Welcome to the forum. I'm not going to lie to you and tell you that this journey is going to be easy, it isn't. But we, I assure you that I am not the only person here that can and will help you.
You have several issues going on that very likely impact your apnea.
Altitude, hey you are in Colorado, I don't see any indication it's an issue but we need to keep it in mind.
You currently have CHF, I would suggest approval from your cardiologist before upgrading.
Is your periodic Breathing actually CSR? Zoom in on the segment and we can see if it matches the pattern for CSR.
As you know your apnea is predominately central Apnea.
You hit many of the possible causes of Central Apnea, these are from the Mayo Clinic.
Central sleep apnea can be caused by a number of conditions that affect the ability of your brainstem — which links your brain to your spinal cord and controls many functions such as heart rate and breathing — to control your breathing. The cause varies with the type of central sleep apnea you have. Types include:
- Cheyne-Stokes breathing (CSR) This type of central sleep apnea is most commonly associated with congestive heart failure or stroke. This condition is characterized by a gradual increase and then decrease in breathing effort and airflow. During the weakest breathing effort, a total lack of airflow (central sleep apnea) can occur.
- Drug-induced apnea. Taking certain medications such as opioids — including morphine sulfate (Ms Contin, others), oxycodone (Oxycodone HCL, Oxycontin, others) or codeine sulfate — may cause your breathing to become irregular, to increase and decrease in a regular pattern, or to temporarily stop completely.
- High-altitude periodic breathing. A Cheyne-Stokes breathing pattern may occur if you're exposed to a very high altitude. The change in oxygen at this altitude is the reason for the alternating rapid breathing (hyperventilation) and underbreathing.
- Complex sleep apnea. Some people with obstructive sleep apnea develop central sleep apnea while using continuous positive airway pressure (CPAP) for their sleep apnea treatment. This condition is known as complex sleep apnea because it's a combination of obstructive and central sleep apneas.
- Medical condition-induced central sleep apnea. Several medical conditions may give rise to central sleep apnea of the non-Cheyne-Stokes variety.
- Idiopathic (primary) central sleep apnea. The cause of this uncommon type of central sleep apnea isn't known.
Treatment.
Your ResMed AirSense 10 AutoSet is NOT designed to treat Central Apnea, Thus with your APAP we treat by trying to avoid Central events.
Generally, there is no absolute here,
Higher Pressures tends to increase Central Events
Higher Pressure Variance both algorithmically and with Higher Pressure Support tends to increase Central Events
So we try to reduce Pressure and reduce Pressure Variance to avoid Central events and come to a comfortable middle.
The machine that treats Central Apnea is the RedMed AirCurve 10 ASV. This is the only machine (by ResMed) designed to treat Central and Mixed Apnea. This works with fairly low pressures and a high Pressure Support when a Central event is occuring. Typically reduces AHI well under 5 and many get "Near Zero" AHIs
ASV therapy is contraindicated in patients with chronic, symptomatic heart failure (NYHA 2-4) with reduced left ventricular ejection fraction (LVEF ≤ 45%) and moderate to severe predominant central sleep apnea and as such you need to be medically cleared.