Self-titrating BiPAP for OSA/UARS w/ hypermobility

[ktopspin888m]

Hi, 

Attached is my Oscar data. Currently only have compliance for an hour or so, will update w/ more data as soon as I can. Currently set with default IPR/EPR: 4-10 cm^2

My sleep study (which was conducted very poorly, no real seal achieved) - shows optimal CPAP pressure of 7.0. 

Could anyone help diagnose what settings might help improve my AHI?  I have hypermobility and lax/weak ligaments in my neck so tossing and turning all night long, never finding a comfortable position. Also will continue to update with a Lofta sleep study soon.

[Sleeprider]

Let's change things up a bit, your settings are awful.
Mode Vauto
EPAP min 5.0
Max Pressure 12.0
PS 4.0

You are using a fixed pressure mode with EPAP 4, IPAP 10 and a resulting pressure support of 6.0. This has left you vulnerable to unstable respiration and high obstructive apnea index due to inability to respond to obstruction with higher EPAP. There may also be a positional element to the OA events. These revised settings will be more appropriate to your therapy and allow us to narrow down the issues.

[ktopspin888m]

Ok, so tried the settings that you've recommended @Sleeprider with a full-face mask. However, I'm really struggling to fall asleep with the full-face mask on, main complaint is dealing with a lot of bruxism. Though that may be potentially due to a combination of both sleep apnea and anxiety.

Some good news though, achieved both great compliance and a lower AHI with a nasal mask! Honestly did  not feel particularly well-rested but hoping benefits will become apparent with time. 

Still several things left to try: 

First things first, try VAuto mode with the nasal mask  
Tongue-retaining device (tongue on the roof of mouth seems to improve nasal breathing, but almost impossible to achieve due to my narrow palate)
Cervical collar 
Thin occlusal hard mouthguard for bruxism (Dentist made me one that was way too thick, almost felt like it encouraged mouth-breathing, looking for any recommendations for material/brand/lab)

[Sleeprider]

Your latest results show a significant improvement, so you're on the right path. I think with PS 6 a full face mask will bounce around a lot on pressure transitions. If you can tame the leaks, you should be very close to perfection. Sometimes a collar will put enough pressure on the jaw to encourage a better position that helps keep the tongue at the top of the palate. I use the Airfit P10 nasal pillows, and as an example of learning air pressure control, I can sip water through a straw and talk while using the pressure. As you become more experienced, your ability to control air pressure will also increase.