Still tweaking Resmed Aircurve Vauto

[alps]

After using APAP for 17 years it began to become ineffective after moving from Michigan to Denver CO.  My new sleep Dr. ran a new sleep test and put me on bilevel.  Sleep test was AHI 42 with mostly hypopneas and some obstructive apneas with no centrals indicated.   Settings from the Dr. were 5/9 PS 4.  I started on the Resmed Aircurve Vauto the second week of December 2017.

In a former thread, several here gave me input on some of my early charts and setting which I appreciate.  The main problem has been CA numbers.  It has been difficult to get consistently into the under 5 range.

Right now the best range has seemed to be on auto with 6-11 PS 3.  I have two charts from the last two nights.  Thursday night looked pretty good but Friday night CA cluster jumped in again.  Now I am no expert on reading the charts but the one thing I noticed was the CA cluster happened about 3 minutes after the big flow spike around 4:32 am.

I had awakened and turned over to check the time.  In the process my hose came off the mask and hence the flow spike.  I did not turn off the machine but re-attached the hose.  My theory: my pressure was at the high end of the range and as I was going back to sleep the instant higher pressure set off the CA chain.

Not sure if this is the cause but would appreciate any input on the two charts.  Any help or suggestions on my present settings would be appreciated.  I want to be able to keep my AHI consistently under 5.  Thanks!


https://i.imgur.com/Wfo5NBT.png

https://i.imgur.com/jMXXCuj.png

[Sleeprider]

You seem to not have an OA problem and H is pretty good. CPAP and VPAP are not really tools to treat CA events, but they can affect you. There are really just a couple options here to control CA. You can try to optimize using low pressure support and more steady pressure, or move to a device with backup that makes you breathe when you have a central (i.e. ASV).

My best suggestion is to try 6-10 with PS 2 and see if that helps. Your event rate certainly rises with pressure above 10, and you seem to arouse and stop therapy for a while. Limiting max pressure to 10 and PS at 2 should help, and it's possible you will have to cut PS to 1.