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I have been tracking your issues and the advice from other forum members is solid. When I first saw your results from your first post I thought maybe you have the wrong machine.
I thought maybe someone made a mistake on the prescription or you were given the wrong machine by mistake. If matters do not clear up in the next week or two you should get another test done and bring along the results to your doctor to show your Central Apnea issues.

Thanks Cannuck for your advice. I saw my sleep doc today. She said I was challenging and will put me on a 4 week trial of an auto bipap and add Sonata nightly to see where that takes us. Overall she thinks the cpap controls my OSA but is puzzled as to the CSA, as it never showed in the sleep studies. She at least acknowledged the CSA this time. And instead of another sleep study she was at least thoughtful enough to order the 4 week auto bipap trial. After all I've learned from everyone here, I went to the appointment hoping for exactly what she ordered minus the sleep med- but I will try that too. One reason for the centrals she thought might be the frequent awakenings so I may be frequently having the sleep wake stuff throughout the night, hence the sleep med. So, I am anxious to see what happens over the next 6 weeks or so. Again, all advice since this started has been greatly appreciated, I've learned so much from all and plan to continue learning!

Good to hear from you, maybe you will get two birds with one stone with the new machine BiPap Apap.(keep us informed on your progress)
All the best.

Wel, I picked up an aircurve auto bipap yesterday and last night felt that I could breathe much easier though my numbers were still bad

http://imgur.com/fyfBOjS

My DME called last night and said I'd have to return my autopap that between me and the insurance co have paid over 4 months on a 6 mo rent to own
My insurance co said I needed to just stick to the autopap until July when it was paid for and then I could try another machine- despite the doctor order for
a 4 week bipap trial

None of this makes any sense to me but from what I've read thats par for course with DMEs and insurance companies
My insurance co uses a contracter- Carecentriix to take care of all DME stuff. I will try calling the insurance co direct to ask them in the am

My DME called today and now said they will pick up my auto bipap tomorrow and if possible bring me an older bipap and charge an out of pocket fee. Carecentrix warned me not to do anything like that and would not allow me to pay out of pocket to finish buying my autopap either- stonewall after stonewall. I'm desperate to feel better and get better numbers...

The settings are wide open despite the MD saying it would have a RX. its set to IPAP 20 and EPAP 4. Tonight I'd like to adjust to higher pressures on the bipap but am intimidated by the IPAP and EPAP values- if I raise the IPAP to 14 and the EPAP to 10 would it just work at those pressures? Thanks anyone

Susan

Your current 9.8-1 version of SleepyHead is having a bit of a problem with the AirCurve data and graphs.
Do you have ResScan available? If so I would suggest that you use it so you can see the data/graphs without the hiccups.
If not, SleepyHead Beta 1.0 seems to play nicer with the AirCurve machines.

its set to IPAP 20 and EPAP 4.

There should be another number in there in terms of setting...PS or Pressure Support. What does it say?
Normally in auto mode there are settings like
Minimum EPAP
Maximum IPAP
PS...Pressure Support
there are a few others that aren't critical at this point.

if I raise the IPAP to 14 and the EPAP to 10 would it just work at those pressures?

Yes....it can be made to function either fixed at those levels or it can be made to auto adjust. All depends on what you want it to do?

I am later getting to your thread...just saw it today.
Scratching my head for sure. Never saw anyone with textbook CompSA for only a couple of hours or none and rampant on other nights.

Thanks for your reply Pugsy, The PS IS 4 with a range of min epap 4 to max ipap 20. I thought higher pressures might help as my titatration which did not show centrals but said a pressure of 15 controlled my osa. So if I set the min EPAP to 10 and left the IPAP at 20 the IPAP might range from 14 to 20?

These are the RESCAN images

http://imgur.com/a/rCJ18


I have heard that centrals emerge when obstructives are controlled? Or that centrals are reported erroneously whenever there are reras, hypopneas or mask leaks? I don't know what to think at this point

thanks,
Susan

If you set minimum at 10 cm with PS of 4 then you will have 14 on inhale and 10 on exhale but it could (if needed) go higher if needed up to that 20 cm max IPAP and all the while if IPAP goes up it will drag EPAP up with it but it won't go up unless it thinks it needs to and it won't be responding to the centrals at all.
So example....if it went to 18 IPAP then EPAP would be 14 because EPAP is tied to PS which is fixed at 4 on this machine. PS can't vary on this machine.

I don't think it will need to go to 20 IPAP.....last night the most it ever wanted to go to was 13.2 and that was right at the end of the night most likely in response to some obstructive stuff that was going on and all we see is few hyponeas that slipped past the defenses.

So in reality the pressure didn't really move all that much last night anyway.
Now would having a higher EPAP all night prevent the centrals...I don't know. Your situation has several people scratching their heads. Myself included.

As to the DME confiscating this bilevel machine...if worst comes to worst...your apap machine will function almost like the bilevel...EPR at 3 is very, very similar to Pressure support....so PS of 3 works really closely like EPR at 3.
Some very minor differences in the timing a little but not enough that it is a critical situation.
I am not so sure that this type of bilevel is the magic ticket anyway. For part of the night and on some nights worse than others it appears you need the ASV type of bilevel and why that happens I don't know. I think I personally have only seen this happen twice with you being the second one and the other one is still trying to sort out why he is having similar issues.

If your heart is normal with no congestive heart failure issues....ASV bilevel would take care of both the centrals (when they occur) and the normal obstructive stuff but doctors and insurance companies often put up a lot of hurdles.

Will these centrals go away on their own...in all honesty I doubt it after this length of time they are still showing up in such nasty blocks....but then we don't know why they are occurring. I don't think that they are related to the pressure going higher though. When you went to 13.2 maximum for last night there were no real centrals to worry about.

Do you happen to have one of those overnight recording pulse oximeters? It might be nice to know what your oxygen levels were during the ugly time frames. You can get one for $50 to $100 and check it yourself.
If the oxygen levels stay nice and high...and you sleep well and feel good otherwise then it may not be that critical but if oxygen levels drop and you aren't feeling so great then perhaps a step up in machines should be considered.

Current settings adequately treat the obstructive stuff but I don't think it would hurt anything to try a little higher if you want to.