Please help with high leak rate

[yankees123]

Just posting last nights screenshot.  Should I keep lowering the pressure support and if so by what amount?

[yankees123]

Posting yesterdays screenshot and wondering if any changes to make.  Past few days sleeping better using the n30 mask.  Do you think a lower PS or pressure would be a good idea?

[Dormeo]

I think you can't go wrong either sticking with these settings a while longer to see what the longer-term patterns look like, or edging your maximum pressure down a little. If you choose the latter, you might conservatively reset your max to 15.6. I would leave the PS where it is, partly to deal with flow limitations and partly just because I bet by now you're used to it and wouldn't much care for it to be lower.

Very good to hear you're sleeping better!

[yankees123]

Thanks Dormeo for your response.  I think like you said probably better to leave things alone for a while.  A question, if I were to lower my max to 15.6 wouldn't it still raise the maximum to that pressure since it is almost reaching the max pressure at the level I have it now?

[yankees123]

Another question, what is going on with the second screenshot?

[Gideon]

I would consider backing off your PS a little.
I think what you have is a very mild periodic breathing that is not an issue.
The waveform indicates that it could be caused by being near your apneic threshold. That is the waxing and waning.

Optionally continue where you are (PS=5) and over time that should diminish similar to Treatment-Emergent Central Apnea.

Either solution I see as acceptable.  The flag you are looking for in a consistent increase in Central Apnea, if that happens, evaluate and react appropriately.

[yankees123]

Thanks Fred, can you explain what you mean by apneic threshold?
Also if I was to reduce the ps what would you recommend? 
Would you leave the pressures I have the same.  
Thanks for your help.

[Sleeprider]

The apneic threshold is the point at which we see onset of some central apnea. Your results look great and your leaks are much better. The variable breathing with fluctuating volume is almost not even what I consider periodic breathing. At this point if you want to try small changes like PS 4.8 then that will give you an ideal if that is a better solution. The results are good enough that we can say no changes are needed at all, but if you want to try changes within a small range, then a slight reduction in PS seems a safe way to go.

[yankees123]

Thanks as always SR.

[Gideon]

Our major drive to breathe comes from the CO2 level in your blood, not from a low oxygen level which only says to breathe faster.. When CO2 is 'high' it signals OK, now take a breath. As CO2 goes low, your breathing becomes shallower, eventually stopping at the 'apneic threshold'. Below this level you will get a Central Apnea no matter what your oxygen levels are. This activity tends to show as a waxing and waning of the flow rate.