Bipap Titration advice needed.

[amafra]

GN again,
After I couldn't believe that I had centrals and that many OA were using fixed settings on Vauto mode, Not sure why EPAP pressure did not show up on the graph, I decided to switch settings again, against friendly and well informed friendly advice here.
I tried to fix the pillow so that I could not move the head too much to the sides. Even though I did not sleep that long, for the first time I felt rested and willing to keep sleeping when I woke up. It was a good feeling that I don't recall how many years I have felt.
May it help to narrow down the settings. Feeling when you get woken up when you say, no , I was sleeping so well. It is very rare that I can remember the last time.
Here is what OSCAR shows.

Settings: ASVauto,  Epap 5, Max Epap 10, Min Ps 2, Max PS 7. 
Device screen report shows:
Pressure 12.5, Exp. Pressure 8.0, Vt 520ml, RR14, MV 7.3, Ti 1.8, I:E 1:1.4,  AHI 0.6

[Sleeprider]

Amafra, that looks amazing compared to what you had before. I don't care what mode or pressure you use, the right collar placement is going to mostly resolve your choke sessions.

[amafra]

Thank you very much Sleeprider for your and other friends here help. Looks like the positional is really what is causing most of my problems.  I felt good sleeping with a mask on for the first time. I woke up due to the hot temperature in the room, plus some noise. Not due to the mask pressure that stayed in comfort levels.
I'm amazed how people help others find solutions to health issues that doctors don't. I'm not saying doctors are not capable, but probably due to work overload or something I found last year all solutions I end up finding come from searching and counting on other people like you and Crimson Nape. The doctor said, I can't tell you why you are having that much AHI. She asked for a facial MRI, which I have not gone through yet. The sleep technologist that monitors me during sleep also could not understand, but It really seems that you figured it out buddy.I will buy a new pillow and order a snore collar from the USA.
One question, looking at ASVauto data, I see pressure variability. Do you think I should move to fixed pressure or these pressure changes could indicate ASV auto is prefered, behaving as auto titrating bilevel autoset?
My previous experiences using ASVauto I thought the machine was crazy, it pushed 24 cmH2O on me. It could be just the fact that I was shoking so much and bipap sensed the need for so much higher pressure to secure airflow.
I will update the post after extra tests with a pillow and collar neck. I expect to help others as well as I get more knowledge on that subject.
Thanks for all your input, especially reading my long posts. I was basically giving up on this until last night. 
Regards

[SarcasticDave94]

My take is that you don't have need of ASV. CA don't seem to be the issue but the Positional Apnea. I'm under the impression that with ASV not being necessary it will act in ways that aren't going to help. Whatever the others have suggested would need to be tried a few days to build a trend, indicating you're headed the right direction. And unless I missed it, I think ASV was ruled out.

[amafra]

Hi Dave,
I just had better sleep last morning (ASVauto) after a terrible with obstructive and central apneas according to OSCAR.
I do not have central apnea, but last S and Vauto generated central apneas, is there any clue on the graph why? I read some reports that ASV would be harmful for people that have a low ejection fraction. It is not my case for now. I do not see any report regarding ASV auto that has variable PS.
My question is, isn't ASVauto just a bilevel version of Autoset that adjust to patient needs at a given time point?
The suggestion is to use Vauto like sudo S mode since it will record flow limitation.
Would I in your opinion set Vauto mode to 12/8 plus positional correction?
Last night 12/6 was pretty bad according to OSCAR and I see I woke up pretty tired.
Thank you Dave.

[SarcasticDave94]

ASV is a specialized BPAP for treating Central Apnea. It uses EPAP and then PS over that. In ASV Auto mode EPAP, PS, and IPAP will all range between the respective Min and Max settings to address events. IPAP isn't user adjustable directly.

The bilevel of AutoSet is VAuto in the ResMed lineup.

[amafra]

Thanks for the fast reply. ASV is recommended for central em complex apnea. Yes, asv auto manipulates Ipap changing pressure support. Is it harmful to use ASV in my case ?
My problem with Vauto is that it always maintains the same PS so if it tries to fix snoring or hypopneas, it will necessarily increase my Epap , sometimes above what my needs doesn't it?I might be wrong but according to what I read, apnea is fixed with Epap, hypopneas and snoring with Ipap. Youtuber Lankyleffty says Vauto problem is that it moves PS to one direction to fix apneas messing up with snoring and hypopneas or the other way around.I'm confused now since Vauto and S mode performed worse. Isn't it looking at my OSCAR. It is true that just yesterday I tried to fix the position of my head after all the Sleeprider input and suggestions.Should I keep Vauto ?

[SarcasticDave94]

I don't see evidence so far that ASV is needed for you. I'm thinking VAuto will work but you need more than the current one night on specific settings to know for sure if it's working. You need to try at least 3 nights to see what trend will develop.

The ASV does treat Central Apnea and Complex Apnea. The problem is you're not presenting consistent treatment settings to build any trends for us to help beyond that Positional Apnea clusters issue.

[amafra]

Sure, I agree I do need to stick with one choice. I will be on fixed 12/8 Vauto tonight and see what happens. Thank you for input Dave.

[Sleeprider]

I'm just catching up. I went to open our summer cottage, and a pipe burst, even though I blew out the plumbing in the fall. This plumbing was put together by my father-in-law years ago and it looks like spaghetti. I need help to simplify and modernize it. Anyway, your problems are simple compared to mine. I'd like you to try 12/8 pressure in Vauto mode so we have a baseline. This will prevent pressure surges and show us exactly what is there. It's really important to understand that different collars work differently, and you have to explore the options to find the best solution. You have a severe problem when that is not treated, but I suspect that you might be able to get by with minimal or no CPAP once you sort out the positional stuff. Doctors just haven't caught on, yet it is an obvious and common pattern of clustered obstruction.