Help with machine settings

[ttwhite1]

The response is standard and the EPR is on, set to 3 and full time.

[ivorpetkov]

Response Standard is OK. 
In our case, I tried "Response Soft" but got an additional increase of Flow limit.
After I changed it back to Standard ,  Flow limit went back to its previous values.

[ttwhite1]

       
So I went and bought a cervical collar from the pharmacy.  I finally was able to sleep with it all night.  I upped my minimum pressure as well. I'm sleeping comfortably with the APAP, so no issues with the mask. It looks like there is still some positional apnea going on, so I'll leave things like it is for a few days I guess.

[Sleeprider]

The new settings are much better, however pressure continues to be driven by flow limits and snores through mos of the night. I suspect you would do better with a bilevel device like the Aircurve 10 Vauto as it would provide more pressure support to offset the flow resistance in your inspiration. That is not an easy thing to persuade your doctor or insurance as there is an appreciable cost factor. I originally attributed your flow limits and snores to positional issues, but they have been very persistent, even with a collar, so it may be a physiological airway resistance, and that is not easily assessed over the internet. It may help to look at some random zoomed images so we can visualize your breathing by looking at 3-4 minute zooms of your flow rate chart. Is the airway resistance and snoring something you're aware of? Could it be an artifact of your beard? Is there anyway you might consider using nasal pillows to get a more direct pressure?

[ttwhite1]

            It may be teeth grinding (bruxism) that's going on.  I am aware of having that.  Here are some flow limit snapshots.

[SarcasticDave94]

When I wanted to get to bilevel instead of CPAP, I played the discomfort card with the CPAP pressure. Might be worth considering if true for you, as one means of how to get on that VAuto.

Sometimes you have to have a negative therapy narrative. Like when doc asks if CPAP is doing well, your answer shouldn't be "fine or OK". Maybe it's "no it's not going so well, it's not comfortable".

[ttwhite1]

Ok, I go in again in December.  What's the difference with a bilevel?

[Sleeprider]

ttwhite, I need more zoom. The segment should be 3 to 4 minutes long so individual wave forms are visible. The bruxism may explain the snoring chart that does not correlate very well with flow limits.

[Gideon]

Santa here. not really but I get called that all the time 'cause of my beard, Ho,Ho, Ho, I have no idea where they see a resemblance.
Seriously now. I see an issue with your flow limits, I saw a need for a BiLevel such as a ResMed VAuto, with its capacity for a higher PS or EPR on your system. I also saw a hint of positional and thought that might help. I did notice your EPR was set to 3 which is as high as it can go.

Titration 101
EPAP (Exhale pressure) manages OA events
Increase IPAP via PS or EPR to manage hypopneas (ok there) and Flow Limitations. Here you need help. Unless you have a positional issue that I don't see for sure, you will need more PS Thus a BiLevel.

To be clear, IMHO your flow limits are bad enough to significantly disrupt your sleep. SleepRider is asking for a closer zoom so he can evaluate your breathing literally on a breath by breath level to actually see what is going on.

With that I'll leave you in his very capable hands.

On leaks you are fine, even with a beard. I saw short periods that were not good but overall not bad. I use a P10 pillow mask and I was a dedicated mouth breather when I started. The P10 does avoid any and all beard issues and as stated earlier many so-called mouth breathers naturally adapt to nasal breathing. though some of us (raising my hand) actually have to learn how.

[ttwhite1]

              Thanks you two.  Here's a closer look at my breaths. I got rid of my beard sometime last week.