[Treatment] After years of successful treatment: a Big jump in AHI and drop in restfulness

[AtRest]

Let's get to the bottom of this.
Set EPAP = IPAP = 8 and PS=0

That. Should be comfortable enough and that should minimize the CA

Also have your doc schedule an ASV titration study, and the LVEF test to clear you for it.  You can always cancel if we take the beast. ¹

The last two nights I've struggled to fall asleep or stay asleep. And in both cases I took off the mask and tried to sleep without any aid and basically suffered the same problems: I am suddenly stopped from falling asleep by a pang of anxiety that I am not breathing. Or about an hour in I wake up due to the same feeling. I was so exhausted today I tried to take a nap just now with the 8-8 settings and sadly experienced the same problem. The jump in results is me briefly powering off the machine after being woken up and I really couldn't fall asleep again. 

   

[GuyScharf]

You might be able to decrease CA further by increasing the Trigger value. Using Trigger, I have essentially eliminated CAs on my VAuto.

[Gideon]

Yes increase trigger setting up one level. 
Then try very high. If you do both in a single night that is fine too.

After that we have done all we can do with your current machine to manage your Central Apnea.

Actually I'd like to return you to comfort. What settings feel best to youp?  Then set trigger to high.

And do ask your doc to schedule an AST asap, and that you will gladly take any cancellations.

[AtRest]

    I want to thank you guys for your support. I've had some good news and bad news. Last night I had my machine set to 8-8 in S mode with Trigger set to Very High (this was before you all posted) and my chinstrap (I dunno why, I don't know what the machine does with Clear Airways, does it try to cause a breath? I figured keeping my mouth closed was a good idea).  I had the usual trying to fall asleep: Clear Airway Apnea's woke me up as I was falling asleep about 2 or 3 times. But then I slept most about 7 1/2 hours waking up maybe twice. Stay in bed because it was still dark out and put another 2 hours of sleep in. I'm kicking myself because I complete forgot to put a SD card back in. But I had 9.14 hours and 3.4 AHI for the entire night!

I woke up without anxiety from lack of sleep and had a nice clear headed morning. I'm still exhausted from the previous two nights, so around 10:30 I popped in the SD card and tried to hit a nap, but gave up after an hour of falling asleep and being awakened by the Clear Airways as I start move from awake to sleep. Seems like what has been said about CSA, it's not consistent? Maybe I just got lucky last night?

I don't really notice any comfort difference between 15-8 and 8-8 other than I swallow a lot less air, so I might not put it back. 

Tomorrow I'm going to call my PCP and present my case for CSA and ask him if we can use the data. Even if he says stick with the PSG test, I'll probably keep that appointment. However, He already provided me with a referral so I can also reach out to a pulmonologist who might be better equipped to handle the data I have. 

Attaching my nap just in case. Thanks for your help guys. Even if this can't be fixed with my current setup, knowing what's happening is very empowering.
   

[SarcasticDave94]

For your learning, on this machine trigger has shown some reductions on the CA for some. It's a help but it's not true treating of CA. That falls upon the shoulders of the ASV as the only PAP machine designed to actively treat Central Apnea. Your setup can avoid it sometimes, this sometimes avoiding applies to any PAP other than the ASV is what I'm meaning.

As a reminder, continue to create a list of symptoms and complaints on untreated feelings due to CA and that ASV is the only treatment. Your symptom list is vital as doctors are more likely to pay attention IMO.

[Gideon]

Your goal tomorrow is to get an ASV titration scheduled at a sleep lab, then to sort the rest out.

[AtRest]

I've reached out to the doctor's office this morning and gave them an update. I'm going to follow up this after with the pulmonologists if I don't get anywhere. To throw a weird curveball into this weekend. Below our my results last night. I woke up twice and had a little trouble getting back to sleep. I don't feel completely rested because I'm so far behind on my sleep, but this feels like some progress:

   

[SarcasticDave94]

OK that's a very good OSCAR. But since we're dealing with consistently inconsistent Central Apnea, let's see what tomorrow brings. If these CA events are like mine, thru may very well show up strong your next sleep session.

Not attempting to discourage. But let's build a trend. IMO this is where doctors get CA wrong; they see it in a down night and proclaim they're treated but even as soon as the next night, there they'd be again.

[AtRest]

Hey guys, I thought I would check in on my status. My AHI has been great, I've attached the overview for the last month or so, as well as last night's data. My only real issue at this point besides actually making sure I get to bed on time,  is staying a sleep now when the pressure hits max and dries out my nose throat and mouth.  I'm think I'm going to cancel the test for the ASV at this point. I have an appointment with a pulmonologist next week, see if I can work with them to get myself off CPAP (if my at-home test diagnosis of 'no treament necessary' is to be believed) or at least just regularly have a specialist check my data to make sure I'm getting good rest or improving my sleep apnea through weight loss.

Is there anything you guys see that looks concerning? And is it safe for me to keep my trigger set to Very High for the easy breathe? Thanks a ton for all your help.