Looking for help dialing in APAP on DreamStation 2 – AHI stays >5 (OA-dominant, occas

Hi!

I’ve been on CPAP for 3 years and still struggle to get AHI below 5. My long-term average AHI is ~15/h, and the lowest I’ve ever achieved is ~8/h. I’d really appreciate your eyes on my data and any suggestions.

Profile & equipment

• Age/sex/BMI: 42 Male, 187 cm, 108 kg (BMI ~31)
  Machine: Philips DreamStation 2 (Auto)
  Mask: ResMed AirFit F20 (full face)
  Current settings: Min 9 cmH₂O, Max 20 cmH₂O, Flex 2, Ramp 15 min (start 9), Humidity 3
  Goal: AHI <5 and better sleep quality

What I’m seeing

• OA-dominant pattern on bad nights; some CA spikes occur.
  Pressure often runs in the mid-teens; I’m not constantly pegged at 20.
  Snore/flow-limit activity is frequent on rough nights.
  Example AHI from attached nights: 25 Aug ≈ 19.3, 26 Aug ≈ 8.3.

Questions for the community

• With OA-dominant events and frequent snore/FL, would you raise min pressure a bit (e.g., 9 → 10–11), or is there a real risk of increasing CA?
  Thoughts on Flex = 2 (Philips A-Flex): keep, lower, or raise to stabilize breathing vs. comfort/CA sensitivity?
  Do the clusters in the Flow + Snore/FL look more positional to you, or mainly under-pressure?
  Max at 20 cmH₂O seems fine since I’m not constantly topped out—would you keep it as is?
  Anything obvious you want me to zoom further (2–5 min windows) and post as additional images?

Notes:

• Happy to add more nights or close-up zooms if helpful.
  If preferred, I can also attach a one-page summary image with the key nightly numbers.

Thanks a lot for your help!

Yow! There are some huge pressure swings.

Do you have ideas about which positions you sleep in? Are you sleeping on your side or stomach for part of the night and rolling to your back for other parts?

Dankyduck wrote: ↑

Fri Aug 29, 2025 1:38 am

close-up zooms

A free account at SleepHQ.com is so easy to use. We can do our own zooming. You don't have to format, and your personal information is redacted.

ChicagoGranny wrote: ↑

Fri Aug 29, 2025 2:48 pm

Yow! There are some huge pressure swings.

So huge that I'd say your minimum pressure is too low, and the machine is thus given permission to go where it shouldn't.
The cycles seem to appear about every 90 minutes - which is the cycle for REM sleep.

A free account at SleepHQ.com is so easy to use. We can do our own zooming. You don't have to format, and your personal information is redacted.

Excellent idea.
And please not you've uploaded your chart with a name on it - you may want to redact it here too.

I'm just learning this stuff as well so take any advice from me with a grain of salt. Is your 95% pressure displayed anywhere on your machine? Or am I missing it in the info you've given. I ask because i had similar results as you've given. My 95% pressure hovers around 15-16 pretty consistently and my min pressure was set to 6. I was advised to set my min pressure to about 2 points below my 95%. So i set my min to 14 (max has always been at 20) and saw a marked improvement immediately. I think that would be worth trying for a few nights.

adams75 wrote: ↑

Tue Sep 09, 2025 9:56 am

Is your 95% pressure displayed anywhere on your machine? Or am I missing it in the info you've given.

His chart has better information than that.

adams75 wrote: ↑

Tue Sep 09, 2025 9:56 am

I was advised to set my min pressure to about 2 points below my 95%.

His minimum pressure is set too low, but there are better ways than you mention to find an optimal min pressure. The shortcut you used would be good until he has time to fine-tune it better.