new user central apnea advice

Hello everyone. I am a new user seeking advice on reducing central apnea events.

I have been reading posts on here since February. Thank you to everyone for all of your wisdom. Being new to sleep apnea it has been invaluable in helping me to adapt to using cpap and not giving up.

I am a 59 year old male with low BMI. I live at 7000 ft elevation. I do not take any prescription meds. Overall, I would say I do not ever feel rested and that I have gotten enough sleep, including the last few months with cpap. This has been a long term issue. For the last 10 years I have been a full-time caregiver for a disabled stroke patient. My sleep patterns dramatically changed beginning then, likely due to stress and having to be hyper vigilant throughout the day and night.

I am currently using a ResMed AirCurve 10 Vauto and a full face Fisher & Paykal Vitera. I started using this machine in mid February 2022. I was originally diagnosed with severe obstructive and central apnea (AHI 73) in June 2021 and given a ResMed AirSense 10 in August 2021. I tried the machine for a month but could not take to it. Perhaps if I had found this forum then I might have been able to keep with it, but I ended up returning it and was prescribed the Vauto.

The Vauto settings on the original prescription were PS 4.0 over 4.0-12.0. After reading suggestions on this forum and some experimentation I have landed on PS 2.4 over 7.0-16.0. I have a feeling the settings could be improved, but I am unsure how to proceed. I have gotten my obstructive apneas down to minimum, although I think the biggest help with the OAs was wearing a cervical collar. Thank you to those on here who recommended the collar. Before I started wearing it my pressure would max out even with higher settings, and I still had numerous OAs.

Now that my OAs are within an acceptable range, I would like to reduce my central apneas. I am exploring moving to an ASV, either through my doctor or buying a used machine on my own. I have attached my original sleep report and a typical night from Oscar. I have had nights recently where my AHI has been down to 3 with a total of 27 CAs. But most nights my AHI is in the 6 to 10 range with CAs totaling 35 - 60. Given this information do you think I can reduce my CAs enough by adjusting the settings on my current Vauto, or should I push to move to an ASV?

Thank you for reading this. I am grateful to have found this forum and for those of you who put so much effort into helping others.

Unfortunately I don't think that you have very many choices with the AirCurve 10 VAuto machine in terms of little tweaks to help with reducing the central apnea numbers.
You have what is called complex sleep apnea and you had the centrals prior to starting cpap therapy so we can't blame them on the therapy itself.

Was your sleep study done at the same 7000 ft altitude???

Your options are limited.
1....your centrals might reduce if you were at a lower altitude but that of course isn't a good option right now.
2....there is a very small chance if you went to fixed mode instead of the auto adjusting mode that the centrals might reduce. Small chance but a chance. Auto adjusting pressures sometimes just don't play nice with whatever is going on to trigger the centrals.
3....ASV machine...it will take care of your obstructive apneas and help you breathe when you have the centrals pop up.

Welcome! As you may know, your elevation may be contributing to your central apneas, and you identify your 24/7 stress as possibly contributing to your feeling unrested during the day. The challenge is to help you feel better within these constraints.

As an experiment, you could try turning off the PS to see whether that brings your central apnea index down. (Edit: I see that Pugsy has just posted with the suggestion that you use fixed pressures. Try that experiment first, keeping your PS unchanged. If that doesn't seem to help after a few nights, then try also eliminating PS.)

It's good to see acknowledgement in your sleep study notes that you may need titration that includes ASV. If eliminating PS doesn't make a dent in your CAI, then I would definitely follow up with the doctor to get that scheduled.

Thank you Pugsy. Thank you Miss Emerita.

My sleep study was at home so yes it was at 7000 ft.

I will try fixed mode for a few nights. But is this going to feel like the AirSense 10? I couldn't tolerate exhaling at a high pressure.

If this doesn't work I will try turning off the PS.

Pugsy, I went into settings and am unsure what you mean by fixed mode. Options are CPAP, S and VAuto. If I use CPAP mode, what set pressure do you recommend? If I use S mode, should I leave the pressure settings as they are now in VAuto?

What mode and settings did you use with the AirSense 10 machine? Did you use EPR with it? If you did, at what setting?

S mode on the VAuto is the fixed bilevel mode...I am torn as to what settings to suggest because
1...don't know what you tried on the AirSense for one thing
2...don't know what impact the PS might be having on the centrals but I suspect not a lot since you had centrals even without using cpap at all. Sometimes PS can trigger centrals but since you had centrals without any cpap or PS...don't know how much of a factor PS.

I think start small and see what happens....S mode....EPAP 7.0 and IPAP 9.4 and that will give you the 2.4 PS you have been using. PS is pressure support and really is just the difference between inhale and exhale.

I don't remember if the prescribed settings used EPR with the AirSense, but I think the pressure was 20. I didn't know anything about settings and didn't know I could adjust them. After a couple of futile conversations with my doctor I just gave up.

I will try S mode 7.0 and 9.4.

Thank you