[Symptoms] Newbie--Complex or Mixed Apnea?

[pente]

I was diagnosed with obstructive sleep apnea in September 2021 with 17 episodes per hour.  I've now had the chance to use my CPAP machine for 8 straight nights with auto titrating pressure range of 5-10.  My events per hour have been 5-12 over this time.  I've been using OSCAR to look at my data. I have a couple of issues but my main one right now is that I seem to be having a lot of CA (clear airway/central apnea) events. I'm aware of the material on CA on the "Optimizing therapy" therapy page.  Here my answers to the questions it suggested:
Did the sleep diagnostic test (the one without xPAP) show any centrals?
-->I don't know yet--waiting on sleep doc to respond to my email from last week--next appointment is in January.
2) How many centrals are we talking about and at what pressure(s) do they start?
-->An average of 18/night (range 7-29).  Mainly these seem to happen after my pressure ramps up and then has begun to taper (e.g. in the 7-10 range).  My number of obstructive events has a similar average and range.
3) Can the OSA stuff (the OAs, the Hs, and most of the snoring) properly be treated at a pressure level that is below that needed to trigger the CAs?
-->Have not tried yet.
Does the number of CAs go up, down, or stay about the same after a few weeks on xPAP therapy?
-->Don't have enough data yet--but last three nights have been high (20-28 CA events/night).

Also: Expiratory Pressure Relief (EPR) is on (type='full time', EPR level = '3').
Screenshot for most recent night attached.

My questions:
A. An average of 18 CA events per night seems like a lot but I have no basis for comparison.  Is it?
B. The first available appointment with my sleep doc is in 7.5 weeks (ridiculous).  Should I start experimenting with narrowing my pressure range (e.g. to 6-7) or wait for more data and/or a chat with the doc?

Grateful for any advice.

[SarcasticDave94]

Try this with your OSCAR, minimize the calendar via the black triangle, and then instead of events tab show us the details tab. It appears you have a Ramp programmed. If so I'd remove it. Ramp and Centrals don't mix well.

[pente]

Thanks, I'll try with ramp off.  
See details attached.

[quiescence at last]

No, 18 or 20 CA events in 5 hours of sleep is not an outrage.  Especially during first weeks of treatment.

These will likely fade as treatment kicks in. 

QAL

[Dormeo]

In agreement with QAL: CAs may just indicate choppy sleep. If you have a period of arousal breathing, that can wash out enough CO2 to delay the "breath-now" command from your brain. The result is a pause in your breathing, and if it's 10 seconds or more, a CA flag drops. With fewer periods of arousal breathing, you'd have fewer CAs, on this scenario. As you get used to using the machine, you'll probably have fewer arousals.

In addition to turning off the ramp, you could consider reducing the EPR from 3 to 2. Try it while you're awake; if it feels OK, give it a try at night.

When you post your next chart, include the side panel details as well as your graphs, all in one screenshot.

Just curious: was 5+ hours all the sleep you got? Is that normal for you? And why the long breaks in therapy?

[pente]

Thanks for the suggestions Dormeo--will give them a try. 

I've been getting around 7.5 hours of sleep (not just the 5-ish on therapy).  Usually this is due to needing to sleep on my stomach for a bit (where the mask is a no go for me) to move away from my majority back (and dash of side) sleep.  Also, once or twice I was unable to fall asleep with the mask so took it off.

[Dormeo]

About stomach sleeping:  some people find that the "Falcon position" helps them sleep on their stomachs masked up.  Description here:

http://www.uarsrelief.com/sleeppositions.html

Photo attached.

I hope it'll work for you!

[pente]

Ah, cool! Thanks.

[Sleeprider]

The big advise in this thread so far is to cut back on EPR. Your pressure is 4 to 10 with EPR at 3 and that is flushing CO2 from your system. you just are not accustomed to that. I think a minimum of 7.0 with EPR 1 and maximum of 9.0 will get you squared away pretty quickly. Turn off ramp if you don't have a problem with that starting pressure.

[pente]

Thanks Sleeprider--I will try.

Do you (or does anyone) know if my entering "clinical mode" to change my own pressure prescription in my first few months of use risks an insurance company deeming me out of compliance and thus not following through on covering the cost?

(With the caveat that I know individual companies can differ.)