Help me interpret my second Sleep Study results

[YouTakeMyBreathAway]

More oxygen drops today (same settings) - feeling similarly tired to always.

   

One thing I noticed is that the BiPap has completely removed all variance to my Inspiration Time:

CPAP: 
   

BiPAP:
   

Going with the advice by Gideon before re: keeping a low amount of CAs for the body to adjust to, which made a ton of sense for me. I think the way to go is to just keep at it with this setting?

That being said, my sleep doctor seemed to think keeping cranking the EPAP would help w/ the hypopneas the machine isn't flagging that he manually scored in the lab stufy, should I try that?

[Sleeprider]

If you're feeling rushed on inspiration, there is no problem in adding to Ti Max. None of your graphs show the Ti graph, and statistics do not show a problem, but if you want to move to 2.4-2.6 seconds, that will not be a problem. If you want to investigate SoO2 drops, you have to zoom in on them to see if there is a respiratory issue where they occur. There is not much to see from a mile-high point of view. While you're at it, get rid of the monthly calendar.

I've said before that higher EPAP (PEEP) generally improves oxygen perfusion. Higher PS results in higher ventilation and reduced CO2.  Your doctor's advise of increasing EPAP for hypopnea and oxygenation is not consistent with bilevel titration guidelines.  In the chart below, in increase in IPAP is equivalent to increasing PS on the Vauto, and increasing EPAP means EPAP min.  Keep in mind that for fine-tuning, you can increase or decrease pressures and support in increments of 0.2 cm.

[YouTakeMyBreathAway]

I changed "Trigger" to "Very High" last night and it eliminated all my CAs. There is one flagged (12 seconds), but there's some breathing junk right before it, so I assume it is not an actual CA.

   

Still getting 16.05 SpO2 Drops/h.

There are no hypopnes flagged, but I'll have to assume the SpO2 drops are caused by hypopneas, so I assume next step is to increase IPAP/PS by 1.0 until SpO2 drops diminish, is that right?

Could also play w/ inspiration time by increasing Ti Min and reducing Cycle sensitivity to Low.

   

[Sleeprider]

I don't recommend changes to Ti Min unless there is evidence of problems in triggering and sustaining inspiration. It's pretty unusual, and the signature is a marked start to inspiration with a brief drop to zero flow before inspiration resumes.

[YouTakeMyBreathAway]

Bumped PS by 1.0 --> 8.0/14.0. 

Result:
- Lowest AHI (0.25) + ODI (3.31) I ever had
- Highest Minute Ventilation (6.88)

   

There are a few remaining SpO2 desats (hypopneas?), so I assume best next step is to raise PS by another 1.0.

That being said, two things I am struggling with:
1. Mouth Leaks: Starting to get some mouth leaks at the higher pressure. I have the F20 but I never got it to not leak at its edge. Thinking of trying the F30i.
2. Tickly Nose: I'm usually fine when I fall asleep, but then during the night there are clusters of my nose just continuously starting to tickle, me having to stop the machine, take it off, scratch my nose and put it back on, which keeps waking me up. I tried leaving my nose hair long, trimming it super short and also putting Lanolin in my nose, to no avail.

And here is a screenshot of all my SpO2 drops w/ flow rate throughout the night: https://imgur.com/a/2mteify

Does anything stand out from seeing these?

[YouTakeMyBreathAway]

I'm very sad - I went straight back to a terrible night today. 

Change: Increased IPAP/PS by 1 from yesterday.
Result: Increased ODI (12.3) and AHI (2.1)
Context: My wife woke me up several times complaining about mouth leaks. Since I also felt a bit stuffy, in an effort to fix this, at 2:20 I did a nasal rinse plus 1 spray of Afrin. She continued to report leaks and my mouth continued to feel dry.

   

[Lucid]

Hi, YouTakeMyBreathAway  Re tickly nose and discomfort, have you tried using the humidifier?  (I use both humidity and tube heat set to Auto.)

You're probably aware, but be careful with Afrin.  If you use it more than three days in a row it will cause a rebound effect that can take several days to go away.

My ENT recommended Flonase and Ayr Saline Nasal Gel.  Flonase doesn't take effect immediately like Afrin but rather after a week or two of use.  The Ayr Saline Nasal Gel helps moisturize the nose.

Neutrogena Hydro Boost is fantastic for dry skin.  I use the fragrance free version for sensitive and dry skin.  (More expensive than some other brands, but you need a lot less so a bottle lasts longer.)

[YouTakeMyBreathAway]

Hey Lucid!

Humidifier - Yep, tried humidifer, didn't notice a meaningful difference.
Afrin - Yes, not using Afrin frequently, I'd say maybe once a month when I'm super stuffy from being sick/having a cold and usually just that single day, not multiple days in a row. 
Flonase - I did do Flonase and Azelastine nasal sprays in the past, but got the sense that these make me overall more tired (separate from sleep apnea) and didn't help significantly w/ night time breathing.

Will give humidifying nasal sprays and that neutrogena cream a shot, thank you!

---

After the bad night yesterday I reverted to the previous settings (8-14, PS 6).

   

Appreciate any and all recommendations on how I can optimize my treatment!

One thing I noticed: My leaks consistently are worse during the second half of the night (at same pressure).

[YouTakeMyBreathAway]

My Minute Ventilation yesterday dropped to 6.00 and I'm back to the same pattern of good AHI (0.24), terrible ODI (20.96).

   

Please let me know what information would be useful to dig deeper.

Comparing a segment w/ many drops to one w/ few, I must say they look very similar: https://imgur.com/a/WXAyIXj

[YouTakeMyBreathAway]

Somehow Tidal Volume + Minute Ventilation are trending back to the level they were at when I used my CPAP w/ 3.0 EPR, maybe my body is adjusting?

   

Here's some of the drops: