Central Apneas: Positional? Something else?

[WakeTired]

Hello 

Here's a detailed history of where I left things a few years ago. @Sleeprider and the rest of the brain trust were exceptionally helpful in helping me understand and get the VPAP optimized. 

https://www.apneaboard.com/forums/Thread...r-UARS-etc

My last post in this forum (from February 2019) could have been written in February this year.  Around March/April, I started sleeping on my back due to hip and back issues. My back and hips (and shoulders - to be young again) much prefer back sleeping.  My sleep apnea, maybe not so much. I use a soft cervical collar. Perhaps I need to switch soft cervical collars from the Caldera Realeaf to something else. I replace the collar about every 3 months. After replacing the collar 2 months ago, there were no significant change in the centrals.

Since I started sleeping on my back, I have many clustered centrals. These could be positional, or then maybe not...

When I wake up, I try to keep the machine with hopes of returning to sleep. My pattern is to sleep 4-5 hours, wake up (no urgent need to go to the bathroom), and keep the machine on for 30-60 minutes. If I fall back asleep, GREAT. If not, then I tend to get out of bed until I'm tired, and then try to return to sleep. sometimes I fall back asleep, and sometimes I don't. This past night (September 5), I did not fall back asleep.

Five hours of sleep isn't uncommon. I try to take a 20-minute nap during the day to offset the fatigue.

I would very much appreciate any insights you can provide with regard to machine optimization or confirmation that my centrals are positional.

[Sleeprider]

WakeTired, That is a lot of central apnea on 9/5, and a bit better on 9/4. I think we need to reverse titrate the PS similar to what we did when we were working on flow limitation, but the other direction. Take PS back to 4.0 and if you are not already using high trigger sensitivity, change that setting as well.

[WakeTired]

Thanks, Sleeprider!

Let's start with trigger sensitivity - currently set to medium - and will move it to high.

If that doesn't help, then we can do a reverse titration for PS. 

Interesting how our PAP needs evolve over time.

[WakeTired]

Problem solved!

Switching from the Caldera Releaf Neck Rest to a stiffer soft cervical problem pretty much eliminated all the centrals. The Releaf wasn't stiff enough to support my neck when I switched from being a side sleeper to a back sleeper. So I now conclude the centrals were due to the collar not being stiff enough.

While I did increase the trigger sensitivity before switching the collar, this did not reduce the centrals.

Thanks, @Sleeprider! I very much appreciate your response and assistance!

[Sleeprider]

That's great news. Be sure to review the new collar and mention what it is here. Your story is one we hear a lot, and supports the advice to keep trying with an alternate size, type or brand of collar. It would be great to hear some more specifics.

Did the trigger sensitivity or PS setting help with the centrals?

[WakeTired]

I don't think the trigger sensitivity was a factor. However, I left it on very high. The key was using a firmer soft cervical collar.

Regarding the cervical collar and a review... Unfortunately, they don't seem to make the collar anymore.  I purchased it online a bunch of years back, and the brand no longer seems to exist. Total bummer, because it brought my AHI back down to zero(ish).

[Sleeprider]

Well, that was very good reasoning on your part. I guess you have some time to source a good replacement for when you need it.