Hey Guys, Help Tweaking machine

[Sleeprider]

Your median EPAP at the new settings was still 7.5 and you nearly hit the maximum at 95%. Each time you had a UA event, the machine raised EPAP and it seems terminated the event. Let's try EPAP 6-9, PS 4-12. The UA events continue to look obstructive.

[ajack]

If it was my chart, I would use the default settings, and raise min epap till the obstructive events resolve. I think use default unless there is a clear reason not to.

[Sleeprider]

Default being EPAP 4-15, PS 3-15. That works.

[Justbreath]

So the reason I had not been using default was because the Areophagia is pretty bad. I did originally start therapy with default settings but could not tolerate even an hour or so. I think my body is slowly adapting to it an I am tolerating it slightly better in slow increments upwards. It still remains a huge challenge, but hopefully it gets better.  I’m not sure how much higher I will be able to withstand. I think my ipap is fine because it seems to stay right under 20 . Epap is def being choked. Will post some results soon. Thanks guys for all your input! ?

[ajack]

You may be better choking back max PS, than the max epap for now. You need the oa sorted. I would use the min epap 4 or 6 for now, then raise the min epap to be between the median and 95 percent, when you get a better idea of what your min epap is heading to. Then I would work on raising the max PS.
Also be aware of positional apnea, if you are getting big swings in epap pressure.

@sleeprider, other than min epap, that is normally set at cpap and adjusted on Oscar or resscan. I think the default settings from the titration guide are the first choice. Unless something indicates otherwise, like this areophagia that has come to light.

[Sleeprider]

My suggestion for EPAP 6-9 rather than max EPAP at 9, and trying to keep PS lower has been my attempt to keep pressure below aerophagia thresholds that we have not really identified. In any event, using this incremental approach is slower, but we will get there. There is no doubt that the Resmed ASV can be a bit enthusiastic in applying pressure when events occur. So, no regrets from me for taking a conservative approach that tries to solve the problem while keeping pressure as low as possible At the same time, the default pressures are the most effective starting pressure for the most people and it is my most frequent suggestion. Whatever works, but by taking a slower pace, my thought is we can find that threshold that beaks obstruction without aerophagia.