[Pressure] Reaching maximum IPAP - Time to change settings?

[Sleeprider]

If you want to get after the flow limits and snores, you are going to have to elevate both EPAP min and IPAP max. I also think you might tolerate additional pressure support.  I don't usually do multiple changes, but I'll make an exception IF you think your comfort is not what it could be.  If you're game, here it is:
Mode: Vauto
EPAP min: 7.0
IPAP max: 16.0
PS: 4.4

I am game

If I am understanding this correctly, this is an effective increase of 2.4cmH20, right?    I will give it a try. 

This increase in EPAP may also decrease the number of "Hypopnea" events that sometimes are flagged, correct?

If I'm doing things right, it should result in more comfort and less flow limitation, snores and hypopnea. I guess there is only one way to know.

[Frajola81]

First night with new adjustments and I got more of the same. I wonder if it is because of this that I am still sleepy until 1:30PM.

As you can see, the period between 4AM and 6AM was particularly bad.  Note that I didn't use the collar this past night... 

I assumed that the increase in pressure would take care of the snores but maybe it was a mistake....   the IPAP is topping off again. Other than that, the therapy was pretty comfortable (some mask leaks but probably because I removed the collar and didn't adjust the straps.)

Are there other solutions to control the snores and flow limitations? Lose weight?  I am 6ft3, 245Lbs. Don't look particularly overweight but there is an accumulation of fat in the belly and face/neck.

[Sleeprider]

I agree the data looks the same. How was comfort with the higher pressure and pressure support? Which collar are you using. Sometimes, it just takes some experimenting with other styles or sizes.

[SarcasticDave94]

Just my opinion but if you're concerned with the nearly flat-topped high pressure at 5:30-6:30, I say this indicates 16 isn't as high as your therapy pressure demands are at that point. Note as well this is within the snore and flow limit increased activity, so that will factor in by demanding higher pressure required. What I'm trying to say is most likely snore and FL are driving pressures to your top setting of 16. Reduce the FL and snore and it may not peg at 16. Something needs to be done to reduce these as what's been tried so far isn't impacting these enough.

Again my observation only. Sleeprider is far more knowledgeable at helping solve this, and I'm not attempting to counter his info. I would normally think the right response to FL and snore is to increase your Min. pressure. But it seems not to have helped on this one night presented. Is that enough time to evaluate and conclude that pressure edits recently done did not work? No offense, but this is what I call a 1 night pattern, unless in fact it has been ongoing longer than presented. As presented, it seems to only be a one night snapshot. Correct me please if I have this wrong.

[Frajola81]

I agree the data looks the same. How was comfort with the higher pressure and pressure support?  Which collar are you using. Sometimes, it just takes some experimenting with other styles or sizes.

I didn't feel anything different with regards to comfort. Felt great actually.

The collar that I have been using is called "Vive Neck Brace" which I order online from a major vendor. It is not comfortable to sleep with it but I might need though the snores and FLs looked bad wearing it.

[Frajola81]

Just my opinion but if you're concerned with the nearly flat-topped high pressure at 5:30-6:30, I say this indicates 16 isn't as high as your therapy pressure demands are at that point. 
...

As far as I am understanding here, even though my AHI is acceptable, my pressure demand may be even higher due to the snores and FLs? Interesting....   
In the titration study, a pressure of 8cm of water controlled AHI, RDI, and oxygen saturation readings, however REM sleep was not observed until 14cm of water (and brought the apnea/hypopnea index to 0). There was no mention of snores or FLs.
And you may be right that the plot I showed is just for one night but before that, all my nights have had an AHI < 1, sometimes <0.5 but snores and FL have been very consistent (Even though I was using the collar). 
You guys think that I should stick with these settings for a couple of days to see if a pattern emerges?

[Sleeprider]

I for one am not in a hurry to see setting changes. It's not like AHI is very high, it's excellent. Comfort is the main consideration and should drive your decision, not just the data on pressure or flow limits.

[Frajola81]

@Sleeprider: But couldn't the FLs and snores being the cause of daytime sleepiness?

[SarcasticDave94]

Me, yes those events can be disruptive to sleep causing daytime sleepiness. There's other potential causes, but for you these are probably the source.

Have to looked into a Corflex collar? I'd not look at it. They are made to order if I recall right.

Sorry on typo, was on phone...

[Sleeprider]

Frajola, if you want to see where the pressure takes you, just take the maximum IPAP to 20. It will be interesting to see if it resolves the issue. The auto pressure algorithm will seek to go as high as necessary to resolve flow limits. I think they are likely positional, but if they resolve with pressure that's fine. Your FL and snores are near zero, and increase in "clusters", so I still think it is something the collar is missing, but I have my maximum pressure at 18 cm. I don't often get there, but when I do, it is never noticeable. I have no problem with trying fairly radical changes, because we can always come back and reset. You can always learn something from making a change, we just have to see what it is telling us.