UARS, TECSA, or post-arousal centrals? Need help with waveforms and fine-tuning CPAP

[elikrohner]

I’ve been on CPAP for over a year. Obstructive are controlled but showing CA around 3/h and I am still very tired. It looks like some of my waveforms show irregular, jagged breaths with subtle flow limitation, then arousals and central apnea flags (~2–3/hr). Also, I see some CAs that look real.

My question: Does my data look more like UARS with post-arousal centrals, or true central apnea? And what would you adjust next- fixed pressure ladder (8.2 → 8.4 → 8.6), narrow APAP range, or perhaps different mode like bilevel/ASV
machine / Settings: ResMed AirSense, fixed 8.0 cmH₂O (EPR off, sometimes 1).
Mask: Vitera.
Symptoms: Still unrefreshed despite low OA/H.

I started with mild OSA — AHI 13.6/hr (3% rule), 6.3/hr (4% rule) on my HSAT. Most of my events were flow-limited breathing and RERAs, not big desats. Centrals minimal at baseline.

Post-CPAP:

OA/Hypopneas controlled (OAI near 0).

CAI rose to ~2–3/hr, most of residual AHI.

RERAs/flow-limitation events persisted (3–7 per night).

Fragmentation remained despite good numbers.

What I see in OSCAR/SleepHQ:

OA and H are well controlled.

Median tidal volume 320 mL, p95 ~500–600 mL (lots of recovery breaths).

Waveforms show jagged, flattened inspirations and arousals followed by central apnea flags (CAI ~2–3/hr).

Tried tight APAP range and higher fixed pressures → didn’t help. ASV trial failed, controlled centrals but intolerable blasts. (PSmin too high).

My ask: Based on these waveforms, does this look like UARS with post-arousal centrals or true central apnea?

Should I keep stepping fixed pressure (8.2 → 8.4 → 8.6)?

Try a narrow APAP range (e.g., 8.4–9.0)?

Should I try Bilevel/ASV?

Thanks in advance

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