[Pressure] Need Advice On What Settings to Adjust Resmed Airsense 10

[Ratchick]

This is something I see in my chart quite often (for clarity, I have severe CSA so I may be different from you, once we see your sleep study). But on my "not so cruddy" nights (relatively) I will have relatively few apneas in the first part of my sleep, and about half or two-thirds of the way through, I get a megaton of centrals all crashing down every 30-60 seconds. In reality, though, even those "good" nights I'm also getting a lot of "almost-apneas" that are either just under the 10-second boundary to count, or where the flow is just a teeny bit too high to count. By using the custom user flags in OSCAR, I can also track those flow restrictions, and they would double my AHI at least, every night.

That said, I'm glad you're feeling better. The AHI is definitely too high in that last session, even if it averages out not so bad overall. Do you have a pulse oximeter? It would be interesting to know if your oxygen levels are healthy during those clusters of centrals.

[SarcasticDave94]

Yep I missed that standard chart for some reason.

OK so you're likely to fall into one of 3 Central types.

Pre-existing CA is mine, shows by a 50% event count or more, compared to Obstructive events, on your diagnostic sleep study

Treatment Emergent CA, shows little to none on the diagnosic but when on PAP the Centrals appear in OSCAR, if you don't use Ramp or EPR (Flex on Philips Respironics), the Centrals eventually diminish after about 3 months

Idiopathic, meaning medical cause unknown for Central Apnea

[Stoaty]

Two sessions last night:

First - 5.5 hours, AHI - 0.55
Second - 1.5 hours, AHI - 13.84 with mostly central events concentrated in the last 30 minutes

Total for night AHI -. 3.43

[Ratchick]

If you zoom into the central clusters from last night, do they look similar to the zoomed-in view you posted a few posts back? Also, what was your feeling about how deep your sleep was, or how close to wakefulness you were during that time?

[Stoaty]

Yes, they look similar but it was more of a mixed picture with:

Clear airway - 9.89
Obstructive - 0.66 (in the past obstructive events were virtually always 0)
Hypopnea - 3.30
RERA - 3.96
Cheyenne Stokes - 0

I don't know how close I was to wakefulness based on my feeling, but the problems virtually all occurred in the last 30 minutes before I woke up.

[SarcasticDave94]

Without seeing the OSCAR shot, it sounds possible that the last 30 minute event group might be SWJ, as in Sleep Wake Junk. If it were SWJ, it's due to the uneven breath control handoff from wake to sleep, and sometimes PAP users transition back and forth and back again.

Personal preference: it's easier to picture what's occurred by having an OSCAR shot along with your description of your thoughts, feelings, etc. Both are needed to give a complete story.

[Stoaty]

Can't post an Oscar shot as I have used up my 3 attachments per post

[Geer1]

Although most events show up as central apnea I am wondering if there is an obstructive side of things. The reason it would be worse later in the morning is because obstructive apnea is usually worse in REM sleep which occurs more often as the night goes on.

I would try a slightly higher pressure to see what effect it has. You can do this by trying a fixed pressure of say 7 cm or you can try by switching back to auto mode and a range of your current 5.6 to 8 cm. These are all still low pressures and with EPR off shouldn't exaggerate your centrals (which are usually caused by EPR more so than higher pressure).

[Stoaty]

I would try a slightly higher pressure to see what effect it has. You can do this by trying a fixed pressure of say 7 cm or you can try by switching back to auto mode and a range of your current 5.6 to 8 cm. These are all still low pressures and with EPR off shouldn't exaggerate your centrals (which are usually caused by EPR more so than higher pressure).

Good idea.  I agree there seems to be an obstructive component.  Thanks for your input.  I will give it a try.

[Ratchick]

The first screenshot you showed had zero obstructive events, really, it was pure central, so hopefully, the small pressure increase will help with that and not worsen the centrals too.