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I would try 10, and wouldn't be surprised if you eventually settled at 11. What I'm seeing is that as the min EPAP comes up, there are smaller increases in IPAP by the machine. 3-days in on the pressure of 9.0 and things went the right direction, but not quite far enough. You're on the right track and hopefully you find that magic pressure where all those hypopnea go away. Still some snores, so this still appears to be residual obstructive.

Since going to 10 and 11 I am getting some mouth opening. Not sure what to do about that. Thanks

I don't like things like chin straps, but it might be the support your need, or it may just pass. What did the increased pressure do in terms of AHI results? How are you feeling relative to before starting ASV?

While BiFLEX should not greatly affect therapy, you might want to try some different settings. A setting of 1 seems to increase IPAP pressure sooner and might help with the hypopnea. A setting of 3 delays the IPAP pressure. I always found it hard to actually feel the difference, but I could see it in my results.

Well I turned the biflex off last night but the ahi for the last 2 days have been 7 and 6 up from 4. I was thinking that the mouth leaking was attributing to that but not sure. I haven't downloaded the data the last 2 days just been going off the machine screen.

Jason the sleep tech over at freecpap told me to go back to the basic setting and let the machine do its job, what are your thoughts on that advice?

Hornnumb2 wrote:Jason the sleep tech over at freecpap told me to go back to the basic setting and let the machine do its job, what are your thoughts on that advice?

well, if by 'basic setting' you mean 'factory default settings' then I'd say that advice is classically stupid. APAPs need to be tuned for best performance.

if 'basic settings' means something else, then... it would depend on what it means.

His Words:


IPAP Max: 25
EPAP Max: 15
EPAP Min: 4
PS Max: 21
PS Min: 4
BiFlex: Off
Rate: Auto

That should do the trick.

Did you tell him that you have both OSA and Central apnea or did you just tell him about the central?

The only difference between where you started, and the machine default, was the EPAP min of 6.0. That resulted in a large number of hypopnea. Honestly, I have no problems with restarting the titration and seeing if it works out. I doubt it will improve things, but you have a difficult complex apnea. You're currently at less than 25% of what your CPAP titration accomplished. This is YOUR treatment and your life, and I support anything you want to do. It could work. If not, you know where you left off.

Pugsy wrote:Did you tell him that you have both OSA and Central apnea or did you just tell him about the central?

I did post my studies and a few days of SH results. I think I will just stay with the settings that were trying now. Not doubting anybody's advice, just thought a sleep tech might know what he doing but I guess he is close to the other doctors that I have dealt with through this lovely journey...

You can try his idea if you wish.
I don't see it working so great because of the OSA stuff that needs more EPAP (you already saw what would happen with 6 EPAP...4 EPAP would very likely let even more OSA type of events happen).
His idea would probably work well if someone only had centrals to deal with though.
And would work okay if the machine responded faster for obstructive collapses or if lower EPAP would hold the airway open.

It's sort of like apap with the 4 to 20 settings. For some people that would work fine if all they needed was 7 or 8 to hold the airway open and prevent the obstructive events....doesn't work so well when someone needs pressures in the teens to hold the airway open.

Did you read that titration guide that I posted and pay special attention to what it says about adjusting EPAP for obstructive stuff?

But if you are curious because he is a "pro"....give what he says a try.

Well I back it back down to 9 because 10 and 11 were blowing out my lips just to see what would happen.