Starting CPAP Help (CSA?)

[scottrichard]

I'm new to CPAP, I'm experiencing some problems and the earliest appointment with my sleep doctor is over a month away. I hope someone here can help. I'll have to provide a lot of information, so please bear with me.

I have full PDF reports that I can upload, but this website apparently won't let me until I have 4 posts. I have uploaded 3 images that seem to be the most important, until I am able to upload the reports.

16 Apr 2025

• See sleep study performed. Key points below.
  
• 23.9 AHI
  
• 262 pRDI
  
• 184 pAHI
  
• 142 ODI
  
• 28 pAHIc
  
• 0 CSR
  
• 7h 41m sleep for indices
  
• 6h 47m sleep for central indices
  

4 May 2025

• First CPAP attempt.
  
• ResMed AirSense 11, pressure 4-20, EPR 3, ramp, soft response.
  
• Unable to exhale without breathing consciously.
  
• Unable to sleep and gave up after 3h.
  

5 May 2025

• Second CPAP attempt, same as first.
  
• Messaged doctor. No reply. Started doing my own research.
  

6 May 2025

• Following research, increased min pressure to 7, lowered max pressure to 15 and set standard response.
  
• Did not change EPR 3 or ramp.
  
• Immediate improvement in ability to exhale. Managed to sleep in 3 blocks of 45m-1.5h, for a total of 4h, before quitting for the night.
  
• OSCAR data shows very little H (2) or OA (6) events, but many CA events (49).
  
• Almost all CA events occurred in tight clusters - 24 in 15m, 4 in 2m, 11 in 7m, 5 in 3m.
  
• CA volume is very concerning - recall sleep study only had 28 in 6.75h.
  

General Notes

• I suffered a migraine (with aura) on 7 May 2025. I usually only get one of these per year.
  
• I am now scared of my CPAP machine and do not want to use it again, unless something is changed.
  

Questions

• Should I be on ASV, instead of CPAP? Even if you eliminate all non-CSA event types from my sleep study, my AHI seems to be around 4.2 with purely central events (6.75/28). CPAP seems to increase CSA for me, so I question whether it is possible for me to ever have a low AHI.
  
• What settings changes would be worth trying?
  
• I notice a lot of cyclical breathing, like Cheyne Stokes Respiration, without the apnea. Is this something to be concerned about?
  

[scottrichard]

I've attached some extra screenshots to this post.

One screenshot shows my OSA events. They look the same as the CA events. Is it possible these are actually CA events?

The other screenshot shows cyclical breathing, similar to CSR, without apneas. Should I be concerned about this?

[custom68]

I had a couple of nights like this and am still working to sort it out. It is pointing to the fact I may need to switch machines as well but time will tell.
What I did that helped was go to the CPAP mode so I was at one pressure. I had started at around 8 with an epr of 2. That helped. I am now down to 7 same epr and trying that for a few nights. It has brought my AHI numbers down but I am still questioning my breathing cycles. My CA events seemed to be pressure related.
You might try that but ultimately you may need to go to that ASV machine.
The folks in here are much better and smarter on these facts than I am. I am just relaying what has somewhat helped my situation.
Good luck.
Dave

[scottrichard]

I had a couple of nights like this and am still working to sort it out.  It is pointing to the fact I may need to switch machines as well but time will tell.
What I did that helped was go to the CPAP mode so I was at one pressure.  I had started at around 8 with an epr of 2.  That helped.  I am now down to 7 same epr and trying that for a few nights.  It has brought my AHI numbers down but I am still questioning my breathing cycles.  My CA events seemed to be pressure related.  
You might try that but ultimately you may need to go to that ASV machine.
The folks in here are much better and smarter on these facts than I am.  I am just relaying what has somewhat helped my situation.  
Good luck.
Dave

Thanks for the reply.

I just read your entire treatment thread. We seem to be in a very similar scenario. Funnily I am an engineer too. My sleep study central events are roughly the same as yours, but my hypopnea and obstructive events were much higher.

My non-central events were well controlled at 7, so tonight I am planning to run 5-8, no EPR, no ramp. If that is an improvement, I will slowly change the min and max pressure until I get to a fixed pressure, like you did.

Unfortunately, based on my research, both of us will need ASV. ASV is contraindicated for some (heart related?) stuff and there’s some tests you should do first. I plan to get started on those tests now, so it’s one less thing for the medical “system” to drag their feet on.

Please keep updating your thread. I will be following with great interest.

[custom68]

It sounds like you have a solid plan going forward.  I have been short to post too much as I was trying to make sure what I had done made a change.  I will see how this weekend goes.  I have times that I feel I am moving forward and others not... So far all i have done is my initial sleep study that was done at my home.  I then received an e-mail asking for my insurance information and I needed a CPAP, unfortunately I didn't ask too many questions as it was all new to me.  That is what I would recommend to everybody diagnosed with APNEA is to dig a little deeper to understand it.  
We will sort it out and good luck with your journey.
Dave

[scottrichard]

I was unable to sleep, with 5-8, no EPR, no ramp.

Every time I would start to fall asleep, I would stop breathing, my O2 would drop to 83-85 and I would startle. The pressures were around 5.5-7.5, when this occurred. I wore the mask for an hour, before bed, to try to acclimate to it.

I was previously able to fall asleep at 7 and EPR 3.

I don’t know what to do. This is not the experience I had hoped for.

The only thing I can think of is to try 6-9 and EPR 3 during ramp only. Perhaps the EPR is what enabled me to fall asleep that one time. However, the CA was significant and I’m guessing that was exacerbated by EPR. I endured that for 2 hours before giving up. I ended up having quite bad insomnia afterward, presumably from adrenalin or anxiety.

If anyone has and advice, I would appreciate it.

[custom68]

I would still look at going to the CPAP fixed pressure and give that a try. I do believe it has helped me some but I am still struggling to get them to a more manageable number. I still believe the changing of the pressure for the treatment was problematic for me, but I am not sure to what degree.
Dave

[SarcasticDave94]

Let's go back to some beginning questions. You don't qualify for ASV if you want insurance to pay. Your test numbers were 28 CA to 184 OA as I'm seeing it. The CA aren't equal or greater than Obstructive Apnea, mostly required for an ASV.

Next, other reasons for CA: high altitude, does this apply?

Yes, you have some CA in OSCAR. You had some in the test, indicating you have a higher sensitivity to have CA already. Your AutoSet will probably induce more CA, here it's treatment emergent Central Apnea. The AutoSet is providing a small pressure increase to your lungs, and every exhale flushes more CO2 than your body is set for as your normal rate. This equals a breath pause while CO2 builds and triggers the next breath.

Next, you're having some of what appears to be Positional Apnea patterns in the middle of that big chunk of CA. Positional Apnea is you tucking your chin to chest and kinking your airway closed externally. Read my signature link for better understanding.

It's possible the Positional Apnea pattern is a mixed up CA and OA flags, but can possibly be really Obstruction based only. Remember your AutoSet doesn't have the inputs needed like the sleep study diagnosis to know for certain the event was Central or not.

Reduce the extra thickness of pillows so your head isn't tilted forward, as applicable. Otherwise prevent your chin from tucking in by blocking the motion with other things. Side sleeping, then use the corner of the pillow to fill the gap between chin and chest. You may need the soft cervical collar to block it as well.

Another thing to address the CA flags, reduce or eliminate Ramp. Also reduce EPR down 1 number to see what reports. Both are variable pressures aspects that may induce CA.