Almost there

[Hojo]

Shin (may I call you that): I'm no pro either but I would look at this way; if on CPAP (not ASV), how would one deal with a constant pressure of 20 and air leaks?  With an ASV, at least the pressure drops during exhalation, generally.

[Shin Ryoku]

Shin (may I call you that): I'm no pro either but I would look at this way; if on CPAP (not ASV), how would one deal with a constant pressure of 20 and air leaks?  With an ASV, at least the pressure drops during exhalation, generally.

On CPAP with a full face mask, I deal with needing a pressure of 20 by using a subtherapeutic pressure like 12 or 14 cm H2O and accepting a high AHI, because I can't get leaks manageable with a pressure of 20 without feeling like my head is being strangled.

Also, for some reason I find it easier to handle high pressures without PS when I use a full face mask.  The PS makes me feel like the mask is lifting away from my face on inspiration and squeezing down on my face on expiration.  Maybe it's just me.

With a nasal mask or pillows, I can do 20+ pressures without an issue.

Sorry if I'm taking the thread off topic.

[CB91710]

Reducing max pressure to an ineffective range is not the proper solution for mask (or mouth) leaks.
If a high pressure is needed to eliminate flow limitations and obstructive events, then preventing the machine from running that pressure will result in ineffective therapy.  It can also be a reason DMEs use to attempt to restrict patient access to machine settings, and some even go so far as to re-set altered settings by remote.

The correct solution for leaks is to find a mask, adjustment, pillow, or sleeping position that reduces or eliminates the leaks.
It will take some trial and error, so it may not be cheap if your DME is not willing to work with you.  We have a decent review section here on the forum, but every face is different, and two of the more popular masks (Brevida and Amara View) do not work well at all for me.

[RLSdss]

Increasing pressure to prevent OAs can increase CAs. Treating severe complex apnea can be a little trickier then just jacking up the pressure.

[ajack]

I have pressures more than 25 and can get a seal. It may be adjustment or the wrong mask. The feeling of your head exploding will pass. You will get use to the pressure and find yourself waking up and wondering if the machine is still working as you can't feel anything.

This seems to a be a thing lately, where the machine 95% number is ignored. It really is there for a reason. It isn't in your long term best interest to reduce treating pressure. You may be better served by getting a bpap in a month, if you need it. Bump one of your threads and put up some charts for advice.

[Shin Ryoku]

Sorry for taking the thread off course.

Coming back to the thread starter's concerns, RLSdss seems to want to get better results with his sleep apnea.

Apparently he has been told multiple times what ASV settings it would take to get those results, but he cannot tolerate those settings due to mask leaks.

So RLSdss, do you feel like you've done your due diligence in finding and troubleshooting the best mask for you?

[ajack]

Increasing pressure to prevent OAs can increase CAs. Treating severe complex apnea can be a little trickier then just jacking up the pressure.

Go back and see your doctor. By the sound of it what you have been doing isn't working and there has been lots of advice.  After you see the doctor, if you still have issues ask for a referral for a second opinion..

My opinion is that it really isn't that hard as I see it. If you followed basic titration procedure, I think you would be much better.  You have an asv. Get the obstructive sorted and use the the right ps settings to vent your lung during a CA. That is what the machine does.

[CB91710]

Increasing pressure to prevent OAs can increase CAs. Treating severe complex apnea can be a little trickier then just jacking up the pressure.

Which is why doctors should be involved.
Treating severe complex apnea is not normally possible with a basic CPAP/APAP machine unless drug therapy is able to clear the centrals.

But also keep in mind that excessive leakage can result in CO2 flushing from the system, which can potentially lead to hypocapnia, which will in turn produce "false" centrals.

[Sleeprider]

I think in some past optimization efforts we found a PS min of 2 and PS max of 8 was capable of overcoming almost all hypopnea and centrals. The problem with current settings is the Pmax or maximum total pressure does not allow for the machine to provide those pressures. RLSdss, you need to understand that setting a reasonable maximum pressure, does not mean that pressure will be used all the time. In fact you may never touch the maximum pressure, but by limiting it to 16 cm with an EPAP range of 9-11, the PS can only operate in a range of 5 to 7 cm. This is below your needs to overcome hyponea, and the reason that you still have them. Also, you seem to do better with a minimum PS of 2 rather than zero.

So the lowest pressures we should be considering if the EPAP range of 9-11 are required for OA is:
EPAP min 9.0
EPAP max 11.0
PS min 2.0
PS max 8.0
Pmax 19.0

[RLSdss]

Sleeprider, 

Last night I started out with my settings for the first hour and a half and got an AHI of 15. So I thought I might as well try your settings. I'm stubborn not stupid. Check out the attachments and let me know what you think. I would be happy to send full encore pro report if you could tell me how to do it.