(09-26-2015, 06:29 PM)Cookie Wrote: My settings are Auto Bipap
Min EPAP = 7
Max IPAP = 11
Min PS was 0 for tonight it is set to 2.0
Max PS was 3 and is now 4.0
In my view your changes are reasonably small and prudent.
With these settings EPAP will initially be 7 and IPAP will initially be 9.
With these settings the EPAP and PS will be automatically raised, if needed, in response to obstructive conditions.
With these settings, PS will be automatically raised up to 4 when needed, unless the machine raises EPAP first. For example, if the machine has already sensed FL or snoring or hypopneas or apneas and has raised EPAP to 8 or 8.5 then PS cannot be raised higher than 3 or 2.5, because PS can never be raised higher than Max IPAP minus EPAP.
With these settings EPAP will be automatically raised up to 9 when needed, unless the machine raises the PS first. For example, if the machine has already sensed FL and has raised PS to 3 or 3.5, then EPAP cannot go higher than 8 or 7.5, because EPAP can never be raised higher than Max IPAP minus PS.
With these settings the IPAP will likely hit its max (11) occasionally during the night, which might be optimal or might be suboptimal; only time (and weekly or less frequent fine-tuning changes) will be able to tell us. If you see the pressure maxing out at Max IPAP, this does not necessarily mean that you should raise Max IPAP.
Especially with patients who are already having occasional CA events while asleep, increasing the Max IPAP setting may increase the number and severity of the CA events. For example, your doctor has already tried raising the pressure to 12 and the number of CA events increased (although remaining still fairly low). And when the pressure was reduced to 10 the number of CA events reduced to zero (at least for the days listed in your post).
Also, an increase in PS can cause an increase in the number of central apnea events during your sleep. A few CA are already showing up in your data, and tonight the increase in Min PS may increase how many CA events you will get.
But I think CA events, especially if fairly short like 20 seconds, may be less disturbing to sleep than obstructive events. Also, I think many patients, perhaps most patients, have a few CA events while falling asleep and this is considered normal.
If you zoom in on the Flow waveform (Flow is the estimated rate at which we are inhaling or exhaling air into or out of our lungs) with the full horizontal scale filled with just a minute or two around a CA event (and with the vertical scale adjusted to perhaps +/- 60 mL/second so you can see fine detail) I think you are likely to see the apnea end with a gradual and smooth increase in Flow and with no signs of distress or jump in heart rate. But if you zoom in around the end of an obstructve event like an obstructve apnea or an obstructve hypopnea or a RERA, I think you'll usually see a sudden gasping for air and (if you're wearing a pulse oximeter) a matching spike in the pulse rate also.
I think it is reasonable to watch the data for a week or two or longer and then make another change.
Some of us write down all changes in a daily diary of how we feel upon waking, to help us keep track of the results of each change.