Get a second sleep test to titrate?

[CaptainKirk]

I have sleep apnea and I use an AutoBiPap...been on it a few years...my numbers have lowered over time somewhat and they now hover around 7. Sleepytime software keeps telling me that his number is too high, and I guess < 5 is the goal right? Would getting a second sleep study to titrate help if I am using an AUTO bipap?

Some boring backstory:
Another issue is that the sleep center I went to was I dunno..well it had a BiPAP dispenser/mill vibe to it. I mean the tech was very professional and seemed knowledgeable but when I first got the machine I called them up and told them that my number seemed too high (16) and that I still felt tired and they kind of shrugged. So I nagged them and was actually able to speak to the doctor over the phone. He said to come on back and they could adjust the settings. I guess it helped a little guess (the number went down to 14). It's now around 7, but ONLY I believe because I lost weight, NOT because anyone has adjusted the settings. 

But it seems I hit the wall and 7 is the limit, but I would like it less than 5. Like I mentioned, I'm not crazy about the sleep center, so I am thinking about making a 4 hour drive to another place so maybe they can titrate me. I plan to write down the current settings so in worst case scenario, I can just go back to those settings. Does a second sleep study for titration usually yield good results with an AUTO bipap? I mean I thought that's what the"Auto" was for more or less?

[jaswilliams]

We can help you tune your machine and lower your AHI please download OSCAR and post your daily chart

[Gideon]

We usually target well under the 5 AHI that the medical community, most of the medical community says is treated.  We also look at Flow Limitations and RERAs which are not a part of the AHI but can have a negative impact on your sleep.

If you have SleepyHead, you can use that, but a lot of the people here are developing OSCAR, SleepyHeads successor.

We do have a fairly high success rate with those that we help.

[CaptainKirk]

Thank you. OK, having poked around the forum, I assume you mean a screenshot? I'll upload as an attachment.

edit: ah, ok, thank you bonjour

[Gideon]

You have a little bit of everything happening.
I would bump your min EPAP up to 7.5 to address your Obstructive Apnea.
You also have Hypopneas, Flow Limitations, RERAs, and Snores.  These are better addressed with Pressure support.  I know you have variable Pressure support so I'd like you to set the Min PS to 3 for now, with the expectation that we will increase that more later.  I have no issue with setting the min PS to 4 now.  
with all this going on I'll put a watch on your Central Apnea/Clear Airway events.  Increasing pressure and/or Pressure Support could increase your Central Apnea.  

So min EPAP to 7.5, min PS to 4.  That should make a difference

[CaptainKirk]

Thank you bonjour, I will try those settings but it will probably take me a couple of weeks. I'm a little hesitant to change things right now because I have a lot of stress in life right now, but I will definitely try those settings and get back to you. Thanks again.

[ajack]

It isn't easy to make your own adjustments at first. If there are no other issues from the last sleep study that needs following up. This chart should be enough for your doctor to make the adjustments and the min epap 7.5 and min PS 4 will make a lot of difference to your treatment. It puts a solid floor from which the machine can work from.

[Sleeprider]

One of the settings on your machine is Flex (A-Flex) and you have it set too high. Flex is a comfort setting, but the setting of 3 works for almost no one. Change it to 2 or 1.  This is not a prescription setting so you won't get in trouble with the doctor. I happen to agree with Fred's recommendations and think you will suffer unnecessarily by waiting for your prescription to be changed.  Let me offer this insight, CPAP titration is nothing more than trial and error, even when it is done by a sleep lab or a doctor.  We increase pressure for obstruction, and decrease pressure for central apnea, but the rules are very well established. By understanding them and observing your results with Sleepyhead or OSCAR, you can resolve them yourself more effectively and faster than if you wait for someone else to do it.  Here is the manufacturer recommended decision tree by Philips Respironics. Both Fred and you doctor will follow this guideline to help you improve results. Actually the Resmed protocol is more helpful, so I'll throw it in for free.

[CaptainKirk]

Thanks ajack, thanks for the decision tree sleeprider and for the explanation of how the process works. Hopefully this all works for me! Thank you all for the support and info.