Are these flow limits my problem?

[k888]

Update:  the GOOD, the BAD, and the COMPLETELY CONFUSING.  I picked up my new Vauto (GOOD!) and have two nights under the hood (NOT SO GOOD.)  I set the machine on Min EPAP 7, Max IPAP 14, PS 4.  The first night was ok, not great.  I had a very stuffed up nose, but it still seemed that breathing was easier.  I had more centrals, flow limits much improved, expiration now longer than inspiration.  So I figured night 2 would be much improved.  Night 1 chart attached.
   
Night 2.  First three hours passed and I woke from a dream.  It seemed good, and I returned to bed.  Then I was aware of air, air, air, thought it was positional, then thought it was pressure.  But I did not trust myself to modify the machine at night  – the values for the bilevel still seem challenging.  And I was waking up my husband, so I quit halfway through the night.  Today I looked at OSCAR and planned to figure out where I should be going and have it ready in case I wanted to change the settings tonight.  I was surprised to discover the machine was set on the Dr.'s original prescription of Min EPAP 5, Max IPAP 11, PS 4.   (COMPLETELY CONFUSING)  Did I sleepwalk in and change the settings?  I don't think I did that.  Can they change it from a distance, auto correction?  It sure didn't help me.  I had consciously decided not to test the Dr's prescription for one night, but it seems I did.  BAD CHOICE.  Screen attached night 2.
   
So, I have changed it back.  Do I have to check again tonight before sleeping?  Or check myself into a care center because I have no idea what I am doing?  Any other settings to twiddle with?  Thanks to all, k888

[Crimson Nape]

Try setting the Trigger to High. This should reduce the CAs.

- Red

[k888]

Thank you Red,
How does that setting work?  k888

[Crimson Nape]

It increases the sensitivity of when to switch over to the IPAP pressure. This can give a slight nudge to make you inhale.

- Red

[Sleeprider]

First, I completely agree with Red, that the solution to the CA events is high trigger sensitivity, and possibly very-high if needed. I like to implement things step-wise.

The good news is when using the settings I originally suggested your flow limits dropped dramatically to under 0.02. That's fantastic progress and should have been much more restful. When I suggested settings for your Vauto, it was based on an observation that your median EPAP pressure with the Autoset was over 8.0 cm. So a 7.0 cm EPAP min was actually conservative, and it actually worked out pretty will with a median EPAP pressure of 7.3. When EPAP min reverted to 5.0, your median EPAP pressure was 6.14 and pressure varied quite a bit. Your tolerance for the settings was much better with a starting pressure of 7.0, with 8-hours of therapy vs only 4-hours with the pressure at 5-11. Your AHI was remarkably higher with the lower pressure and flow limits rose to 0.05. It's possible your DME changed the settings remotely, so you need to double-check your settings, and consider putting the device in Airplane mode to prevent the DME from tampering. Once we have optimized your settings, you need to request the doctor modify the prescription so the DME stops doing this. Remember I suggested a "self-titration" note in the prescription for this reason.

[k888]

Thank you both.  I will change the trigger to high and double check all the settings before going to sleep.  I would love to put it on airplane mode (and call them with some choice comments) but I will be wise.  They will be monitoring for insurance coverage.  I will request a change in the prescription at my next dr appt.   k888

[Gideon]

The "clusters" of CA events are happening during the times that your tidal volume is very erratic indicating that you likely are awake at those times.
I do agree that the increase in Rrigger setting should help the CA numbers during your sleep.

[k888]

Latest report with a night of contrasts.  I slept well, but now am tired, possibly just from looking at my chart!!   (–:
It seems the settings adjustments for trigger HIGH worked beautifully for the first part of the night.  Then my collar failed?  It should not have, as it is quite new.  I am adding a full view and a closeup.
I have recently improved my mask straps so that it does not whistle as much at the highest pressure.  Maybe I should increase the highest pressure on the assumption that it will only go there if I am in a position that needs to be corrected?  Last night I was so tired, and with the mask working better, I just slept through it all.  Now I would like to sleep some more, k888

   
[attachment=57979]

[Sleeprider]

Only you know your tolerance to higher pressure. I can promise you can set it to 20 cm and it will only go there when you have clusters of positional OA, and it will certainly go there. Most likely another 6 cm of pressure will not break the obstruction which is why so many here rely on a collar.

[k888]

Please forgive this long post, but I need guidance, please.  The night of Jan 4 posted above really threw me.  I did have a collar on all night.  I use a Corflex 3½”, and since I am 5’4” & 108 pounds, that’s a pretty heavy duty collar.  For several reasons, I sleep on my back, raised, and do exert downward pressure on the collar.  I have had a lot of collars fail, or so I thought, but going from completely working to total failure in one night is not what I expect.  My experiments since then have left me wondering again if part of my problem is actually a need for higher pressure, higher some nights than others?   Meaning, I need a collar, but some of the “positional apnea” on my charts is actually the machine trying to deliver adequate pressure but not being allowed to?  I have had so much trouble at higher pressures with blowing/leaks/face farts, and aerophagia that I have tried to minimize pressure, but maybe those events only really happen when the pressure is inadequate and the blowing is persistent?  One problem is that a really bad night leaves me so sensitized that even a little extra blowing the next night makes me hyper alert.

On Jan 5, I defensively set my numbers close to what my CPAP numbers had been (Min EPAP of 7, PS 3.2, IPAP 14.)  Then I increased max IPAP to 17 after getting up a little after midnight – I could see the numbers were poor, hoping it would wake me up if there was a positional problem.  The improved chart in the second half of the night surprised me.  Fewer events & pretty good flow limits.  It made me wonder about higher pressure.  Chart posted.
[attachment=58390]

I have continued to experiment.  Had a great and then good night(s) at min EPAP 7.6, max IPAP 17, PS 4.2 on Jan 8/9.  Then a horrible night with same pressures Jan 10. The blowing made me so sensitized/crazy that I subsequently reduced max IPAP pressure to 15.  I had two good nights and then last night bad again.  I slept for hours but am already sleepy this morning.  Please give me some guidance about what you see and next steps.  It will be greatly appreciated.  Posting charts for Jan 12 & 13.  Many thanks, k888

[attachment=58391]