Help with evaluating data

[jwalsh126]

Hi everyone - I really need some help.

I'm back in titration mode trying to figure out my next steps. The side-sleeping experiment was short-lived after a few days of back pain and struggles getting comfortable sleeping on my side (I didn't get any good sleep). I may revisit that in the future once I have a more comfortable setup.

My entirety of APAP has been less than 2 total years, and for 270 days straight I was on a setting of 9.5-13 with AHI ranging from 1.5-3.0 very consistently. I had A-flex 2 set to the best of my knowledge, but possibly A-flex 1. The average difference b/t IPAP and EPAP was usually slightly less than 2.0cm h20. I was loving my treatment and didn't think much about it until I slowly started developing aerophagia symptoms which progressively got worse to the point where my stomach was 100% capacity bloated in the middle of the night and I had to literally expel gas before going to sleep. This quickly developed into pain and diarrhea. After more trial and error I called my sleep doctor who reduced my min pressure all the way BACK down to 5.0.... after 2-3 nights I was getting way more OAs and Hypopneas so clearly I wasn't feeling rested. Every since then, I have seemingly tried every combination of settings I can think of. I have tried NO flex with pressure min. at 6.0 and even that made me develop some aerophagia symptoms, albeit with less effective therapy. I then re-enabled A-flex to 1 and tried various min pressure increases up until where I have been the last few nights at 8.0. For the first time, I have recently tried A-flex 3 in an attempt to keep the higher minimum pressure, but reduce aerophagia. I think it is kind of working, but I attached results from the last 2 nights which show AHI numbers higher than I thought they should be, considering Sunday I thought I felt energized and great. I don't know if A-flex 3 is now introducing more problems of its own, but I am going to stick with this narrower range of 8-11.0 with A-flex 3 for another 2 weeks to see what the trend is. I'm really not sure if my stomach and sphincter can handle the higher pressure of 9.5 that I was once at for several months. I am really in need of help here regarding next steps and my thought process. I can provide zoomed in info or data from other nights with other settings I mentioned if that would be helpful, but I pretty much laid out my APAP history in this post.

Please let me know if I am on the right track to getting back to where I consistently was. Are there any other suggested changes that I can make (like maybe trying a nasal pillow if for some reason aerophagia is worse with FFM). I'm not sure if A-flex 3 is a long-term solution, or if I need to better optimize my pressure. Pugsy suggested I try a flat pressure to see if I am possibly getting arousals from the brief Respironics test-spikes, but I haven't tried that yet because i'm not sure what pressure I would pick for that. I now can't tell if I need a higher pressure, or if my body is being overwhelmed and/or A-flex 3 is introducing more hypopneas and/or centrals.