Help titrating new BiPap - problem with Central Apneas

[kettle101]

I recently upgraded to a Resmed AirCurve 10 VAUTO from a Dreamstation 2 Auto as my sleep doctor based on my sleep doctor diagnosing me with UARS after a sleep study, which displayed high hypopnea and RERA with low OA and CA. If it would be helpful, I can post that study and my original study (5 years old) and representative OSCAR data from my old machine. 

I switched to the Resmed BiPAP based on some reading I did on this board specifying that UARS responds better to the increased pressure gradient offered by BiPAP as it is more 'comfortable.' However, I am frequently having nights with high Central Apneas, mostly clustered in the at the end of the night (likely in REM sleep?). This also seems to coincide with increased likelihood of waking up. I've attached some representative OSCAR data (with some closeups if that helps). 

What do you recommend to address these Central Apnea clusters? They were typically not an issue on CPAP auto. Thanks in advance

[Sleeprider]

Please post charts with the Details tab showing rather than the Events. This will give us much more useful information on settings and respiratory statistics. Your CA events are not very serious and occur somewhat randomly, but in large part near the end of the night. Your DS2 CPAP does not have settings that we can exploit to manage CA events, but it would likely help if you will reduce the Flex settings, which I assume are on setting 3. I think you could reduce events with a setting of 1 or 2.

[quiescence at last]

It would really surprise me if you were getting CAs in REM sleep.

Also, recent is an important word. Many of us have more CAs when our treatment is adjusted, especially if there is a change in pressure support (PS or EPR).

QAL

[kettle101]

Please post charts with the Details tab showing rather than the Events.  This will give us much more useful information on settings and respiratory statistics. Your CA events are not very serious and occur somewhat randomly, but in large part near the end of the night.  Your DS2 CPAP does not have settings that we can exploit to manage CA events, but it would likely help if you will reduce the Flex settings, which I assume are on setting 3.  I think you could reduce events with a setting of 1 or 2.

Updated charts attached, please let me know if I should zoom in on any. Just to clarify, I am using a Resmed AirCurve 10 VAUTO. Last year I was using a Dreamstation 2 Auto (I can post charts if that helps comparison) but switched to the AirCurve as of 6 weeks ago as I had read resources on here that suggested the BiPAP may help with UARS and the RERA and hypopnea that entails. I can say that central apnea was not an issue with the Dreamstation 2 last year (had that on FLEX setting 2). Thanks.

[Sleeprider]

Thanks for the more useful charts. Your machine is not changing pressure very much, and is addressing all obstructive apnea and flow limitation. The remaining CA events will probably respond to changing trigger sensitivity to high. If that does not bring it to less than 1 event per hour average, then we can look at slowly titrating back pressure support 3.8, 3.6, 3.4 etc. I think you will find the high trigger sensitivity is sufficiently effective.

[kettle101]

Hi Sleeprider, sorry for delayed response. I have had my machine with Trigger on "High" since shortly after receiving, since I found the "Medium" to be uncomfortable. The charts you are looking at are results with the "High" setting already on.
Thanks

[kettle101]

Hi, bumping the thread to check in on the above question. (Trigger is already on High). Thanks

[Sleeprider]

If you want to further reduce CA events a Very High trigger sensitivity may help. Feel free to give it a try. Sorry I missed your last post. Things got busy, and I have surgery scheduled for tomorrow.