seems like I need to raise max pressure?

[Gideon]

I'd say try a PS of 6. If that doesn't work we can try manual "S" mode. that will eliminate all increases.

[yankees123]

Fred should I increase from present ps of 5 to ps of 6 in small increments?

[yankees123]

Fred can you explain what you mean that if we try" S" mode that it would eliminate all increases?  Do you mean flow limitation increases and if so why would that be?  
Just trying to understand, thanks.

[Gideon]

If I understood you correctly you are complaining about the pressure increase driven by your flow limitations.  By setting to "S" mode you eliminate any increase in pressure for any reason, thus eliminating that reason,   the pressure increase driven by your flow limitations, from being a cause for your discomfort.  "S" mode provides a fixed EPAP and a fixed PS so other than that change on every breath there will be no pressure variations.

Remember that changes are based more on how you feel and how you sleep and not the numbers.  

If it was me I would go to PS = 6 and if that did not feel as good as 5 I would then go to 5.4 or 5.6 (there is no 5.5) and try that.  A big enough change that you should be able to feel the difference.

[yankees123]

Thanks very much Fred, will let you know how the changes feel in a few days.

[Sleeprider]

I would also suggest that with increased pressure support at 6.0, you can probably reduce EPAP. There are no obstructive events. I would use settings of EPAP min 8.0 max pressure 16 and this will result in a pressure range of 14/8 to 16/10.

[yankees123]

Not sure really what to do.  I have been suffering with flow limitations for a long while and have been adjusting my PS to counter them.  For the past month I am noticing an increase in AHI and CA.  I have had low AHI readings for quite a while, and my sleep routines have not changed.  I can see my AHI and OA events are also increasing.  Not sure if I should increase the PS or the EPAP .  I am not waking up refreshed for about the same time as this has been occurring.  I use a cervical collar every night.  
Thanks for your help.  
Just another question.  Do you ever get to a point that the settings that you are on can last for a long period of time and not need to be tweaked all the time?

[yankees123]

Anyone have any advice on my problem?

[Sleeprider]

I think it's pretty obvious these recent apnea are in clusters and that tells us a soft cervical collar is the tool of choice. We're at 24 pages and I don't recall if you're using one already, but if so, you need a better one. Your therapy is excellent other than the periods when you obstruct due to poor airway alignment. Have you looked at the soft cervical collar wiki in my signature?

[yankees123]

Thanks for responding SR.  I use a cervical collar  every night because I have neck issues.  Will make sure it is fitting properly and let you know how it goes.  I have read the wiki on cervical collars.