Your Doc said you shouldn't use APAP, my response to him would be that CPAP mode, any machine, can increase the instance of CA in a susceptible person by simply washing out too much CO2. High (not bad) CO2 is the main signal for us to breathe, it is complicated but that is the simple explanation. Low CO2 levels are the single and by far most common cause of central apneas.
Seriously, don't be afraid of that, especially here, IF we see that happening here on AB we always recommend settings to offset it. Here is a partial list of what MAY, not WILL, elevate CA events.
- higher EPR/PS (pressure support)
- Higher pressures
- Uneven pressures
- Using medium and lower Trigger settings on a BiLevel
- Meds, especially pain meds like opioids, CNS meds
- CHF (Congestive Heart Failure)
- Stroke
- Seizure
- Brain Injury
- Obesity
- neuromuscular disorders, especially those that affect the diaphragm
Your charts all say via the leak chart that you are mouth breathing via the flat tops of the leak rate chart. Mask leaks usually have a series of spikes. We need to identify and correct the cause of your "Large Leaks" and any leaks that are disturbing your sleep. This is your one consistently off parameter.
We need to see why your sleep is being disturbed. Be aware at this time IMHO, the cause is NOT apnea, you simply do not have enough events. Apnea is NOT the only thing that could be causing your symptoms. Thus, I'm sure, the NP's recommendation to see a Sleep Psychologist
Because of your gasping comment, I'd like you to try
Min pressure = 12 (+2 from APAP success)
Max pressure = 20
EPR=3 Fulltime.
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