Not sure where to begin

[Yawn Wayne]

I'm not sure of my history with central apneas, but yes I did take opoids after my surgery.  I'm at the point now where I only take the occasional pain pill.  (twice in the last week)    I did notice a definite spike in my AHI graph right after the surgery.  I would have expected it to diminish back to the norm by now though...?

[Gideon]

can you post a sleepyhead chart from pre surgery?

[Sleeprider]

Your graphs could still use some refinement, but let's confirm your settings and where you're at for therapy. Your machine (Auto BiPAP 760) is set to Auto B mode with EPAP min 12, IPAP max 25, PS min 0.0 and PS max 8.0. The Philips machines are notoriously slow to respond to obstructive events, and yours is doing a poor job. In spite of all the obstructive events, your median pressure is at 12.9 cm and the maximum pressure reaches 16.0 and your machine seems stuck on zero pressure support, meaning IPAP and EPAP are equal.

I think your problem is a combination of positional apnea where your head and neck alignment are causing your airway to be occluded (chin tucking), and you appear to need a higher minimum EPAP pressure. My recommendation is to strongly consider a soft cervical collar or wedge to prevent your chin from tucking (see link to wiki below) and an increase in minimum pressure and minimum pressure support. Let's start with a minimum EPAP pressure of 11, and increase the minimum PS to 3.0. If you provide your neck circumference we may be able to better suggest a collar or wedge. The revised pressure settings should give you pressures ranging from 14/11 (IPAP/EPAP) to as high as 25/22, however I don't expect the machine will increase nearly that high. If you can correct the chin tucking, the OA events may significantly decrease as shown in these wiki articles we wrote for members with flow limitations and obstruction associated with poor head alignment or chin tucking. The increase in minimum pressure support is simply to use your BiPAP in a more comfortable way and to see if it will properly deliver pressure support. There is a small risk that using pressure support may increase CA events, but I think we can deal with that if we see it.
http://www.apneaboard.com/wiki/index.php...onal_Apnea
http://www.apneaboard.com/wiki/index.php...Limitation

[Yawn Wayne]

can you post a sleepyhead chart from pre surgery?

Sure.  Not sure if you meant literally right before the surgery, but this is the night before my surgery.

[Gideon]

again you have no events showing, please enable them

[Yawn Wayne]

again you have no events showing, please enable them

Sorry about that, still learning the software.    I've attached a new screenshot.

[ajack]

It is going to take a bit for you to get the charts right.
Keeping it simple till you sort it. look up your machine in the list
https://www.apneaboard.com/adjust-cpap-p...tup-manual
I would change the min PS from 0 to 3 as suggested.

[mesenteria]

After major surgery, one is necessarily forced into the most comfortable and sustainable positions.  This will be very true while trying to stay asleep.  As Sleep Rider has expressed, it would be a strong suspicion in my mind when addressing what appear to be positional events, or events that my be highly dependent on one's sleep position.  It's about all that is left now that any opioids or other semi-stupefactants are out of the picture.

[Yawn Wayne]

Thanks everyone for your responses! I hope to look into it further this evening when I have some more time.

I may have to look into some sort of collar. My neck circumference is about 19 inches.

[mesenteria]

Thanks everyone for your responses!   I hope to look into it further this evening when I have some more time.

I may have to look into some sort of collar.   My neck circumference is about 19 inches.

I'm not going to suggest it is necessarily so in your particular case, but I learned early in my own diagnosis that neck circumference is fairly highly correlated to sleep apnea.  I seem to recall that if one's neck circumference is greater than 15" (38 cm), one runs the risk of having or developing obstructive sleep disorders of some kind.