[Treatment] central apnea breathing pattern

[Eightadayorbust]

Dear Board,
How can I optimize my treatment? Should I seek another specialist? 
I was diagnosed in 2019 via sleep study when about half my events were obstructive and half centralized. I think the bipap is helping reduce obstructive events. But I have more “Clear Airway” events than I would like and many are characterized by the Cheyne-Stokes pattern of breathing, as shown in the attached. 
Cheyne-Stokes is often associated with congestive heart failure, stroke, or neurologic disorder. I am fit (BMI~24, resting HR ~50, crossfit athlete), and my heart is healthy. I am free of neurologic disorder and have not had a strokes. Another cause can be elevation, and I do live at high elevation (2000 m). But, I see the same pattern when sleeping at low elevation as well, perhaps not as frequently (have not run stats yet).

I attach two images, the first the overall summary for a typical night and the second the same night but zoomed in to show one sequence with the cyclical breathing pattern. Zoomed in inserted here:     

Suggestions for what to try? 
Thanks,
Eightadayorbust

[Eightadayorbust]

    Here is another zoom in to see the breathing pattern in more detail

[Hypoxic]

Hi Eightadayorbust,
I'm in the same unpleasant condition as you, struggling with untreated CAs.
I wish I could offer some help...
I'll stick to your thread hoping the experienced users give some valuable insight.

[Jay51]

A lot of the time CA's can occur due to too high pressure.  The 1st suggestion to try would be to lower your PS max down.  I think your range is 2.0 to 5.8 or so.  Try decreasing this range slowly and hopefully that can reduce your CA's.  

Also, sometimes when a person starts therapy, they get more CA's simply due to breathing better.  They get rid of more Co2 out of their system.  Co2 in the bloodstream is the main signal to take a breath.  So this is usually why it occurs.  

Give this a try and keep reducing your PS max and repost some charts again.  

Cheyne-Stokes respirations can be innacurrated flagged by pap machines.  Of all the members that post supposed CSR breathing, very few are actually CSR.

[SarcasticDave94]

Elevation 2,000 meters, correct? That's equal to 6,561 feet. Might be a cause for the CA.

If your machine has trigger controls, you may want to edit to higher.

[Eightadayorbust]

Thanks for the suggestions. I reduced the PS max from 6.5 to 5.

For what it's worth, the central events were flagged in my most recent sleep study -- half of the events were obstructive and half central. That was without any CPAP, which suggests it's not just the CO2 clearing issue. What concerns me is in the last sleep study, my O2 dropped to 85% and was below 90% for ~6% of the time. Too much.

[Jay51]

Hopefully reducing PS max from 6.5 to 5 will help.  If not, you can always reduce the PS max even further:  From 5.0 all the way down to 2.0 in 0.2 increments each time or even in whole numbers (from 5, to 4, to 3, to 2).