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[Gideon]

As a lover of high pressure and highr PS (for myself) I can see no reason for these high pressures and PS. Actually for PS =4, that is a common initial setting for a BiLevel.

Why are your settings so high? do you have any breathing or cardiac issues other than apnea?

The Central Apneas, and your numbers tend to indicate some over-ventilation which is consistent with the higher settings.

Seeing your sleep studies would help to understand this, as would knowing your respiratory and cardiac health.

Without any condition to contraindicate reverse titrating (Titrating Down) both PS and Pressure to find a sweet spot. Reverse is bsed on the assumption that your pressures are high for a reason.

Do note that Central Apnea numbers will consistently bounce all over the place, we call this consistently inconsistent so it will take time to validate that setting have impacted the Central Apneas.

[Oarsman50]

Don't have any breathing problems and work out regularly.  Did have any episode with "indigestion" back in 2018 which resulted in two stents in the Right Coronary Artery.  I don't feel any limitations and feel good generally. I have attached the 2020 data on my sleep study and the results/recommendations

[jaswilliams]

During your sleep study the best AHI was 4.9 at 18/10 but they selected the settings where your AHI was 12 with events all central.... I do not call that a success you need to be on an ASV. The sleep Dr is hopping it will work for you, that’s just a guess

[Gideon]

PS O  C  AHI  O2
12/9      3  0  0  32.9 94
13/10    3  0  3   57.8 93
15/10    5  0  0   44.8 92
17/10    7  2  9   15    92
18/10  8  0  1   4.1   95
19/11    8  0  8   41.4 88
20/12    8  0  27 27.9  89
20/14    6  0  14 33.4  91
22/16    6  0  12  12     92

Note that Centrals are all over the place.  What do you do when you are on the 30 yard line, 4th down,  and you don't know a good play to call?   PUNT!!!

You likely need an ASV

[Oarsman50]

2nd night on the change from 22/17 to 20/16 bipap settings.  Looks like the AHI was one of the lowest since inception.  The clusters disappeared for the most part and the events were down.  Overall felt pretty good. Probably keep this setting for awhile to see what happens.    

[Sleeprider]

That is more in-line with expectations. When you're ready, we will continue to reverse titrate to lower pressure. The titration study results were chaotic and no pressure tried actually demonstrated efficacy. In the end you were not given the best settings. The sleep report is very difficult to interpret without formatting and the methodology appears flawed. Considering they titrated you to 22/17 with an AHI of 12, we are certainly doing better now.

[SarcasticDave94]

It's so reassuring to know these medical pros know what they're doing. Not. There's times that the medical practitioners guesswork is hazardous. Best to you while getting better settings than others guessed at and got it wrong and got paid to do it.

[Oarsman50]

Ok it has been about  a month for me since I changed from the 22/17 pressures to the 20/16 lower pressures.  As long as I am using a full face mask over the nose, my AHI readings are below 5, usually below 3.  I have been experimenting with other masks such as nasal, nasal with pillows, and full face below the nose.  None of these gives me below 5 readings, but I also have not used them over a couple of days each.  Should I remove the extra variable (the mask) and concentrate on one mask to optimize the settings before trying new masks?  Thanks in advance.

[Sleeprider]

Once you settle on a mask, we can look at charts and see if we can do anything more. Congrats on the progress so far.