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

[SarcasticDave94]

If you reread Crimson Nape's post in #7, he tells you how to see the seconds for timing the CA events.

On a bilevel like this VAuto, even though you're running S mode:
EPAP is exhale pressure, this also is the air setting that holds your airway open
IPAP is inhale pressure
PS or pressure support is the difference between IPAP and EPAP

Above your charts in post #8, I suppose this was some data from a sleep study. BTW you can blacken or redact personal info to be safer in posting the reports, which may have data your not conveying or aware of its importance. Regardless, the CA were down in result 1 and up in result 2. That's the Central Apnea trait of consistently inconsistent. Note as well on result 2 that CA were greater than Obstructive. If this were the diagnosic sleep study, just maybe you have pre-existing/predominently Central events and should be treated with an ASV, best case scenario ResMed AirCurve 10 ASV if applicable. Repeating, just maybe for now.

[AtRest]

If you reread Crimson Nape's post in #7, he tells you how to see the seconds for timing the CA events.

On a bilevel like this VAuto, even though you're running S mode:
EPAP is exhale pressure, this also is the air setting that holds your airway open
IPAP is inhale pressure
PS or pressure support is the difference between IPAP and EPAP

Above your charts in post #8, I suppose this was some data from a sleep study. BTW you can blacken or redact personal info to be safer in posting the reports, which may have data your not conveying or aware of its importance. Regardless, the CA were down in result 1 and up in result 2. That's the Central Apnea trait of consistently inconsistent. Note as well on result 2 that CA were greater than Obstructive. If this were the diagnosic sleep study, just maybe you have pre-existing/predominently Central events and should be treated with an ASV, best case scenario ResMed AirCurve 10 ASV if applicable. Repeating, just maybe for now.

Sorry I thought Crimson was talking about the tooltip timeout, I think I might be too dense or tired to understand how to measure the length of my CA's.

 The test results I posted were from an at home sleep study, middle of last week without my machine. Relative to what I'm getting on the Aircurve, those results actually look very good (AHI around 2 for both nights). My doctor (PCP not a pulmonologist) and I couldn't believe those could be correct considering what my machine is reporting for AHI every night, but we did not know that that high AHI is almost exclusively "clear airway" and not obstructive. That's what's making me conflicted that about whether to keep using the machine which I've depended on for sleep for so long. 

Having said that I check settings and Easy Breathe is  "ON" , Ti Max "2.0s" Ti Min "0.3s", Trigger "Med", Cycle "Med".

I think I will try the following changes tonight unless anyone else spots the potential for trouble:

IPAP 15.0 -> 13.0
Ramp ON -> OFF
Trigger Med--> High

EDIT: I think I figured out what you mean by length of CA:
   

[SarcasticDave94]

OK, that home study, to have graded Central Apnea, you had to wear a chest effort belt. Am I correct?

[AtRest]

It was the belted kind with oximeter on my finger and the little nasal hoses. It wasn't specifically to find CSA, I think my PCP prescribed this test because that's the go to for testing these days.  My at home test results from 2018 and my original 2012 test results from a sleep center can't be found. All we had to go off of were the current settings on the machine from 2018** and my decade old recollection of being told I had severe OSA. Up until 6 weeks ago when I suddenly started to have terrible sleep and panic attacks, I honestly hadn't even been looking at my AHI. I had called the DME while waiting for the sleep test to come in to see if they saw anything wrong with my machine and they said I should talk to my doctor about CSA. I don't think my PCP is really familiar enough to know what to do with that information, so he said just wait for the at-home test. At home test says I'm cured, but both he and I are skeptical considering the AHI in MyAir app. I asked if he could lower my pressure to see if the settings were too high, and he said he didn't feel comfortable recommending any changes without another sleep study, this time at a sleep center. Which is fair. I'm just struggling with 6 weeks of bad sleep and found you guys. 

**Other background: In 2018 I asked my then PCP (different doctor's office) to look at replacing my very old Respironics Bi-Pap device now that I was on insurance. They ordered an at home test (the exact same one and service I just took a test on) which came back saying I had mild OSA and recommended a down grade to a CPAP. I threw a big fit, because I didn't feel like I was any healthier (thick neck, well over 30 BMI) and after lot of back and forth, my PCP agreed to re-prescribe the original settings from my old machine and the AirCurve 10 I have now. Unfortunately, neither the test provider nor my old PCP office are able to find the results of that test for comparison.

When I was originally diagnosed with sleep apnea way back, I was about 265 pounds. About 2 years ago I got down to 245, and since Covid started over a year ago, I've dropped to 205 and I am continuing that trend. So I suppose it's possible I've changed enough that my OSA might be much better now. This might all be self inflicted as well, the Bi-pap had served me well for so long, I couldn't stand the idea of letting it go. I had used it every night that I had power, and it was all set and forget for me. Other than cleaning and replacing parts, I never even looked at the AHI, never really thought about it all. Just put it on and got a good nights sleep. 

Sorry about the rambling story.

[SarcasticDave94]

The belt was present. OK good enough, it was set to count CA regardless of purpose of the diagnosic test.

Let us see if others concur. Whether with this doc or another you decide. If this doc grades as perceived incompetent regarding CA, well another doc then. But you want to address CA in the negative light. I suggest noting down CA existence, that they disrupt sleep, your not gaining well rested state, and so on. Due to that you want a lab titration for ASV. And if an ASV will be scripted, strongly request a ResMed AirCurve 10 ASV. It's the best at CA combat.

PS Side note, you're wanting to stick with ResMed anyway. You're going to be used to the ResMed breathing patterns.

[Gideon]

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

[AtRest]

I will try that tonight. But will not my Aircurve doesn't have an independent "PS" field from what I can see. It has "Mode" set to "S" and then IPAP AND EPAP.

My doctor's office won't be open on the weekends, but they are already working on getting me a test in a sleep-center, I believe a PSG test. Is that equivalent of what you are recommending?

[Crimson Nape]

PS only appears when you have the AC10 set to the Auto mode. The S-Mode only displays IPAP and EPAP, since both are static pressures, there isn't a need for a PS setting.

Each mode's pressure settings are independent of the other modes. This means that you can set your S-Mode to one pressure setting and your Auto to another. The reason I'm telling you this is to let you know that you have a third option. Your AC10 has another mode, CPAP mode. Since you are turning your AC10 into a regular CPAP, by setting both the IPAP and EPAP to the same values, why not switch the mode to CPAP, configure it for the test, and retain all your previous settings for the other modes?

Either decision you make will be fine. They all lead to the same result.

- Red

[AtRest]

Thank Crimson Nape, that makes sense to me. Also I looked up ASV titration and why the LEFV is needed for it. I don't know if my doctor and insurance will go in for skipping the PSG on the way to that device.

[SarcasticDave94]

I can see a new PSG being skipped if you build a solid case now. To me the PSG is the diagnosic base. They already should have this, and a new diagnostic isn't doing a bit of good.

LVEF left ventricle election fraction... Tested by an echocardiogram, which is an ultrasound of the audio visual of the heart. Typical it's done at a medical building or hospital in the imaging department. You need to lie on a cold exam table with chest exposed, tech drags the probe across chest when prepped with the cold gel to facilitate getting the images. 30 or so minute exam.