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Cheyne Stokes Respiration ?
RE: Cheyne Stokes Respiration ?
This shows a very disrupted inspiratory breath that needs more pressure support. You need bilevel. Talk to your doctor about bilevel therapy (Aircurve 10 vauto) and evaluate for RLS or PLM. If you sleep with someone, do the tell you that our have a lot of sleep movement? Something is causing extreme restriction in your airway so that you have several false starts to inspiration, and a flow limited breath.
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RE: Cheyne Stokes Respiration ?
i sleep by myself (apart from my cat) ?

What is RLS and PLM ?
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RE: Cheyne Stokes Respiration ?
RLS = restless leg syndrome
PLM = periodic leg movement

Both are movement disorders that can cause arousals/sleep disruption.

Either you are having some sort of periodic obstructive apneas (some sort of obstruction that happens then your body finally forces a breath, hyperventilates to compensate for lost breaths then the process repeats) or you are having central apneas. This last data says obstructive but most of your earlier data pointed more towards centrals. One thing I have noticed looking at my grandfathers data is that it seems like these machines have some trouble determining central from obstructive in these situations(periodic breathing) especially if there are leaks present (which there was during your main obstructive period).

Your breathing issue in this case is either obstructive in which case higher pressure or larger pressure support (recommendation by sleeprider for bilevel) would be the solution. The machine has already hit your current max of 15 cm and that didn't help so you could try setting max pressure higher to see if it helps, maybe it is something positional and a cervical collar might help too). If central in nature it may be being caused by EPR. I will agree that your last data looked more obstructive in nature but your original data looked more central which is why I was curious if adjusting EPR might make a difference. Raising pressure or pressure support(bilevel) would only make centrals worse and I still think it would be worthwhile to try a reduced EPR just to see if it seems to have any effect. If it doesn't then that would indicate the issue truly is obstructive and a bilevel, increased pressure or cervical collar should be your main focus, if it does help then things change a little.
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RE: Cheyne Stokes Respiration ?
Thanks Geer for your detailed response. I will try my cervical collar for the next couple of nights to see if that helps. I have a feeling it might as my chin definitely drops. Problem is the full face mask together with the collar make my claustrophobia even worse. 
Next I’ll try the EPR with auto ramp as you suggested

Appreciate your assistance 
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Positional Apnea? and CSA
I have attached a couple of my recent results and would like any comment on

(1) Is this positional apnea?
(2) Are the Central excessive and anything to be concerned about?
(3) Is resp  rate of concern?

(I did a bilevel sleep study last week and will post results to help choosing from a simple Bilevel S as opposed to ASV in my case)

Many thanks

Attached Files Thumbnail(s)
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RE: Positional Apnea? and CSA
1. yes, I see some chin tucking, though some of it is suspect because it is somewhat near your sleep wake boundries.
2. maybe, it is below professional concern (CAI <5). it depends of if it is bothering you.
3. RR, it is something to be investigated. The first look has to be on is it real. Can you post a couple of charts 2-3 min where the RR is high so we can see your flow rate.

What happens to your CAI when you cut your EPR? Try EPR=2.

Also, since you are asking about your centrals, also post a couple of 2-3 min segments showing centrals
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RE: Positional Apnea? and CSA
Thanks Bonjour

I have attached screenshots as requested

I have tried to cut EPR=2 a couple of times, but found the exhale pressure too much so reverted to 3. Will try again tonight

Regarding the clusters of apneas just before sleep, I always start lying on my back for 10-30 minutes to relax, then when ready for sleep turn on my side. It appears lying on my back induces these apneas...

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RE: Positional Apnea? and CSA
If the apneas are happening when you are awake they are not because you are on your back, it is because you are awake. It is called sleep wake junk and you can have apneas and all sorts of what appears to be garbage breathing while awake. In reality none of those apneas should be flagged if you are awake (and they wouldn't be in a sleep study), the problem is these machines can't tell when you are awake or asleep so they score everything and you need to interpet the data. In short it is only sleep disordered breathing if you are asleep. 

Another member was posting breathing waveforms like those, I don't know what causes them but I sure am curious. Hopefully the sleep study you did might have some answers about them, I would take some examples and ask the doctor you are dealing with about them as they are not a normal looking breathing waveforms. If they don't know try and push to get an appointment with someone that might (pulmonologist etc).
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RE: Positional Apnea? and CSA
Good to know these are not centrals. I now recall you explaining some of this in another post . The sleep study should show anyway

I'm seeing a Pulmonologist on 28th Feb, so I will definitely ask him about breathing

In your opinion would a vauto, ST or ASV help make my breathing more regular?

Also, Ive only had 5 episodes of periodic breathing (comes up as Cheyne stokes on my cpap) in over 2 months. I guess this wouldnt necessitate an ASV unless it becomes more frequent?

thanks for your help
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RE: Positional Apnea? and CSA
Closeup 1 - apparently, based on the total lack of data for over a minute, it looks like the machine turned off for a minute. This makes this closeup SWJ. I was looking for waveforms similar to what you have at 2058 and 2059 as this would indicate the central apneas are CO2 dependent. This is also why I want to see a drop in EPR with 2-3 min views of CA events.

Closeups 2&3 - your RR is about 15 based of breath count, yet the RR rate is double that (roughly). This is because the Flow rate is crossing the zero-line more than once per breath. (add the zero line to the flow-rate chart for clarity) This ragged breath is not normal and as a minimum, we should understand what is happening.

It is typical, not always, for apnea to be worse when on your back. If you choose to sleep on your back your machine just needs to be optimized for that. Avoiding sleeping of your back is valid, and effective therapy for some individuals.

Exhale pressure, I would like you to do an experiment for me. Get a tall glass of water and a straw. Place the straw in to near the bottom of the glass. Now simply blow bubbles.

Any issues?

Assuming the glass held 8 inches of water, I did say a tall glass, that was equivalent of the maximum pressure your machine can generate, 20 cmw.

I'm not questioning that you are having issues with aa lower EPR, but I'm sure it is not because of the pressure itself. Note that a CPAP could not blow up a balloon.
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