Advice for Resmed Airsense 10 Autoset Pressure

[JackStraw]

First, I want to say thank you, thank you, thank you for Oscar. I thought the only way to track how well my CPAP functions was by AirSense’s smiley faces! When I ran across Oscar a few weeks ago, the software really opened my eyes to the amount of data I can pull from the machine.
 
A bit of background. I’m a 60-year-old male who weighs 203 pounds and am active throughout the day. In my early 30’s I was diagnosed with sleep apnea and have been using a CPAP every night since. In January 2021, I replaced my original Sullivan V CPAP with a ResMed AirSense 10 Autoset. I also purchased a ResMed N20 mask/headgear in large.
 
Throughout 2021, I had a love hate relationship with the AirSense. Some nights I had a great night’s sleep and other nights were, well, awful. A few weeks ago, I found the Apnea Board through a Google search which opened my eyes to a wealth of information on using my CPAP. The biggest find was information on mask fit from which I learned my N20’s cushion was too big which is why I was fighting with major mask leaks. (I thought the leaks were due to poor design.) I replaced the cushion with a medium and the headgear with the standard size which has made a very positive impact on how well I sleep at night.
 
Now that I have the mask fit issue resolved, I’ve been using Oscar to track my data. I started with the MAX and MIN pressures at the default and have tried to work down from there. Attached are charts from the last few nights and would like to ask from some advice on my settings. 

Thank you in advance.

[Sleeprider]

Welcome to Apnea Board. Your therapy results in impressive AHI, and your change in mask cushion size seems to have resolved any leak issues. About the only thing I could pick on are a fairly high residual flow limitation or upper airway resistance (UARS) in spite of EPR 3. If you're feeling good with your current therapy, it may not be worth chasing. Flow limitation can arise from different areas in the upper airway, including nasal, or through the soft palate. It may be possible to drop flow limits by increasing your pressure range by about 1-cm, however pressure support using bilevel is usually the most effective. This article in our wiki discusses the issue, and was influential to me to move to the Vauto. http://www.apneaboard.com/wiki/index.php..._and_BiPAP

Your therapy looks great and it's good you were able to discover Oscar and the resources of this forum.

[staceyburke]

Welcome to the board.  What I see are flow limits in all of the nights.  Flow limits are apnea also and are treated with EPR, however, you are doing what you should with an EPR of 3.  It is the highest your machine can go.  The bipap can go higher and may be what you have to have to make the flow limits disappear.  We can try raising the min level one to 11 but that is about all I have.  Maybe someone else will have another answer.

[JackStraw]

Thank you both. I'll raise the MIN pressure to 11 from 10 and see what that does for me.

[pholynyk]

You should raise both the Min and Max pressure by 1 cm H2O because you are bumping up against the max quite often. The flow limitations are driving the pressure increase, so you may find you are still bumping against the top.
Of course, comfort and good sleep are more important than the numbers, so keep that in mind.

[Dormeo]

With the mask problem solved, are you sleeping well? If so, as other have said, don't worry about the flow limitations. But if you are still having some rocky nights, you might consider trying an experiment that doesn't involve buying a new kind of machine.

Your FLs seem to be clustered, which suggests to me there may be a positional element in their occurrence. A common culprit is chin-tucking, which can narrow the windpipe. If you use a high pillow, try using a lower one. And consider trying a soft cervical collar. More good information here:

http://www.apneaboard.com/wiki/index.php...cal_Collar