YIKES! With changes, I'm worse!

[kingskid]

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Made recommended pressure changes and I am now worse!  The changes were 8 min, 12 max, EPR 3.  I feel fine during the day and pretty much always have other than sometimes getting sleepy around 3:00PM, but the changes made did the opposite of what I was expecting.  Afraid to go to sleep tonight with those changes but don't know what to change them to.  Help!

The first two are two recent screenshots (May 15 and 23) to compare with the last two nights that seem okay to my unpracticed eye.  There were set at 7 min, 10 max, no EPR.

[Gideon]

First, your numbers are great, there is nothing wrong with them.  What is important is how do you feel?  better or worse than the previous settings?
Do not chase numbers.
We did manage to reduce the Flow Limits, but it was at the cost of increasing Central Apnea, again which settings felt better?

[kingskid]

Well, bonjour, I am managing to sleep longer with the new settings, but do have a little trouble keeping my mouth closed with the increased pressure.  I don't feel much different, maybe because I never felt bad during the day.  Would occasionally get a bit sleepy in the afternoon, but I tend to be rather high energy so no real difference noted.

[Gideon]

it is easy to get the numbers "dialed in" but almost always the final adjustments are all about what makes you comfortable.

[kingskid]

it is easy to get the numbers "dialed in" but almost always the final adjustments are all about what makes you comfortable.

I started CPAP because of waking up and gasping for breath, not because I felt bad during the day.  My main concern is the CAs because as I understand it, those are connected to stopping breathing.  Since I live alone, that is a real concern for me because no one would know if I keeled over in the night...at least not for several days.  So I guess what makes me comfortable is having peace of mind about getting my CAs under control.  Since that is the case, how would I adjust my current settings?  Thanks.

[Sleeprider]

CA events at the level you are experiencing them are either "I have had plenty of air and don't need a breath now" (10 seconds), or a sleep disruption. It is nothing to be concerned about healthwise, or that you suddenly are going to quit spontaneously breathing. Look at the duration of the events. If they are short duration pauses in taking the next breath, there is no problem. I have CA events all the time, and they seem to be a part of better sleep for me. In your case, your pressures are stable, and CA events see to occur at times when the leak rate is near zero. I don't think they are of any concern, and it's nice to see the flow limits and other events resolve. I think if you just go with this for a while, you will find the events diminish as you adapt.

[Gideon]

it is easy to get the numbers "dialed in" but almost always the final adjustments are all about what makes you comfortable.

I started CPAP because of waking up and gasping for breath, not because I felt bad during the day.  My main concern is the CAs because as I understand it, those are connected to stopping breathing.  Since I live alone, that is a real concern for me because no one would know if I keeled over in the night...at least not for several days.  So I guess what makes me comfortable is having peace of mind about getting my CAs under control.  Since that is the case, how would I adjust my current settings?  Thanks.

IMHO the point to begin to think of taking aggressive action is with a CAI of 2.5 to 3.  The medical community won't even look at it until CAI of 5. 
An ASV would likely give you peace of mind and that machine actively treats Central Apnea.  You do not medically qualify for that based on your numbers.  You may be able to work with your doctor to get an ASV, not common, but it has been done.

Since higher pressures and higher pressure differences tend to increase Central Apnea you would want to minimize pressure differences (PS = 0) and minimize pressure, EPAP = IPAP = 6.  This is not what I recommend.  You need to get comfortable with having a few centrals.  Believe me, no one around here will let you get your Centrals out of control.  You will be getting suggestions to see various specialists and recommendations to bring your centrals down.  

This will likely result in a substantial increase in your Obstructive Apnea, Hypopneas, Flow Limits and RERAs.  
A better treatment, other than ASV, is to balance your obstructive and your Central Apneas, to have some of each.

[kingskid]

CA events at the level you are experiencing them are either "I have had plenty of air and don't need a breath now" (10 seconds), or a sleep disruption.  It is nothing to be concerned about healthwise, or that you suddenly are going to quit spontaneously breathing.  Look at the duration of the events.  If they are short duration pauses in taking the next breath, there is no problem.  I have CA events all the time, and they seem to be a part of better sleep for me.  In your case, your pressures are stable, and CA events see to occur at times when the leak rate is near zero.  I don't think they are of any concern, and it's nice to see the flow limits and other events resolve.  I think if you just go with this for a while, you will find the events diminish as you adapt.

Okay, thanks, that relieves my mind.  I’ll persevere and check back with more charts later.

[kingskid]

Thanks, bonjour, you and Sleeprider have eased my concerns.  I will stay with the new settings and give it some time.  You guys are so helpful.  When I look at the charts, I just don’t know how to correctly interpret them.  Feel like I am starting to get a chest cold today and took some deep lung drops and that helped.  Maybe that is affecting me on the CPAP.  Oh well, time to try it out again!  Will submit more charts in a few days.