Exact same AHI every night/Trouble with Centrals after switching machines

[ilgak]

Hello everyone,

I was recently diagnosed with sleep apnea in September with a home sleep test from bluesleep. AHI of 17, and finally some answers on why I've been tired my whole life haha. Following that, I was given a Luna G3 APAP machine. Thanks to the wealth of knowledge on this forum and other places, I was able to pitch a fit and get the machine swapped for something OSCAR compatible and now have a Resmed Airsense 11 Autoset. I basically copied my settings one for one to the new machine, but have found a new, peculiar issue. I seem to be having events flagged as central apneas and it seems to be in the same ballpark of quantity nearly every single night (roughly 1.7-3 CAI). I have attempted fiddling with the EPR setting on the machine, and even turned it off for quite some time to see if that helped. I have also fiddled a bit with the pressure settings, mask type, mouth taping and etc. I also tried a night with CPAP mode at a slightly higher pressure and that is by far the worst feeling night I have had since starting therapy.

I should add that I'm aware the machine score is not the most reliable but it is definitely impacting my sleep. The irony of the entire situation is that I had FINALLY had two nights of excellent, uninterrupted, sleep with the Luna G3 when my new machine arrived and I had to box up and send off the Luna. The most recent change I have made is turning EPR back on and to a 1, which seems to have helped some with preventing arousals. I will post OSCAR charts from last night, as well as a night a few weeks ago for comparison.

Myself:
30 yr old Male
185 lbs
5'6"

Machine Settings (Transferred from Luna):
Min Pressure 9
  -I have dabbled a bit with using a lower as well as higher minimum pressure as well. This had zero effect on much of anything other than creating more flagged hypopnea events.
Max Pressure 14
EPR 2--Full Time (Was called Reslex on Luna)
    -I have since turned this off, and then back to 1 in an effort to reduce centrals. It has had zero effect. Turning it back to 1 has helped with allowing me to stay asleep a        bit more the past few days for some reason. I have tried 2 for a nap the other day and found it fairly uncomfortable.

Ramp Off
Humidifier 1 (Rainout happens easily since I live in a pretty arid climate)

Mask Type/Other Relevant info:
-Most nights I use an Evora FFM. Will probably be attempting to switch to something that is not a hybrid mask. This one rarely leaks or doesn't leak much but none of the sizes fit me exactly right. It is good enough most nights for now.
-I have tried a Resmed P10 Nasal Pillows mask. I like it okay but I find it to be fairly uncomfortable over time as it seems to cause pain/irritation on my nostrils. Additionally I find it leaks as I toss and turn, and I have to mouth tape when I use it. 
-I am a side sleeper
-I use a soft cervical collar which I started using when I had the Luna. It made a major difference preventing Obstructive events.


Sorry for the wall of text. Any help will be appreciated it. Since starting therapy I have had 3 nights where I've slept great which is more than I can say since...ever. My scores are a bit different from when I was using the Luna machine but even though they are low(ish), I am definitely not feeling my best since switching machines.

Thanks!

[SDM1]

I have never had the machine you are using but if I had to guess, I would say you are trying to manually set up a machine that is an auto set. The auto machines have very little settings that you need to set, rather finding your minimum and maximum settings and letting the machine do its job with your changing settings through the night. Find the sleep titration guide for your machine and set it according to manufactures suggestions and only change it as they suggest. When I got my Resmed 10 ASVauto I to was trying to narrow down the settings in hopes of better sleep. Once I figured out that all I was doing was restricting the Auto features and returned back to suggested starting settings, my AHI average is now around 3.1 over 30, 60 and 90 day averages. Don't try to change setting daily, use longer term averages only, you will have different numbers every night at any settings.

PS, your sleep docs goal is to get your AHI under 5.0, once you are there, they consider you set.

[ilgak]

Thank you for your response.

I have actually used a lot of the information here and elsewhere to arrive at the settings I am at currently. So far, the only tinkering I do with settings at this point is in an effort to try and relieve fatigue, and generally I allow at least a week before I make a judgement on whether or not the setting change was helpful or not. I am definitely better than before therapy but I still do not feel like I am getting good quality sleep most nights.

[SDM1]

I know your pain, I was diagnosed nearly 35 years ago and through my own efforts in the last few years feel like I'm finally getting results that matter.