New to all of this. Here's my data.

[ajack]

I'd listen to sleeprider, I saw an ASV chart where positional apnea was also raising CA, this might be the same thing. I'd keep this in mind as you go forward.

edit double post, I saw that sleeprider responded and so wanted to include that, but finished up making 2 posts.

[tm76]

Thanks again guys.  I really appreciate your help.  It's really great to see you spending so much time helping all of these people out.  I'll update again soon after trying your recommendations.

[tm76]

Best night so far after adjusting min to 9 as advised.
I'm finding it really strange to not be so tired all the time.
Thanks once again ajack and Sleeprider!

https://imgur.com/a/27bLu

[ajack]

I'd now try a soft foam cervical collar, to see if the clusters are from chin tucking. It could be from a sleep stage but they do erupt. Mine go stupid in REM sleep.

there are also some leaks that need sorting

If it continues, I'd try min 10cm, the DS is a slow machine and likes to be close to the 95%

The CA seem fine with the flex you are using.

when you get a full face mask, you need it for a cold. It might be interesting later, to look at your Med/median tidal volume and breaths per minute.

[Shin Ryoku]

I think this thread may be a good example of why most specialists consider CPAP (in this case APAP, but not ASV) to be the preferred first-line therapy for symptomatic patients with hyperventilation-related CSA, including primary CSA, even in patients with preserved ejection fraction. No one knows the mechanism by which ASV caused excess risk in low EF patients in the SERVE-HF trial or whether the findings from that study indicate a related risk for people without low EF.

To quote from a recent review at UpToDate.com written by M Safwan Badr, MD at Wayne State Univ SOM:

CPAP is the preferred first-line therapy for symptomatic patients with hyperventilation-related CSA. This approach is largely based upon the extrapolation of evidence from studies that focused on CSA in patients with heart failure [2]; there is a paucity of direct data regarding the treatment of patients with other types of hyperventilation-related CSA.

ASV remains an option in patients with hyperventilation-related CSA and a preserved ejection fraction, although treatment decisions in such patients should be individualized, and there is a paucity of direct data in these patients [15].

Patients who are already using ASV for other indications (eg, heart failure with preserved ejection fraction, primary CSA, treatment-emergent CSA) should be informed about the safety signal from the SERVE-HF trial; in some cases the balance of risks and benefits may still favor ASV therapy, particularly in patients who are responding to therapy and have failed prior CPAP.

[tm76]

I've been using a collar for the past few nights.  I also bumped up my min slightly to 9.5.  My AHI still seems to fluctuate a good bit. It seems like the longer my session the higher my number: https://imgur.com/a/cn7Wf
But last night was still one of my best nights so far: https://imgur.com/a/uqsWx

I'm generally a side-sleeper, but that's a little uncomfortable with the collar.  Also, I've noticed that the wisp seems to get a little more leaky when I'm on my side.  Should I try a nasal pillow?