[Pressure] Sudden AHI Increase - Central Apnea

[isomorphism]

Hi. I posted this on Reddit and someone recommended this forum. TL;DR is at the end. 
OSCAR report from last night, additional info about apneas from last night, and OSCAR report for a typical night last month are in this imgur post:
imgur com/a/DeBrRUD
(Not able to post images or links yet)

-I have Severe OSA. Before treatment, my AHI was 120 and SpO2 was 70%
-I've been on BiPAP for 5 months and I've seen good results so far and feel much better. My AHI is usually between 5 and 10 +/- 2
-According to my Fitbit, my SpO2 is steady around 95% but I don't know how much I believe that. 
-I've lost 50 pounds since starting treatment and 70 pounds since my initial sleep study (Currently 336lb 5'9")
-Starting at the beginning of this month, I've had a spike in AHI, some nights in the teens, with last night recording 31/hr (and I woke up at 3am to 44/hr)
-----These are almost entirely Central Apneas 
-I have had sinus pressure and some pain in my ears. I've also been having difficulty breathing in the morning and early afternoon, getting back to normal in the evening. 
-My pressures are set to 23 and 13 (BiPAP) and my breathing with the mask on is pretty shallow. 
-The machine has been showing 0 leak when I go to sleep and also 0 when I wake up, but OSCAR is showing a lot of big leak events.   
-----My mask cushion is about 3 months old. Could that be contributing to the leaks? 

I was informed yesterday, while trying to schedule an appointment for this, that both my Primary Care doctor and Sleep Specialist no longer accept my insurance. I have a solution for this, but it will take about a month. I will see a doctor as soon as I can. [/America]

I think my pressures are set too high, considering my weight loss. I'm not sleeping in any different positions than normal. (on my back. One pillow)
I have a soft cervical collar arriving tomorrow, but I still think I need to change my pressure ASAP. 

Any thoughts or suggestions? 
Should I lower my pressure slightly? If so, do I lower both pressures? How do I do it. is there just a file on the SD card to edit?

Sorry this post is a mess, but alas, so am I. 

TL;DR - 
Before treatment - 120 AHI and 70% SpO2
During treatment - 7ish AHI and better SpO2
Lately: much higher AHI and more Central Apneas
I suspect my pressure is too high and I cannot see a doctor for it at this time. 
help pls

Thank you.

[Gideon]

https://imgur.com/a/DeBrRUD

[Gideon]

You are running with a PS of 10 which is much higher than typical and could very easily be the reason your centrals are so high.

Try this, pretty much a restart

Mode: VAuto
Min EPAP= 10, a bit lower than your current 13
Max IPAP=25, machines max, but I don't see your pressure going anywhere near that.
PS= 4, the default PS, we would adjust as needed from here.
Trigger: = medium, we often increase this parameter to help with centrals, this puts it at the default setting while we get a baseline at these settings.

[isomorphism]

My PS was set to 0 and Trigger was already on medium. 
I changed PS to 4. Should I keep Trigger on medium or move to high? I can totally read

I will try these settings tonight and report back tomorrow

[Gideon]

Don't forget to change the mode to auto.

[isomorphism]

imgur com/a/OQhlfOO

You are literally a lifesaver. Thank you so much.
This is my lowest AHI since beginning treatment (1.3)
The mask was actually comfortable to wear
My daytime breathing today was noticeably better.

Lack of sleep was unrelated and I'll update again when I get a full night's sleep.

You are awesome. Thank you.

[Gideon]

This is a good spot, excellent numbers.
The rule of thumb is to find the lowest pressure that your are comfortable with that meets efficacy.

Remember these settings as they are safe for you, but after a few days simply to let your body get used to the lower pressure, set your min pressure to 8.

This is a test which settings feel better, are more comfortable to you. Purely subjective judgement and no hurry.

[isomorphism]

imgur com/a/sJGuVb1

One of my headgear straps came undone so I had quite a bit of leakage later on.
Why was pressure not moving before the big leak?

[Gideon]

Leaks have nothing to do with pressure. Flow will be increased to compensate for leaks and within reason, pressure will be constant.

Flow limits are what is driving your pressure increases.

Typically flow limits are treated with an increase in PS, and this may have been why your original PS ended up at 10. Currently they look positional so tell us about your pillows. You want to use 1 vs 2, thinner/ less firm to keep your neck straighter. I don't want to bring a soft cervical collar in unless it is needed