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Your 12 EPAP is not quite high enough to deal with the snores...maybe 0.5 to 1 cm more EPAP.

Your cpap at 17 cm...looks good on paper. Did you ever try a lower setting and if you did what were the results both in terms of AHI and the gastric issues.

I wonder what would happen if you dropped IPAP to 15 and increased EPAP to 12.5 or 13.

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I can see where 10 cm cpap wouldn't be enough.
This slightly higher AHI at these new bilevel settings is insignificant in terms of therapy. I wouldn't give that little bit of an increase much of a thought.

How was your sleep in general with this new machine and these settings? How much relief from the gastric issues did you have?
Did the snores wake you up?
What is your primary sleeping position?....on your back or on your side?

What mask are you using? If it happens to be a full face mask...I might have another idea to try that wouldn't involve the pressure increase.

If it were me and the snores disturbed my sleep...I would first try 12.5 EPAP and see how much that little bit of increase would help with the snores.
I would also maybe try 15 cm IPAP if I was still having some gastric issues.

Sometimes we have to make a compromise and maybe let a few snores and/or a small number of little apnea events slide in a trade off not to cause so much gastric distress. If we can keep the AHI less than 3.0...(I know the usual line is 5.0 but I like to try for 3.0 or less if at all possible)...and the belly is okay then maybe a little compromise is in order. But that's a little premature because we don't know what would happen if you tried just a little more EPAP.

If you can answers the questions above it will help me understand a little better what is going on and what options might be available.

Never mind the "what mask?" question. I see you have another thread where you mention you are using the Wisp mask.

And you also mention that you are sleeping primarily on your back?
I assume that sleeping on your side seems to make the gastric issues much worse? Is that correct?
Unfortunately supine sleeping can cause our OSA to be much worse for some people and need more pressure when on our backs than when on our side.
So damned if you do and damned if you don't.
I wonder if a combination of side sleeping with bilevel pressures (slightly adjusted) would be a viable option.

I assume this one night on bilevel was in the supine position....is that correct?

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Did you ever have a pressure when sleeping on your side where you didn't have the gastric issues with any semblance of a decent AHI?

I am just wondering if maybe with bilevel we could get you back on your side since you prefer it anyway and not blow your belly up in the process. Maybe on your side you won't need as much pressure and combine that with bilevel relief...might get lucky.

If it weren't for the snores last night....how was your sleep quality and gastric issues?

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If you still had the gastric issues last night...how about reducing IPAP to 15 and try EPAP either at 12 (and just let the snores slide if you slept through them) or 12.5 and try to address the snores too.

It would be interesting to see just what your AHI and snores are if we didn't have the gastric issues.
To do that we either start low and work up or start where you are and work downward.
Normally I don't suggest changing 2 things at the same time but in this situation I probably would do it because the 0.5 increase in EPAP isn't a huge change and needs to be done anyway for the snores.
Then take IPAP down to a point where the gastric issues don't rear their ugly head and at that point evaluate the AHI and how you feel.

So I would work on resolving the gastric issues as best I could and see what's left once you find a line where the gastric issues aren't messing with how you feel.

Oh....have you had a GI work up? Any GERD history? Hiatal hernia?

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Some options to try.
Try 12.5 EPAP and IPAP of 15 and sleep on your back....same thing but IPAP of 14.
Try 12.0 EPAP and IPAP of 14 and sleep on your side.
Try to find an IPAP setting that doesn't make the gastric issues worse is my thought here and an EPAP that takes care of the snores.
It's obvious after last night's experiment that when side sleeping the snores are reduced which is what I expected. I was hoping that with the lower pressure the gastric problem would also lessen....but you weren't that lucky.

The reason I asked about GI issues is that normally most people don't have that much gastric issue when side sleeping.
Makes me wonder if some other issue is at play here and compounding the problem.
The lower esophageal sphincter normally does a much better job preventing air from entering the stomach unless it is damaged in some way. The most common cause of LES damage is GERD and not all GERD causes massive heartburn symptoms....there's something called "Silent GERD" that can affect people. Though most people with GERD will have some sort of heartburn type of issue.
Hiatal hernia could also be a factor...the stomach sort of pushing upwards through the diaphragm and maybe compromising the LES junction making it sort of stretched out a bit and thus making it harder for the sphincter to keep closed well enough to prevent the air from entering the stomach.

I assume that you have already tried the standard ideas...don't eat anything close to bedtime and that sort of thing.

Do you have or have you ever had any signs and symptoms of GERD? Heartburn? Pressure in the chest? Anything like that?
Hiatal hernias don't always cause huge symptoms....I have one but it is small. Didn't even have a clue I had one until I had a scope of my esophagus because my GERD had scarred my esophagus and some food got stuck and scared the hell out of me.

Now, I am not saying that you have any GERD or stomach hernia but for someone to have such bad gastric insufflation issues even when on their side makes me wonder if it is possible something else is a factor.

[quote="paps"
Never have been able to sleep on the side without gastric issues as far as I can remember. I have been able to sleep left side/stomach, on a pillow, chin up... but, I tend to curl my chin toward my chest in the middle of the night, then gastric problems get bad.[/quote]
Wondered when I saw this if you had ever tried a soft cervical collar to keep your chin up.

paps

Have you tried putting your machine on auto bipap and then tweak from there (particularly the exhale pressure)

I still think you'd do better sleeping on your side and incline your bed so the acids stay in your stomach. No eating after 6pm.