How to set Max IPAP and Max EPAP on VPAP

Background: after unsuccessful APAP for years (not able to sleep more than 3-4hrs with mask, lots of flow limitations), and ENT suggesting UPPP and palatal surgery, I got a BiPAP off of craigslist. Resmed Aircurve 10 VPAP. I have also been told by my ENT I have expiratory palatal collapse, so the idea of a BiPAP seemed worth trying. I asked the ENT for advice but they were not helpful so I was basically only own.

So far it has worked better than APAP, many nights almost no flow limitations, and I have been able to sleep longer with it. My issue is, I do not understand how to interpret the Sleepyhead data to fine tune the IPAP and EPAP accordingly. I have it set to max IPAP=11, max EPAP=4. Can anyone offer advice on how to fine tune these? Is there a measurement in Sleepyhead that would help? Looking at it, the only one that seems relevant is "Mask pressure" which generally fluctuates between 5 and 9 with each breath. Or is this something that requires lab titration?

Is the machine an AirCurve 10 Vauto or is it an AirCurve 10 S?
Sounds like you are using the VAuto but need to confirm.

You don't need a special titration to fine tune things unless you are having some unique problems.

To help you tweak the settings and explain what you are seeing on the software reports from SleepyHead can you post an image of a typical recent night?
Once we see what you are seeing we can have a better idea what to offer.

Don't know how to post images or what we need to see...
Check out this thread for examples (we don't need all of those graphs you are seeing)
viewtopic/t103468/Need-help-with-screen-shots.html
and this
https://sleep.tnet.com/reference/tips/imgur

and this...3 pages so be sure to read them all
https://sleep.tnet.com/resources/sleepyhead/shorganize

In general EPAP is what we use as a baseline very similar to the minimum pressure when using an apap machine in auto adjusting mode.
It's what is commonly used for Obstructive apneas.
There's a difference between EPAP (exhale) and IPAP (inhale) and that difference is called Pressure Support (PS) and it sounds like yours is set to 4...
IPAP max is just where the machine can go to if it needs to and it could drag EPAP up depending on your settings.

There is no max EPAP on a VAuto machine...did you mean minimum EPAP of 4 when you said

tiredman wrote:I have it set to max IPAP=11, max EPAP=4.

tiredman wrote:"Mask pressure" which generally fluctuates between 5 and 9 with each breath.

the difference is 4...so that's what leads me to believe you are using PS of 4.

With these settings as an example
Min EPAP 4
PS of 4
Max IPAP of 11
you start the night with 4 EPAP and 8 IPAP and the machine can go up to 11 IPAP but if it does go up to 11 then EPAP will be 7...there's always that 4 cm difference.
If you are seeing 5 EPAP and 9 IPAP mostly...the machine is increasing just a little but not going up very much.
Probably not a lot of movement and if you never hit the 11...no real need set it higher anyway.

Once we see a typical report I can maybe explain things a bit more and offer more specific thoughts or ideas.

Thanks so much for your reply, Pugsy. It is VAuto.

Sorry I meant Min EPAP=4, not max.

The PS is 4.

Other machine settings:
Ti Max- 2.0 sec
Ti Min- 0.3 sec
Trigger- Med
Cycle- Med

Here is a recent night sleep. Please note that I did wake up at least once during the night. I was more rested than usual after this night of sleep.

I see no reason to change the settings at least from this report. The machine doesn't ever move around very much in terms of pressure variation and you don't seem to even touch max IPAP of 11 so no need to increase the Max IPAP.

The bulk of your AHI is central/clear airway and we can't fix that with pressure and they may not even be real and even if they were all real there's not enough of them to worry about.