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Sleepyhead data
Hope to get interpretations to help my new Medicare doctor decide what changes might be needed.

My AHI on home testing was 45.

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AHI is not bad. Mostly Obstructive. You're running wide open at 4-20.
PR machines are a bit slow to raise pressure. At some point an increase in the min pressure may be useful.
Probably around 10 cm-water.

You have some central. Might be pressure induced. Let's see what your doc says.
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I think JustMongo has nailed the root problem that minimum pressure needs to be increased to a therapeutic level. The machine starts off behind the curve to prevent obstructive events, and pretty much never catches up. Increasing pressure to 10 cm is conservative, and well below your median pressure, but it's a good place to start. I think you are going to be closer to 11-12 when fully optimized. On the other hand, I consider your clear airway or central events to be negligible.

Your leak rate is okay. Be sure to bring up any comfort or leak issues that you find disruptive.

Note that the machine is detecting a much longer inspiration time than expiration time. You would need to zoom in on the flow rate chart to see what is going on, and it may just be a flow irregularity during exhale that is being misinterpreted by the machine. We see this a lot, and it's usually nothing to worry about. It seems to be more frequently seen with Philips Respironics machines which rebound to IPAP pressure more quickly when it detects an abrupt flow reduction in exhale. You appear to be using a low Flex setting. The exhale pressure relief (EPR) of Resmed machines stays in EPAP until inhalation starts, and the rise is slower. Given your pressures and possibly this "hitch" in exhale, that might be a more comfortable option. If you want to post a closeup of a couple minutes of flow data, we might be able to see what's going on.

I think your doctor is going to consider this a good outcome, and is unlikely to recommend any significant changes. He will focus on how you feel, and whether you are getting better rest. That is relavent here as well. If you feel the low minimum pressure is a problem, especially at the beginning of therapy, that is enough reason to raise it. If the pressure is disruptive as it reaches its peak, that might justify using more flex or a machine with a larger EPR.
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