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Help getting my AHIs back down below 3

I was diagnosed with OSA twelve years ago and in a sleep study last August, I was diagnosed with Complex SA and CSA. Initially, I was prescribed with a Resprionics Bipap ST, which brought my AHIs down to the 20’s and after another sleep study in April, my pulmonologist prescribed the PR System One Bipap Auto SV Advanced which I’ve been using since early May. After increasing my EPAP to 8 mid-June (my Rise Time is 3), I have had relatively low AHIs (below 4) but over the past two weeks, I have had 9 days of AHIs above 6 and as high as 13! I haven’t done anything differently except getting a new mask cushion, which helped for a day or two. Does anyone have a suggestion in helping me get my AHI’s back down to 3 or below?




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The PR ASV... I think we need user Sleeprider to help you.
He knows PR machines inside and out; plus knows how the ASV works.

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JustMongo passed away in August 2017
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Thanks for the vote of confidence JM, but much of this game is trial and error.

Jeffo1, you're still showing obstruction as a major feature. You're going to need to increase EPAP by 0.5 increments until that reaches acceptable levels. I'd leave other settings the same. Can you list your settings mode. It looks like you have plenty of pressure support to deal with centrals. FWIW the Resmed Aircurve 10 ASV seems to be easier for some people to get in sync with. If your doctor or supplier is open to trying something else, that's what I'd do.
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Thanks, Sleeprider!

I've increased my EPAP minimum to 8.5 so we'll see how the next week goes. What is the highest one could go regarding EPAP minimum?

Here are my settings, as you requested. Maybe there's something that might eventually need adjusting?

Max Prep 25
EPAP min. 8.5
EPAP Max 15
PS Min 3
PS Max 15
BPM 14
Ti 1.4
Flex Type - none
Rise Time 3
Ramp Time 0
Tubing Type 15H
Humidity Level 3
Tube Temp 3

Is there anything I'm missing?

Thanks for your help!


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I thought maybe this copy of my Sleepy Head statistics might shed some light on why my AHI continues to recently be high:

[Image: 2wo9jea.jpg]


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Everything looks good. We don't know medical history so my only comment is on Ti max (inspiration time), with a median respiratory rate of 14-15 bpm as shown in your data, normal Ti max would be 2.0-2.1. Shorter Ti max at that respiration rate would be appropriate for restrictive or obstructive respiratory issues. You might want to try a longer Ti max and see if that keeps you from feeling cut-off and results in better sync.

Note you are also using the slowest rise time (time it takes for machine to reach IPAP pressure from EPAP), so the longer Ti may help. Both rise time and Ti are comfort features and you can experiment with what works best.
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Thanks! I'll try going to a 2.0 Ti and see how I do.
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Reading this thread it looks like BiPap machines need far more finesse than ordinary CPAP/APAP and Sleeprider knows his stuff!
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