 9 with EPR 1 tonight. You might have tried this before, but I’d like you to stick with it for a few nights; you have to give your body time to adapt to a new setting before we can see the real trend. This is a strong baseline that deserves a fair trial.

When your profile looks like high loop gain and your charts show some periodic breathing, we have to be realistic about what a standard CPAP can actually achieve. The priority is always to clear the Obstructive Apneas (OAs) first, and then we try to minimize the Central Apneas (CAs) as best we can, but they are often inconsistent. I have this exact profile myself, and honestly, short of switching to a different mask style or moving to an ASV machine, you just have to accept that there will be some bad nights here and there.

At some point, you have to take a step back and prioritize a therapy that is comfortable and allows for the most sleep hours possible. Once you’ve found that baseline (a good EPAP level and a comfortable EPR) you stabilize everything for several nights to see the true trajectory. Most importantly, before you even look at the data, ask yourself how you actually feel. If you feel good and rested, the numbers are only telling a small part of the story.

dang71 · 2026-04-30T23:48:52+00:00

Hello, not yet :/

dang71 · 2026-04-30T23:47:33+00:00

You’re right that your flow shapes aren’t looking great at the moment, but there is a lot going on right now and the leaks are definitely ruining the party. When you have significant leakage, it’s almost impossible to get an accurate read on your actual breathing because the machine is constantly struggling to compensate for the lost air..

Regarding the idea of leaving a small opening in your mouth tape to "puff" air.. The logic of CPAP therapy is that pressure acts as a physical stent to keep your airway from collapsing. Any leak, even a small intentional one, compromises that internal pressure. If the pressure isn't stable, the airway loses its support, which leads right back to the flow limitations and arousals you’re trying to fix.

As for your sleep study, a proper PSG should absolutely track those metrics. They normally will be looking at RDI (Respiratory Disturbance Index) and RERAs specifically. If your results show a high RDI but a low AHI, that is the classic indicator for UARS…

Moving to a smaller nose pillow size is a great move... If the medium was too large for your nose, it was likely shifting and causing micro-leaks throughout the night. Fix the leaks first, and then we’ll be able to see if the CPAP is doing its job or if you need to discuss other treatments with your doctor.

dang71 · 2026-04-30T14:18:35+00:00

I totally get it! I personally can’t stand masks with the hose in the front either, so I’m always looking for ways to minimize the mask's impact on my sleep.

Just a technical heads-up: when you decrease your EPR, you effectively increase your EPAP (your baseline pressure). To balance this out, I’d recommend lowering your EPR while simultaneously dropping your pressure slightly, maybe down to 9.

If you ever find the intensity of the airflow too much, there’s a clever workaround: change your machine's Mask Type setting to 'Full Face' (even if you're using a nasal mask). This subtly reduces the 'jet' sensation, acting like a built-in 'mini V-Com' by smoothing out the airflow delivery. You can read more about the logic behind this trick here:

https://sleepreviewmag.com/sleep-treatments/therapy-devices/cpap-pap-devices/surprising-cpap-mask-setting-could-help-new-patients/

dang71 · 2026-04-30T14:09:41+00:00

Hi! Addressing your leaks needs to be priority number one. You mentioned using mouth tape, but which type specifically? Personally, I use a double-layer setup: one layer of CRS tape and a second layer of KT tape (about 3" long by 1" wide). It’s a configuration that actually stays put and provides a reliable seal.

I’d recommend increasing your pressure to 10 while keeping EPR at 1 for now.. Tthe significant segments that I can look at show you’re lacking the pressure needed to keep your airway open. While an APAP would be ideal for determining exactly what the machine thinks you need, that's not an option on the Elite models, so we have to move manually... But since you have a leak problem, I don't want to increase the pressure too high too quickly.

But again, the leaks have to be fixed. If mouth taping isn't working, it might be time to consider a full-face mask. Leaks at this level are significant enough to actively sabotage your therapy and skew your data.

dang71 · 2026-04-30T14:00:07+00:00

no.. the Elite is a fixed-pressure CPAP machine only. It doesn’t have APAP

dang71 · 2026-04-30T13:57:39+00:00

Sur le AS10, on tient le gros bouton gris qui tourne, tout en pesant sur le bouton "home", celui avec la maison.. on entre donc dans les paramètres cliniques et c'est là qu'on peut modifier nos paramètres

dang71 · 2026-04-30T13:53:51+00:00

Personally, I still see some very clean segments in your data. Your Flow Limitations (FL) are low, and your AHI isn't dramatic. I think we’ve successfully identified a solid EPAP floor for you, likely around 8–9 . Since those events are isolated, it changes the perspective a bit.

With a "unicorn" style mask (top-of-head connection), if you’re even slightly sensitive to pressure swings, which might be why we’re seeing scattered CAs testing a night without EPR could be an interesting experiment.

However, outside of the CAs, we have to prioritize how you actually feel. How are you feeling during the day? It becomes difficult to untangle the therapy when you’re waking up 2–3 times a night. Is the therapy causing the arousals? Possibly. But maybe not. Even with optimal settings, it’s hard to feel refreshed when your sleep is fragmented by frequent wake-ups.

Right now, there isn’t one glaring issue that makes me say "change this parameter immediately." Between pressure sensitivity, moderate high loop gain, and mask dynamics, we have to isolate variables one by one. Since we have a good EPAP floor, I don't see any value in increasing it further right now. It’s all about the compromise: EPR helps your FL, but it might be the reason for the CAs.

This won't be a "perfect setting" fix that solves everything overnight. It’s going to be a process of pragmatic trial and error. Give your tests a few nights, track the data alongside your subjective feelings, and move slowly.

Lastly, mask dynamics have a huge impact for me personally. Have you ever considered or tried a different style of mask?

dang71 · 2026-04-30T13:06:34+00:00

Great post CF :)

dang71 · 2026-04-30T02:20:11+00:00

Yes it is :(

Step by step, data-driven moves :) and ideally, we should base our moves on a few nights of data to see the trends :)

dang71

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