Central apnea is quite a different beast from obstructive (though many people have both), and the VPAP Adapt is quite different from an ordinary CPAP or Autoset. With this in mind, there are a few things to be aware of, which might contradict what other members have contributed.
<This paragraph edited>Sleeping on your back or side does make a demonstrable difference in obstructive apnea. There is also evidence that it reduces the rate and severity of central apnea. http://www.journalsleep.org/Articles/290808.pdf Unless you have back / hip problems, it can't hurt to sleep on your side and it is likely to help.</Edit>
Use the ramp if you find the pressure stops you getting to sleep. But keep the ramp time as short as possible. In my view the default setting of 45 minutes is excessive and if you need it that long, then there are other problems happening. During the ramp time just breathe slowly and evenly and the machine will match its pressure support to your breathing, helping you along without forcing the pace.
Pulling the mask off while you sleep is common, and is something all of us do at one time or another. It becomes a problem when it becomes habitual and you regularly lose therapy hours. You could try turning on the leak alert which will sound a loud beep if you take the mask off without shutting down the machine. (You can't use leak alert and smart start at the same time). However it's better to concentrate on the reasons you might be pulling it off, which is usually a discomfort caused by leaks, high pressures, uncomfortable mask & straps or getting tangled in the hose. If you have a bed partner he/she might notice if these things are happening, and also give you a nudge if they notice you're sleeping without the mask.
Your maximum pressure is 19, not 12 as mentioned above. This is because the base exhalation pressure has pressure support added to give you the inhalation pressure (IP = EP + PS). So your exhalation pressure will vary between 6 and 12, and your inhalation pressure will vary between (6+2) = 8 and (12+7) = 19. That maximum is getting pretty high and if your machine is actually getting up there, that might disturb your sleep. High pressures can also cause high leaks which (even if the machine shows a smiley face) can interrupt your therapy and disturb your sleep.
For these reasons, I would urge you to get hold of either ResScan or Sleepyhead software to monitor exactly what's happening. Link to SleepyHead: http://www.sleepfiles.com/SH2/ I prefer SleepyHead over ResScan, and there is a very good instruction thread in the stickies in this forum. With the software, you will be able to identify the pressure ranges the machine is actually using, any large leaks, and the time and circumstances of apneas and hypopneas. Then you can fine tune things to get the maximum benefit out of your machine. The VPAP Adapt is a remarkable device which can give truly amazing results, once you've got everything properly set up.
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