Should I increase EPAP? And What's a Reasonable Max EPAP setting on ResMed ASV?

[RayBee]

I was wrestling with the idea of increasing my EPAP Max pressure to try to get my AHI's consistently below 5.0. But my problem is, if my therapy pressure goes above 20 cmH2O I have a lot of aerophagia problems. And I can't keep my mask from blowing out a substantial leak. Either way, over 20 is a problem for me.

So whenever I change my settings, I tend to keep my Max EPAP + Max PS = 20.

I had Max EPAP set to 10 and Max PS set to 10 for a while and my AHI's were Min 4.96, Max 6.92, Average 5.67.
Then with Max EPAP set to 9 and Max PS set to 11 my AHI's were Min 5.13, Max 7.86, Average 6.46.

So it appears that with a change of only 1 cmH2O, my Max and Average AHI's were roughly worse by "1" with the lower EPAP.
I can't say that I noticed any comfort/discomfort differences with the two settings, but in keeping with my rule of overall max of 20 cmH2O, I was wondering where I might get the best therapy versus diminishing returns.

Obviously EPAP Max 10 & PS Max 10 provided better results here. Should I just play around with progressively higher EPAP Max / Lower PS Max settings until I hit my "magic" numbers? Maybe go to EPAP 11 and PS 9 (or even 12/8) and see if it beats the 10/10 historical AHI numbers? I'm not sure what settings sound reasonable... Or not.

Sample data:

[SarcasticDave94]

I haven't modified my settings a lot since starting ASV, but I did adjust things up recently on EPAP Max and a shift of PS upward on both Min and Max. For me, EPAP seems to make pressure adjustments that I notice, whereas PS adjustments aren't as noticeable. FWIW EPAP is designed to be the throat air splint as I understand it, maybe that's why I notice it more. And by way of clarity, when I say noticeable, I mean I can feel it.

I could be wrong, but it sounds right in what I experience, PS of any machine chosen setting is of shorter duration as compared to EPAP which seems to entail a longer time. If actually true, you may wish to do the bump/edit on PS.

[SarcasticDave94]

BTW my EPAP Min and Max are 9-15 and PS Min and Max are 4-15

[RayBee]

Thanks Dave.

I really appreciate the insight into your experience and machine settings. Do you ever have any problems with aerophagia or your mask leaking? That really seems to be a problem for me which limits how I set up the machine. I know we're only talking another 5 cm, but it really is problematic for me. I can only hope I can overcome those issues over time.

I have finally been putting together in my mind that on our ASV machines, EPAP treats OSA's and PS treats CA's. I guess I kind of already knew this after looking at my SH / OSCAR charts for a year. I suppose I have to figure out where the greater need lies and play whack-a-mole with my max settings.

I wish ResMed had a 5th setting to simply just cap therapy pressure. Then I could increase both EPAP and PS Max settings and still cap it at 20 cm. That would be ideal. But until that day, I'll just see what I can do.

My original prescription was EPAP 4 to 8 and PS 4 to15. I know that was not effective. And I don't get any support from those idiots anyway. So thank you Dave for sharing your experience. I think I'll bump up the EPAP Min and Max by 2 cm each and go for a 2-week test.

BTW... Sep 12 will be my one-year anniversary of being a hose-head. I don't see any convenient place on my machine to place the birthday candle. 

[Sleeprider]

Ray, I have mentioned before that your UA and H events occur in clusters and force your pressure higher. You tried a soft cervical collar that did not fit correctly. I'd like you to look through this thread by another ASV user who is new to the forum and found the right collar. http://www.apneaboard.com/forums/Thread-...rve-10-asv

[SarcasticDave94]

Thanks Dave.

I really appreciate the insight into your experience and machine settings. Do you ever have any problems with aerophagia or your mask leaking? That really seems to be a problem for me which limits how I set up the machine. I know we're only talking another 5 cm, but it really is problematic for me. I can only hope I can overcome those issues over time.

aerophagia was an issue but I adjusted and it's not an issue now, mask leaks still exist sometimes especially with fluctuating weight, it's nowhere near as bad as at the start however

I have finally been putting together in my mind that on our ASV machines, EPAP treats OSA's and PS treats CA's. I guess I kind of already knew this after looking at my SH / OSCAR charts for a year. I suppose I have to figure out where the greater need lies and play whack-a-mole with my max settings.

for myself, I adjusted to get the least of all events, I only adjusted EPAP Min at the beginning and having bumped up both EPAP Max and the whole PS range up a bit here recently

I wish ResMed had a 5th setting to simply just cap therapy pressure. Then I could increase both EPAP and PS Max settings and still cap it at 20 cm. That would be ideal. But until that day, I'll just see what I can do.

My original prescription was EPAP 4 to 8 and PS 4 to15. I know that was not effective. And I don't get any support from those idiots anyway. So thank you Dave for sharing your experience. I think I'll bump up the EPAP Min and Max by 2 cm each and go for a 2-week test.

let us idiots here support you instead...less expensive and nicer people to boot...post results on self test

BTW... Sep 12 will be my one-year anniversary of being a hose-head. I don't see any convenient place on my machine to place the birthday candle. 

side of the power button works OK

[RayBee]

Ray, I have mentioned before that your UA and H events occur in clusters and force your pressure higher.  You tried a soft cervical collar that did not fit correctly.  I'd like you to look through this thread by another ASV user who is new to the forum and found the right collar.  http://www.apneaboard.com/forums/Thread-...rve-10-asv

Thanks for directing me to this thread. Very good read and very good information. I do find a lot of similarities between us. Good call.

I'll be looking into some of the solutions that worked for Idanielle01 in about a week or two. Have some life-gets-in-the-way family issues I need to concentrate on in the mean time.

[RayBee]

Thanks Dave.

I really appreciate the insight into your experience and machine settings. Do you ever have any problems with aerophagia or your mask leaking? That really seems to be a problem for me which limits how I set up the machine. I know we're only talking another 5 cm, but it really is problematic for me. I can only hope I can overcome those issues over time.

aerophagia was an issue but I adjusted and it's not an issue now, mask leaks still exist sometimes especially with fluctuating weight, it's nowhere near as bad as at the start however

I can only hope these things get better with time. I'm happy to hear that they did for you - it's encouraging news.

I have finally been putting together in my mind that on our ASV machines, EPAP treats OSA's and PS treats CA's. I guess I kind of already knew this after looking at my SH / OSCAR charts for a year. I suppose I have to figure out where the greater need lies and play whack-a-mole with my max settings.

for myself, I adjusted to get the least of all events, I only adjusted EPAP Min at the beginning and having bumped up both EPAP Max and the whole PS range up a bit here recently

Great info. I'm still learning. I'm kind of a data junkie, so I love analyzing my OSCAR data.

I wish ResMed had a 5th setting to simply just cap therapy pressure. Then I could increase both EPAP and PS Max settings and still cap it at 20 cm. That would be ideal. But until that day, I'll just see what I can do.

My original prescription was EPAP 4 to 8 and PS 4 to15. I know that was not effective. And I don't get any support from those idiots anyway. So thank you Dave for sharing your experience. I think I'll bump up the EPAP Min and Max by 2 cm each and go for a 2-week test.

let us idiots here support you instead...less expensive and nicer people to boot...post results on self test

If you guys are idiots, I guess I'd be comfortable calling this my second home.  Will post when I can.

BTW... Sep 12 will be my one-year anniversary of being a hose-head. I don't see any convenient place on my machine to place the birthday candle. 

side of the power button works OK

 Awe man...  Anybody know how to get candle wax off my PAP machine and un-stick the power button???

 for the info Dave. Much appreciated. I think you and I are a lot alike. Kinda scary.