Help Interpreting Resmed Aircurve 10 VAuto Data

[fracturedhibernation]

Hello all,

I'm posting here in the hopes that someone will give me guidance on what is (still) going on with my sleep and how I can tweak my settings to feel better. I was diagnosed with moderate sleep apnea (AHI=16 and with an arousal index of 70 per hour) and have been using BIPAP consistently for a year now. I originally began treatment with the Phillips Dreamstation Auto BIPAP, but have recently switched to using a Resmed Aircurve 10 VAuto. While I feel better than before I started using the BIPAP, I still deal with a good amount of brain fog/daytime sleepiness that hasn't gone away. 

I originally started with my settings on auto BIPAP, but now I'm using the standard bilevel mode with a EPAP of 12, IPAP 18 and EPR 6. I have arrived at these settings by slowly moving both my EPAP and IPAP up, as well as increasing the PS to hopefully help with my RERAs. I think I've found a good fitting mask (the Airfit P30i) and I use the Coverall stretch tape on my mouth at night to minimize leaks. I'm disheartened that minimizing the leaks has not made me feel better.

If anyone could take a look at my data and tell me where I should go from here, it would be greatly appreciated. My AHI is very low and I suspect I am still having RERAs that aren't being addressed by the machine. Looking at my data, I see some funky breathing patterns but I am not sure what kind of arousals they are (are they RERAs, unflagged hyponeas, or weird centrals not flagged by the machine?)

Some additional information: 

• I have gotten blood work done recently so I think I can rule out other factors causing the fatigue
  
• I am only waking up once or twice at night (that I'm aware of) now that I have a well-fitting mask with minimal leaks
  
• Last night I changed the trigger setting from medium to high, I can't yet tell if it made a true difference
  

I'm attaching a screenshot from the past two nights. Thank you in advance for your help!

       

[Sleeprider]

You are using your Vauto in S-fixed pressure mode with a pretty high pressure support. It seems to be working, but without knowing how your therapy looked at lower PS, it's hard to judge. Do you have any examples of PS at 4.0 or 5.0? What made you choose to go this high? Did you have obstructive events at lower EPAP? There are no RERAs possible with these settings and you don't have flow limits. In some cases, you need to be in Vauto mode for the machine to register and report flow limits. That can be done in Vauto mode with EPAP min 12.0, IPAP max 18.0 and 6.0 which preserves your same pressure. Personally, I would drop EPAP min to 9.0, IPAP max 18.0 and PS 5 or 6. We learn more with the machine in an automatic mode.

Don't study your flow weve form too closely, I assume you're human and will have variation. you are making an error of assuming residual fatigue is due to your PAP therapy. There is simply nothing here to cause fatigue, and at best the therapy can keep you free of respiratory disturbances, but not make you sleep better. A blood test does not eliminate all other potential sources.