Struggling to improve sleep quality. Please help!

[SarcasticDave94]

Here's another thought to add to the CA discussion. If there's a concentration of CA (or OA) at the beginning or end of a sleep session, this is the time of sleep wake transitions and can produce sleep wake junk or SWJ.

Another thing, some Central event flags may really be breath holds during positional change. Example, one who's side sleeping may hold their breath while flipping onto their back.

Think about what a CA is, it's a cessation of breathing for 10 or more seconds. Someone may hold their breath while flipping to their back or side, and if it's 10 or more seconds, viola a CA.

This does not do away with Central events being a real issue for some, me included. In 2017, my lab diagnosic shows 24 Obstructive to 124 Central, one of these CA was 90 seconds. Result? He needs Auto BPAP. Er wrong! Dope slap the duck.

[Ratchick]

Exactly what Dave says. What gets marked as CAs can be all kinds of "junk" - but that's the mechanism behind how carbon dioxide is related to centrals. 

The ones that tend to happen when you're awake are, as I said, usually because you've either taken a deeper breath and you simply don't need to take another breath within that ten seconds or (as Dave pointed out) you're rolling over, pulling the covers up, holding your breath (though those often pop up as obstructives too), deliberately slowing your breathing... etc. 

@CorruptAlligator:

When it comes to the collar - I could see that if you are suffering a lot of arousals because of positional apnea, it's possible that the CAs are caused by you waking/rousing, taking a deeper breath, washing out your CO2 and lengthening the time needed to take a breath. So because you're getting more arousals, you're getting more "falling asleep junk" CAs afterwards. Once you're wearing the collar, you're having less obstructive events and less flow limitation, and therefore fewer arousals, fewer deep breaths, and fewer "junk" CAs post arousal.

Also, if someone is either on APAP/CPAP and is able to lower the max pressure or reduce pressure spikes by eradicating the positional apnea with the collar, that's also going to help reduce treatment-emergent centrals too. The less pressure, the less carbon dioxide you blow off, so the less treatment-induced centrals. But obviously, it's going to depend from person to person. 

However, for people like myself and Dave with CSA, there's a completely different issue going on and needs a whole different kind of therapy.

That said, there's no denying that carbon dioxide levels are intricately involved in your respiratory drive, far more than oxygen levels are for most people (with some exception for those with certain other cardiopulmonary diseases). To the extent that they have to be careful about putting people with more severe COPD onto oxygen straight away (without other assistance) because they've grown so used to the high levels of carbon dioxide in their blood (called hypercapnia) that they DO rely on the oxygen levels to drive their respiration... and so, if you give them supplementary oxygen too fast, then they lose all drive to breathe, and end up in respiratory arrest.