Need to find the best min max pressure

[Deweym]

             I have been using cpap for about 10 years. The first 5 was with a Resmed S9, and and changed to the Resmed AS10 for its flexibility. My initial setting on the AS10 was 12 min-16 max. My AHI readings have usually been below 1.0. For the last few months I have been having problems with mask leakage and I also have lost some weight. As a result I have been reducing my pressure on a weekly basis butI still have AHI readings below 1.0 . I am attaching screenshots of a typical night at 12-16 and one at 6-10. Sorry. I posted one screen twice. So my questions is why shouldn't I be using the lowest pressure settings available if I can still keep my AHI below 1.0?

[Sleeprider]

Your results are very good on both fixed and automatic PAP pressure. Your only events are a few hypopnea, and on Autoset pressure at 12-16, your pressure fluctuated on flow limitations. If your objective is to minimize pressure, let's try a minimum pressure of 7.0 Maximum 12.0 and EPR at 3. Your current EPR setting is 2, and the additional EPR should help with hypopnea and flow limitations. I suspect we can reduce maximum pressure a bit from 12.0, but would like to see this profile first.

[Deweym]

I will try that tonight. How does ramp time affect anything? I have been using auto ramp.

[Sleeprider]

I prefer not to use ramp at all. Your starting pressure with these settings is only 7/4 pressure which should be no problem. Avoiding ramp helps establish a better mask fit and avoids any issues with sleep transition. Ramp is a comfort issue, and if you feel you must use it, then it's your choice, and Auto with the highest pressure you tolerate is okay.

Regarding your charts, your tidal volume and minute vent are extremely small for a male adult. Are you aware of any issues that result in such shallow respiration or capacity?

[Deweym]

Ok. I will turn ramp off. I don’t know the answer to your question. Can this be an issue?

[Sleeprider]

It's nothing to worry about. Tidal volume is the amount of air your respire in milliliters per breath, and minute vent is the air respired in liters per minute. You have the respiratory volume of a smaller woman, at least on CPAP, but if it isn't bothering you enough to rais a question with the doctor, then it is probably not important. A simple pulmonary function test at your next physical would rule out any issues.

[Deweym]

    Here is last night's results with pressure at 7-12, ramp off and epr at 3.

I did notice that some air was being forced out of my mouth at times. Why is that?

[SarcasticDave94]

If you're using a full face mask, mouth leaks or breathing should not affect proper therapy, but it can affect comfort by drying your mouth out somewhat.

[Sleeprider]

With your flow limits, any auto-pressure will automatically cause pressure to reach the upper limit and stay there. If the higher pressure is causing leaks or discomfort with the Resmed, then you can try titrating pressure downwards. It may let a few more events in, but comfort counts. It is nice to see hypopnea is pretty much gone. The only OA event happened where your pressure dropped back to about 8/5, so you have some room to work with in lowering pressure. I think a pressure range of 8-10 with EPR 3 looks pretty good for lowering pressure and maintaining efficacy.

[Deweym]

Thanks. I will try that. I have a question about epr. 
What determines whether epr should be on or off? 
If on, what determines the setting number?
Should the epr setting have any correlation to the min pressure setting?