Any way to tackle the remaining CAs?(AutoSet for Her)

[ChinaMan]

Sleeprider and I are on the same page.  The zoomed views validate that you have fairly extensive flow limitations and once again flow limits are much more extensive than the stats indicate.  I was going to suggest starting at EPR=2 because the flow limits are so extensive.  Follow SR's settings and let's see what happens.  Expected is a decrease in flow limits and an increase in Central Apneas, what we don't know is how much, CAI may not increase.

ResMed measures the 'flatness' of the breath and presents an index of 0 to 1 with higher being the more significant.

Should I also switch to AutoSet Standard?

[Gideon]

Let's see what we get before we look at the ASV route.

and yes, Autoset standard

The Rule of thumb is that you must  fail CPAP, fail BiLevel without backup, fail BiLevel with Backup, before you get a chance at ASV.  
We are ASV proponents so don't worry,  we will send you down that path if we feel it is the correct one.

[Sleeprider]

The difference between Autoset Standard and For Her is the rate at which pressure increases are applied. For Her reacts faster to the first flow limit, then slows down, while Standard will continue to respond.  In the interest of changing only EPR for now, feel free to stay with Autoset for her, and we can try the mode change later to see what affect it has. The idea of adding EPR is to prevent the flow limits from even being an issue. Your exhale pressure will be lower, but your inhale is assisted by the pressure support of an inhale pressure that is higher than exhale.

[ChinaMan]

The difference between Autoset Standard and For Her is the rate at which pressure increases are applied. For Her reacts faster to the first flow limit, then slows down, while Standard will continue to respond.  In the interest of changing only EPR for now, feel free to stay with Autoset for her, and we can try the mode change later to see what affect it has.  The idea of adding EPR is to prevent the flow limits from even being an issue. Your exhale pressure will be lower, but your inhale is assisted by the pressure support of an inhale pressure that is higher than exhale.  

I understand turning on EPR to tackle FL part. But I am still confused about the rationale regarding switching to AutoSet Standard.

[Gideon]

It is pressure support that best treats flow limits, as you see the for her provides an initially quicker, but a slower and lessor response overall.

We are not against it if it works, but we are looking to attack the flow limits as hard as we can. Again, if you want to try the for her as a step in the process, neither one of us has an issue with what works, even if we haven't done it that way before.

[ChinaMan]

It is pressure support that best treats flow limits, as you see the for her provides an initially quicker, but a slower and lessor response overall.

We are not against it if it works, but we are looking to attack the flow limits as hard as we can.  Again, if you want to try the for her as a step in the process, neither one of us has an issue with what works, even if we haven't done it that way before.

I heeded you guys' advice––The flow limitations were reduced a lot, the CA remained about the same, and I feel better. Any further refinements can be suggest? How to reduce CAs or even further reduce flow limitations?

[SarcasticDave94]

Be aware you cannot treat CA with any PAP machine except an ASV. You can avoid some with your APAP.

[Gideon]

The numbers are still acceptable, yes the central apneas too.

I would like you to try EPR = 3 tonight and likely for several days.

Very important is how you feel, Which is better EPR=2 or EPR = 3?

We are looking for a balance between obstructive and central apneas where you feel best.

[ChinaMan]

Be aware you cannot treat CA with any PAP machine except an ASV. You can avoid some with your APAP

Should I reduce mini pressure and increase EPR to 3?

[Sleeprider]

The only change to make is EPR setting. Keep everything else the same. The change to EPR 3 will make your minimum EPAP pressure only 5.0 cm (8.0/5.0), but if we see a need to increase the minimum pressure from 8 to 9.0, we can make that call after the first night.