Hypopneas resolved, CA's persist--help!

[AZAwake]

I've been on CPAP for 17 months with hypopneas 99% resolved.

I had an AHI of 26 (clinic PSG, hypopnea-dominant).

But can't kick these OA events.

Most nights Oura ring shows several breathing disruptions (good vs "optimal" rating by Oura).

Importantly, I still feel unrefreshed most days.

RX pressure was 7. 

Changed to auto range of 4-10 recently to try something new.

Here's last night's OSCAR along with additional CA details. PSG summary also attached.

Any ideas?

[Jay51]

Do you wear a soft cervical collar?  I see one instance of clusters of OA's just as you are falling asleep.  The collar may help with H's also.  

I have complex apnea.  I hope that you don't.  Things like raising pressure and raising EPR are great for defeating OA's and H's.  EPR is especially good at reducing FL's.  BUT, raising pressures and EPR can cause more CA's.  It is a balancing act for sure.  

I would suggest trying a collar if you are not already doing so.  Then, if you are having more OA's, H's, and FL's, then increase pressure and increase EPR. 

If you are having mostly CA's, then trying lowering pressure and lowering EPR.  

It is strange that you are having CA's now (you had virtually none on your PSG).

[paulag1955]

Is it typical that you have that many CA events each night?

Can we get a zoomed in view of some of the CA events? Specifically, the cluster of events just before 1:00 am and maybe a couple of the single events?

[AZAwake]

Is it typical that you have that many CA events each night?

Can we get a zoomed in view of some of the CA events? Specifically, the cluster of events just before 1:00 am and maybe a couple of the single events?

Hi Paula,

My CA events range from 1.5 to 4 per hour. Last night was on the higher side in that range and I've been yawning all morning.

Attached is a zoom-in of the CA cluster around 1am (2 parts broken into 2 attachments).

And a zoom-in of a 3:30am event (1 attachment).

Grateful for any advice.

[paulag1955]

I asked for the close ups so that people more knowledgeable than I am can have a look to see if those are real CA events or if the machine is misidentifying some of them. This is important because the settings that are more likely to help with the CA events are kind of the opposite of the settings that help with hypopneas.

[Deborah K.]

Your setting can be easily changed in ways that will help your comfort and treatment.  Your beginning pressure is too low for an adult.  You are almost bumping up against your high pressure setting. You are not getting any therapy during ramp.    Here are my suggestions:

1.  Raise your starting pressure setting to 7.
2.  Raise your high pressure setting to 14.
3.  Since you are using only five minutes of ramp, either drop ramp altogether, or at least raise the pressure to 7 if you feel you need it.

As to your centrals, they are mysterious to me. I still have some centrals most nights, but considerably lower than yours. Hopefully one of the real experts will have some advice for you soon.