Advice on how to improve my dad’s sleep

[colomom]

My 80 year old father has many health issues (to list them all would take many pages). The big ones are hypertension, a few heart issues that the docs don’t seem concerned about (murmur, moderate aortic valve stenosis, left bundle branch block). A spine and shoulders that are pretty much completely broken down, extremely painful and sadly beyond repair. Severe depression which has been a lifelong struggle, but has recently severely intensified due to physical health issues. Recent intermittent memory loss/ changes in speech (ex slurring words, stuttering, getting lost in thoughts). Recent problems with weakness, syncope, pre-syncope, and falls.
BPH and additional urinary retention that resulted from Cauda equina syndrome and a surgery to remove the offending tumor in which some nerves including nerves that control the bladder had to be cut (he now has to self cath a couple times a day to fully empty bladder).
Meds aren’t many Tamsulosin, diclofenac for pain and 25 mg of hydrochlorot for edema (also lowers BP).

After years of me trying to convince my dad to do a sleep study, I finally talked him into it and he did a home study which showed he has severe OSA. He followed my advice and got a great machine (ResMed 11) and after trail and error settled on a mask he likes (F&P Brevida) He has used his APAP religiously since he received it and it has really helped his sleep! Inspite of that with all his pain and other health issues, his sleep while greatly improved is still pretty bad. Wondering if anyone more knowledgeable than I am can glean anything from a couple of Oscar screenshots I took of typical nights and offer any suggestions on anything that could be done to improve his sleep even more. Thank you for your help!

[Pugsy]

Are we going on the assumption that the bulk of those central flags are arousal/awake related?

[colomom]

Are we going on the assumption that the bulk of those central flags are arousal/awake related?

I figured the centrals were most likely arousal/ awake related, but while on some of the centrals I see obvious spike that scream arousals, I didn’t see any huge spikes in flow patterns before the the majority of the centrals. I’m not very good at analyzing this stuff so I really don’t know. Here are a few more random zoomed in shots of the breathing proceeding centrals. What do you think?

[Pugsy]

You've actually zoomed in a little too closely and not included enough of the flow rate prior to the flagged event to maybe help with the evaluation. Some more obvious arousal breathing after a couple of those...makes me think to lean more towards arousal related.
That said...even if it is the real deal it is entirely possible some of them are sleep onset centrals and those are normal and if someone has quite a few arousals then that in itself will increase the chance of real sleep onset centrals happening.
The more we wake up and go back to sleep the greater the chances of those sleep onset centrals happening.
Reduce the wake ups...reduce the sleep onset centrals...if that is some of what is seen here.

So we are back to trying to figure out how to try to fix the known problem of the crappy sleep...with or without the centrals it is a known problem and one that is extremely difficult to fix even if we know the problem.

My gut tells me that for the most part his OSA is well treated and he is very likely just having crappy sleep sessions due to all that is going on with him.

The 01:20:20 first flagged central and the 2 following....I really think they are very likely arousal related.
The flow rate just is a bit irregular. Doesn't look like the nice boring rhythmic breathing of being asleep.
It looks like he probably has a lot of those which I tend to call "iffy".
Even if real....not much we can do about them anyway. It's not like he is having a bunch of OAs or hyponeas right before the clusters of centrals that we could maybe blame the OAs for causing the arousals which in turn likely cause the arousal centrals.

In other words I don't see an urgent need to go tweaking the pressures BUT there are times when the pressure itself varies fairly widely and it wouldn't be impossible for those variations to maybe cause some sleep disruptions.
If it were my dad...I would seriously consider increasing the minimum to around 6 and see what happens with the pressure changes as well as his sleep. I would also consider maybe adding in a bit of EPR to see how he responds.
I don't know if it will help or not but it is something to try that might (stress the might) help and I don't see it hurting anything to give it a try.

Good luck. It's not easy and I fully understand the desire to help. I just don't see anything screaming "change this and it will fix the problem".
I am speaking as someone who also has well known crappy sleep and it's from all the old age stuff and I have already gone through the tweaking routine to try to help but when crappy sleep isn't caused from airway issues then cpap can't help much. I do a lot of tossing and turning related to discomfort issues...about 75% of all my flagged events are arousal related. I wake up often during the night...sometimes go right back to sleep but sometimes it takes a while and it's usually those "a whiles" that I end up with arousal related flagged events.