Fairly New APAP User

Greetings, all.
I have been lurking for a few weeks now. I've been on APAP for a little over three weeks now. I'm using a ResMed Airsense 10 Autoset with an Airfit P10. I've just switched from medium to large nasal pillows. When I did my initial sleep study about six weeks ago, I had an AHI of 48.9. For my titration study, I had an AHI of 1.9. My pressure range was prescribed at 6-13. Since starting therapy at home, according to the device, my AHI has been averaging about 7. I bought an SD card and only have detailed data from the last two nights. For the second night (6/2), I adjusted my minimum pressure to 8. Screenshots from Sleepyhead are below. Thoughts?

Welcome to the forum.

The bulk of your AHI is CA/Central and more pressure won't reduce those.

How is your sleep quality? Are you waking often or spending much time awake with the mask and machine on? If you are some of those centrals might be more related to awake breathing false positive flags and not a concern except they reflect poor sleep quality.

For some people the addition of EPR exhale relief into things can make centrals pop up or worsen. Not sure if that is what is going on with you or not because we don't know if you slept soundly or woke often.
If you slept soundly for the most part you might try turning EPR off and just see if it makes a difference in the central apnea numbers or not.
It's not very common but there is a rather small percentage of people who will develop centrals because of EPR being used when they didn't have centrals before cpap.

Do you take any medications of any kind? If so, what.

You may want to go here and watch the videos that explain how to figure out if those events are real or not.
Especially the bottom video.
http://freecpapadvice.com/sleepyhead-free-software

I'll add a little more about myself.
I'm a 48 year old male, 5'9" and 185 pounds. I take Benicar for hypertension and Prilosec for acid reflux. Since starting treatment, my sleep quality has improved, but I am still waking at night and am still feeling tired during the day. My blood pressure seems to be coming down somewhat. I also recently (Feb. 7) had surgery for Chiari malformation. There is a strong correlation between Chiari and both centrals and OSA, but I haven't been able to find anything definitive that suggests it is a causative relationship. I will try turning off the EPR. During my titration study, the centrals were nonexistent. I would love to get back to that point.

You can try turning off EPR and see what happens with the centrals then.
If no joy then we need to dig deeper and figure out if those are real centrals or just some arousal breathing irregularities getting flagged by mistake and if they are they should fade as you start sleeping more soundly with fewer wake ups.

Your meds are not known to suppress respiration which could lead to the centrals so I doubt we can blame the meds.

Awake breathing is very irregular and these machines can't tell if you are awake or asleep. They only measure air flow so sometimes those awake/semi awake breathing irregularities can get flagged but they aren't real and if you aren't asleep they don't count in the evaluation. We have to mentally ignore awake breathing flags.

What you might also do if you think about it is when you do wake up during the night reach over and push the button to turn the machine off and then push it again to turn it right back on. This will show up on the graphs as a break in therapy line which makes it real easy to spot awake time. You know you were awake if you turned the machine off and right back on. Any events near that break in therapy we know for sure aren't real.

I've turned off EPR and have given myself a little time to acclimate. In looking at the CA events, I think they are mostly SWJ, as they mostly coincide with times I remember waking up. Any suggestions on changes? I'm still feeling some fatigue during the day, but it has definitely improved. Thanks for the help!

Not much we can do about SWJ except try to reduce the arousals or whatever is causing the wake ups. Easier said than done. Hard to figure out what is causing the arousal in the first place.

You might try more minimum pressure on the off chance the arousals are related to a flow limitation or maybe the pressure changing is disturbing sleep a bit.
More minimum will better hold the airway open in the first place so maybe reduce the FLs somewhat and stabilize the pressure a bit so it doesn't roam around so much. For some people the least little change in pressure can be a factor in sleep quality.

There are arousals related to breathing and there are arousals that we don't know the cause and they are called spontaneous arousals.
Figuring out the cause for spontaneous arousals is hard and we really can't tell from the data available from the machine.

So for you there is a need to improve sleep quality....reduce the awakenings. Not an easy job for sure.

It is also possible that you just need some time for the brain to come to accept his new best friend...the mask and machine and quit poking you to say "hey dude do you know that there is an alien stuck to your face?" ....
I think it took me about 3 months for my brain to quit doing that. Just wake ups from the brain because of the new way of sleeping.

If it were me I would probably try more minimum pressure on the off chance that the wake ups are related to some breathing issues that don't really show up much on the data we have available. I don't think your centrals are related to pressure or the use of EPR...I think that most likely they are just a product of the arousal and are SWJ and thus they don't count and would be ignored. I know it's hard to ignore that many of them though. It's something to be tried...will it help or not...dunno. But you will have at least tried something.
I did that early on in my therapy. Found out nothing really changed in terms of sleep quality or the AHI but it helped me rule out pressure increases helping or not.