Advice requested to improve treatment

PB and CA numbers aren't higher than obstructive numbers. They are actually quite low.
One tiny segment of PB immediately before a break in therapy...my bet is probably irregular awake breathing...and even if it isn't there's not enough PB to worry about.

My first suspect for the change in pressure needs starting at 00:15...probably rolled over on the back.
It's a little to early to suspect REM sleep stage but not impossible I suppose if REM came a bit earlier than normal.

There is room to reduce the obstructive stuff and I really doubt that increasing the pressure is going to impact the centrals one way or another.
If it does...then bring the pressure back down.
I would do small increments though..like 0.5 because I think it is an easier adjustment and there's really no urgent need for big leaps.

Thanks. I'll try another .5 increase tonight. I'm happy my AHIs seem to be getting better. The night before last it was 2.4 with 1 CA, 4 OA, and 11 H. That was one of my best nights so far. Don't really feel better, but I figure this is going to take some time. And I don't really feel worse anymore, like I did at the beginning. Do that's some progress I suppose.

Until you actually are sleeping more soundly it really isn't going to make all that much difference what the numbers are.
Nice low numbers are easy to get for the most part but getting good quality sleep is much more difficult.

Also remember that even with good quality sleep in enough hours with minimal wake ups we don't always feel so great but it's not from cpap therapy or sleep apnea. There's a long list of culprits out there for not feeling so great.
But we have to start somewhere and optimizing our therapy is just a common sense starting point.

And there is a lot of truth to the "give it time" thing. Sometimes improvements are so very gradual that we don't really notice just how much things have improved until something happens and we get a rude reminder just how bad things used to be.
Mine came when I went on a trip and forgot the long hose and had to sleep one night without the machine. Man did I ever realize just how bad I used to feel when I got to feel that way again.

OK, I've had two nights with the slight minimum pressure increase to 7.0. I feel like I should hold there for now. I think it has achieved one of my goals, which was stopping lots of mask leaks. I have had barely any leaking the past two nights. I do notice that when I sleep on my side, I don't get leaks, and I mostly like to sleep on my side. But when I try sleeping on my back, leaks start to come from the bottom. When I lie on my back I can feel my face flatten and jaw slacken and then a little leak comes. So for now, I'll just stick with mostly side sleeping.





Although these are decent graphs, both nights only felt like so-so sleep. I am still waking up a lot during the night, and therefore not seeing much (if any) improvement. (It's only been 3 weeks). I think it's due to adjusting to this equipment on my face and worry about my sleep. My graph for last night looks really good towards the end. Well, that's partly because I was awake from about 3:30-5. One thing that helps me get back to sleep is trying to get cold. The heat of a mask on my face makes me pretty warm (as does being pre-menopausal), so I have to remember to try to get cold to fall back to sleep. That's what I did at 5am, and I slept really well after that. (I use the heated humidifier - does anyone think turning off the heat would help with this problem? My nose gets stuffed up a lot, and I've felt like the heated humidifier is helping with that, but I don't know for sure.) I hope I can soon be less aware of the mask and the hose and the sound of the machine. Way too hyper-aware of all of it.

Are you using the heated hose or the regular non heated hose?

If using the heated hose you can adjust the hose air temp cooler and not have to sacrifice humidity if that is your preference.
During the summer I don't care for the warm air (but it feels good in the winter) so I have the hose and humidity controls set separately.
I want as much moisture as that humidifier will crank out.

If using a non heated hose you are more or less at the mercy of the humidifier heating for control over hose air temps and if you cool it down with less heat that means less humidity delivered.

If using the heated hose you can even turn it down to 1 or maybe even Off (not sure with the DreamStation) and still have control over the humidity and have it higher if you wish. You may experience condensation in the mask or hose but if you do there are ways to reduce that annoyance. During the summer months I don't have much issue with condensation but in the winter months I do because I keep the bedroom really cold.

It is the heated hose. I'll look into turning the heat down.

One other question - I had 5 CA's last night. What numbers would be worrisome for CA's?

5 Centrals over the entire night wouldn't be worrisome to me at all even if they were all the real deal.

Doctors won't start even raising an eyebrow unless you start having enough of them that you get a 5 per hour average or maybe some really dense clusters of centrals which might mean a whole bunch of sleep onset centrals keeping a person from progressing into the next sleep stage.

I once had 17 centrals in 17 minutes...1 a minute. Never did figure out what that was from. I thought I was asleep from the respiratory pattern but it was maybe a bit iffy. Might have been semi awake breathing. Only had it happen once though so I never really dug very deep trying to sort it out.

Your centrals are random and spread out over the night and not really all that numerous. Some might be sleep onset...some might be post arousal if you woke up briefly (you may or may not remember it) after an obstructive event. Some might be SWJ. No matter what they are in your situation though I wouldn't be worrying about them. Just not enough of them throughout the night to raise the alarm.
Especially since you are so new to therapy and still having trouble staying sound asleep. There's a good chance there are a couple of awake/semi awake pauses in breathing happening.

If you are worried about increasing the pressure causing centrals...don't. It's not all that common really and chances are you aren't one of the 15% or so that will get centrals from cpap pressure. I normally see pressures in the high teens and my central count is no different than yours.

From these reports here....you have a long way to go before your central count would be worrisome.

Happy to report that my small pressure increases seem to be working. Since changing my minimum to 7 about 5 days ago, my lowest AHI has been 1.8 and the highest 3.4. These are much better numbers for me. Best of all is a huge reduction in leaks. They were a real problem at first but haven't been a problem lately. The other factor that seems to influence my sleep is my pillow. I have a pretty thick pillow at home, but I'm currently at my mom's house and using a much thinner pillow. It's helping me sleep really comfortably on my side with no aches in my neck and no mask leaks. Think I'm going to need to buy a thin pillow when I get home! (Oh, and I may need to import some crickets. Love falling asleep to the sound of crickets!)
Thanks everyone for advice given!

OK, looking for where to go from here. My AHI tends to be in the 3.0-4.0 range lately. It feels okay, although I felt much better when it was 1.8 a few days ago. That sleep actually felt much better than most. The first sleep since I started that actually made me feel like cpap could make a difference for me. Anyway, last night was 6.2, and I know it's just a one-nighter so I shouldn't obsess about it. But, I'm wondering what advice you'd have for this clustering. I tend to have 2 clusters of events each night -- one around the 1:00am-3:00am range and another closer to 5:00am. Yesterday's are different time frames, however. The good news is that I am sleeping better through the clusters, but, I shouldn't be having the clusters at all, right? (Also, I was surprised my AHI was 6.2, because this sleep felt better than the 3.2 preceding it. I think one reason is because I didn't have many events in the last couple of hours before getting up. I think I feel worst when I've had lots of events shortly before I have to get up.)

As a reminder, I had an initial pressure set for me of 5-15. I have changed it gradually to 7-15. Since then, my AHI's have been all under 5, except for last night.

Two usual suspects when we see clusters like this and not much of anything else of great importance during the other parts of the night.
Supine sleeping
REM Stage sleep
or maybe a little of both.

It's obvious that the pressure during the cluster isn't sufficient to hold the airway open and prevent the airway collapse.
It could go higher but doesn't...so the only other potential fix is to use more baseline/minimum pressure in an effort to better prevent the airway collapse from happening whatever the cause.

The timing of the clusters looks like it could very well be REM stage sleep. It could also be that you were on your back maybe....or maybe it is a combination of both. You probably also have REM in those wee hours of the morning (where we normally will have more REM) and not much is happening then.

I don't know that I would invest much time in doing much about just one night like this. It's a bit ugly but you don't feel the ugly and in fact think you slept better than some of the other nights where it wasn't so ugly. I don't advise changing things willy nilly based on one night's ugly results. If we did that we would be changing things all the time chasing last night's results and we simply don't sleep the same each night and it will drive us crazy.

I am familiar with REM clusters because I have seen lots of them because my OSA is documented worse in REM sleep...like nearly 5 times worse.
Supine sleeping hasn't ever seemed to be a big factor for me but it can be for some people. I once built a wall to make sure I never ended up on my back and stayed on my side and never moved and I still had the probable REM clustering.

Google "sleep stages" and take a look at the hypnograms showing the various sleep stages and when they occur and compare REM cycle times. When you talk to your doctor get a copy of the results and look to see what is mentioned about REM AHI or supine AHI.
Should explain what is probably going on. My non REM AHI was 12...my REM AHI was 53. Supine or non supine didn't really change much but some people it will.

Then you can decide how you want to deal with nights like last night. We all have them from time to time and sometimes we don't ever really know for sure why they happened.
Should you start seeing more nights like last night than you want to see or your AHI doesn't quite come down to what you would like to see you can always try a little more minimum pressure and you might not need much to break up the clusters.
If it were me and I only saw this bit of ugly once maybe every couple of weeks and the rest of the time not much going on then I probably wouldn't do more than shrug my shoulders. But if I saw this once or twice a week I would again try a little more minimum pressure.
I know you have been doing 0.5 cm increases slowly and that's what I would continue to do if it were me. Might get lucky and just a tiny bit more pressure will hold that airway open better and while you might still have an occasional OA slip past the defenses it won't be such a dense cluster.

I don't advise making changes based on one lone night though. Heck, just a couple of weeks ago I built a wall and made sure I stayed off my back and I had a night with the AHI of 10.2. Go figure that one. The night before it was less than 1.0 and the night following it I had less than 1.0 AHI. About all I could do was scratch my head and shrug my shoulders. I felt no different otherwise and I slept about as well as I normally do.

Thanks for the reply, Pugsy. My AHI at sleep study was 20, but is was 71 during REM sleep. So the REM is definitely a problem. But yeah, good to know weird nights just pop up here and there.

Ahh...you are like me then.
All I can tell is that sometimes you are just going to have some weird clusters and have no explanation for it.

For me it was always the first REM cycle where I was almost always "worse". Made no sense because I know that we have more REM in those wee hours of the morning but it was rare that I ever had much ugly show up there.
Always about 90 minutes after sleep onset which is usually where the first REM stage pops ups. I would just laugh and call it my witching hour.

I never really worried too much about ending up on my back since it didn't seem to make that much of a difference and I just figured sleep however I could sleep and let the machine sort it out since we have zero control over REM.

Yes, mine is appearing to be exactly the same as yours. First REM Cycle is the part of the night where I have the most trouble. The rest of the night is pretty good. Going to be raising the minimum pressure to see if I can improve that. Doctor also suggested that would be good (currently at 7 - she suggested working up to 8 or 9), since my REM AHI is 3 times more than non-REM.