Help with EPAP/IPAP/PS settings on my BiPAP Auto Philips System One

[timkay]

It has been many years since I started sleeping with a Philips Respironics BiPAP Auto System One at night.
The settings have not been adjusted recently and I feel that they might not be accurate anymore.
Ideally I would see a doctor and get a sleep study, but that's not a possibility right now.

OSCAR Overview: https://pasteboard.co/JrPGtVs.png
OSCAR Daily: https://pasteboard.co/JrPGEFp.png

Above are links to screenshots of my data in OSCAR. Please let me know what adjustments I should make.


Thanks a lot for your help!

[Sleeprider]

With EPAP min 6.0 or 8.0, PS 4-6 and max pressure 16.0 your events are mostly CA and in an acceptable range. Until recently, your therapy time was usually under 4 hours per night, and even when longer, your therapy is fragmented into multiple sessions, so we can assume you're not very comfortable.

To get a better handle on your therapy needs, I want to have you try a fixed BiPAP pressure (BiPAP S mode) with EPAP 7.0 and IPAP 10.0 with BiFlex at 1 or 2. This will stabilize the pressures and take out some of the variables as we try to find an effective pressure range. The use of a lower pressure support (3-cm in this case) should help reduce the CA events. Your machine is getting pretty long in the tooth, and when you go for a replacement, I think you will do better on a Resmed which follows respiration better than the Philips. We can deal with that later. As far as a sleep test or clinical titration, I'm not sure what benefit you think might result. A titration test is nothing but trial and error you can do yourself, and that is exactly what we will be doing here.

[Gideon]

Welcome to the forum.
You have had consistent issues with Central Apnea.
To fix that I'm going to ask you to change your PS
Set Min PS = max PS = 2
I want a single PS initially while it gets dialed in to remove any confusion, your PS is pretty stable.  Lowering is intended to reduce your central apnea.  How successful it will be will depend on the cause of your central apneas.  This works best if the cause is excessive flushing of CO2 out of the system.  You may need to further reduce  your PS but we should see some results with this.

edit
I see SR and I replied at the same time.  Our goals are the same, get better control of your central apnea and improve your sleep.   Either of our changes will move you in the right direction and we would likely suggest further changes once we see the results.

[timkay]

I followed Sleeprider's settings of EPAP 7, IPAP 10, BiFlex 1

Here's the OSCAR daily: https://pasteboard.co/JrYDOxc.png

[Sleeprider]

That looks a lot better. How did it feel? 9-hours, low leaks, AHI lower across the board, less fragmentation. There is still some apparent arousals but at least we can see a pattern rather than chaos.

[timkay]

I lay in bed for a long time and had trouble falling asleep, but that's a normal occurrence.
On most nights, I would've taken off the CPAP mask and turned off the machine after taking so long to fall asleep, but last night I kept the mask on.
Even so, when I lay in bed it felt more comfortable than usual.

[timkay]

Here is the data from last night: https://pasteboard.co/Js854aU.png

I kept the same EPAP 7, IPAP 10 settings. I slept better this night compared to the night before.
I took off the CPAP mask briefly after a midnight run to the bathroom, but put it on again when I woke up later in the night.

[Sleeprider]

This fixed bilevel pressure is working well and allowing you to sleep. If I could get you on a Resmed machine, i think the pressure deliver would further improve results, but I don't see a clear need to either increase or decrease pressure from the 10/7 fixed mode you are currently using. i think it might be helpful to look at some zoomed views of the flow rate at 2-3 minutes so we can see the shape of your respiratory wave. Overall, it looks pretty good.

[timkay]

Here are some zoomed in views of last night: https://pasteboard.co/Jsb0PLF.png https://pasteboard.co/Jsb1cSs.png

I will keep my machine on 7/10 fixed mode then.
Thanks for your help.

Is there a particular ResMed machine that you would recommend for me?

[timkay]

If I were to change to a ResMed machine (for example, a AirCurve 10 VAuto), what settings would I use?