Looking for ideas to improve my settings

[waitedwaytoolong]

I just had a one year review with the medical group who set me up after an in-hospital titration. I use a ResMed Aircurve 10 ASV due to OA and CA events. I also use a viatom O2 Ring. The initial settings provided by the sleep team were very aggressive and uncomfortable. With help from this forum, I have adjusted them and have settled to settings I am comfortable with. I did change from ASV to ASV Auto using recommendations from members and that was a significant contribution to my current comfortable sleeping. While I think things are good, I am posting to see if anyone can suggest adjustments to improve more. I am posting 3 charts, one is full night, the second is a one hour view when the machine intervened significantly, and a 20 minute zoom from the one hour chart. I generally have a lot of flow limit events and even though my stats are within acceptable limits, I wonder if there is a way for me to reduce them. The limits are short duration but high values. The one hour chart is a period when snore was flagged so probably poor positional posture? I do wear a collar. My preferred sleep position is  on my back but I have modified it to mainly be on my side. I presume I went to my back for the one hour period. I will appreciate any observations and recommendations that will help me tweak things a little better.

[Sleeprider]

Clearly your AHI at zero is achieving everything your doctor and sleep technologist would want with EPAP min 7.0, EPAP max 10.0, PS min 5.0 and PS max 15.0. Your own adjustments for comfort are exactly as we would coach on the forum, using ASV auto mode and minimizing the amount of EPAP pressure swing. We can't determine from this chart if you might tolerate lower EPAP min or PS min, so I'll assume you have experimented in those variables. Flow limits on ASV are a bit tricky, and we tend to ignore them because they usually arise when there is no or inadequate spontaneous effort and the machine is forming the breath. This naturally results in a flat inspiration wave as the lungs fill and increase resistance to the ASV pressure support. It would be inappropriate to manage flow limits under these circumstances, and your minimum PS would certainly eliminate flow limits in most people with normal spontaneous inspiration. My only thought is to actually see if lower minimum PS increases the rate of spontaneous inspiration (reduces CA events), as indicated by fewer excursions to higher PS inputs. Hope this helps.

[waitedwaytoolong]

Thanks Sleeprider. You are correct, I tried lower epap pressure but my last adjustment was upward 1. I can try reducing it again and see how that goes. By the way, you provided a lot of advice to get me where I am today!