sleep struggles, ASV and centrals, AHI under 3

[gdubyac]

Hi There,
I was hoping the community could give some advice on what’s going on and what settings I should try adjusting. I’ve been sleeping moderately poor – low energy levels and not waking up rested despite good AHI and 7-8 hours of sleep as reported by my resmed aircurve 11. I am confident it is sleep quality/apneas causing this.

I need help from the online community because I lost my sleep doctor (they moved) and the doctor I waited a month and a half to see has no idea how to use PAPs to treat centrals. It’s going to be 6-9 months before I can find and get in to see a competent sleep doc.

FWIW I think the thing it makes sense to try is increasing the PS range significantly, but that’s mostly a process of elimination judgement. You’ll be able to see this in the notes below and my sleep data, but I tried increasing epap for 6 to 7 from 8/27 thru 8/31 but this made my sleep worse (ahi worse + my experience of wake-ups and restfulness). I guess that this increased the numbers of centrals I was having so starting 9/1 I decreased epap to 5 and increased PS to 0-10

Here’s a link to my data: https://sleephq.com/public/teams/share_ ... 3956e8e751

What my settings have been: June 2026 to 8/27/2026
Mask: p10 – never have any leak issues
Machine: Resmed aircurve 11
Mode: ASV
EPAP: 6
PS: 0-5
*those are the only settings available to be changed in clinical mode. I cannot directly set the max IPAP, but epap of 6 and PS of 0-5, the max IPAP is 11

8/27 -> 9/1: all settings same except epap from 6  7

9/2  present: what I’m experimenting with
ASV
EPAP: 5
PS: 0-10

Notes on me:
I have well documented central, obstructive, and mixed apneas from type 2 tests including 1 in lab test in 2024 and another at home test from snap diagnostic in 2026. I live at 5300 ft elevation. ASV titration study in 2024 sort of suggests PS should go up to 15, but wasn’t tested at max of 10, and the underlying data isn’t available to suggest whether I needed 15 or not. I tried ASV in 2024, but wasn’t able to tolerate the pressure support – it would wake me up with most ramps. In 2026, I’ve been able to tolerate the pressure through a combination of switching to p10 (nasal pillows) from n30i (cushion in 2024) and several other airway interventions that have significantly improved my airway and nasal breathing ability. NOW, I can tolerate PS of 0-10 though I’m not sure if I can tolerate 0-15 or higher (haven’t tired). I’m 34 and in relatively good shape – my BMI is misleading and probably have 20-25% body fat. I don’t have any heart conditions. I take long acting methylphenidate daily.

[Sleepzilla]

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[zonker]

until I eventually 1) learned how the machine works with context to how I work, and 2) gave myself some time to adapt to the therapy experience instead of constantly fighting it.

^^^^^THIS!^^^^^

and it really can't be stated enough.

[gdubyac]

This is awesome and thorough advice. I can’t wait to implement.

Question for Sleepzilla, can you explain how you figured out I’m have OA’s. I was thinking most of my UAs and hypotonias are centrals because the vast majority of any flow restrictions occur when the pressure support is ramp up already which I thought meant the event was a central: https://www.apneaboard.com/wiki/index.p ... rpretation

Also Sleepzilla - I've been on the forums reading and learning as much as I can, and I've noticed you’ve helped a lot of people. Thank you so much for them and me!!!

I know it’s bad to move things around like this, but should I change my settings again (e.g.,) ASVauto and let that epap range a bit, and open up my PS range even more? Do this right away and try to get used to it rather than use the settings I have now:
Mode: ASV
EPAP: 6
PS: 3-9
Ramp: off

[Nocibur]

I have well documented central, obstructive, and mixed apneas from type 2 tests including 1 in lab test in 2024 and another at home test from snap diagnostic in 2026.

Do you have those complete reports?

[gdubyac]

these don't have a ton of detail. if y'all need more info please let me know what so I can ask my providers for the additional things. also i couldn't upload my 2024 study, it's too big, so I just uploaded a few pages, first is analysis with no treatment, 2nd page is with pap, 3rd page IDK.

2026 will post next

[Sleepzilla]

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[Sleepzilla]

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[Nocibur]

In re: 2024 study do you have the data for Sleep Efficiency, Sleep Stages and Arousals?

Also include those parameters in the 2026 study.

What is "CPAP 0.99"?

centrals2.jpg (38.79 KiB) Viewed 1846 times

Isolated centrals are usually (always?) normal phenomena.

Frankly, I would consider the possibility (probability) that you don't have anything that would benefit from from xPAP, and that the chief issue is "bad sleep".

[Nocibur]

It appears a lot of decisions affecting the rest of your life were made on data from this area:

centrals3.jpg (8.17 KiB) Viewed 1841 times

where you were literally jumping around in bed.

IIWM I'd actually be looking at the NPSG raw data to see if it is indeed valid or should be dismissed as artifact.

[Nocibur]

https://www.psychiatrist.com/jcp/sleep- ... phenidate/