Central Apnea Clusters

Hey gang, been on CPAP for nearly a year, having trouble getting ahi under 5 mark. Sleep study had my AHI at around 35 with both OSA and CSA events. Currently 80% of events are CSA fixed pressure is 14 with epr on 2 with ramp pressure of 8. Always seem to get clusters of 4-5 Apneas after relatively normal looking breathing 5-6 times a night. Hit a bit of a dead end tried lower pressure of around 5,7,8 even auto of 5-10 and 7-11. Every time I change pressure it seems to be the answer for a few days then creeps up again I also have ADHD and take a slow release Ritalin but doctors keep telling me this shouldn't effect things. Any guidance would be greatly appreciated, have also attached a recent night via sleephq if anyone has any insights TIA
https://sleephq.com/public/e90f7caf-0e0 ... 5f00ccdfc0

How's your sleep quality in general?
Do you remember very many awakenings?

The bulk of your AHI both central and obstructive apneas appear when it looks like you weren't asleep.
I did a quick scroll through the flow rate zoomed in and maybe 5 or 6 flagged events (both OA and CA) seem to be asleep related flags....the rest of them you weren't asleep. The bulk of your AHI isn't real asleep events...they are awake/arousal related events. Remember the machine can't tell sleep status because it only measures air flow or breathing.

Feel like I had an ok sleep, work breakfast radio and go to bed very early 7:30pm and wake up 2-3am, always struggle late afternoon with tiredness, since I started therapy I have this thing where I'll randomly wake up usually after 2-3 hours then sleep till around 2-3am. On this particular night got up for toilet break, tried to get back to sleep but just laid there awake collecting apneas. When you see a spike out of nowhere followed by 4-5 Apneas is that a position change, post arousal Apneas or the real deal? Every single night looks similar to this regardless of what pressure I'm on. It's very confusing for me Here is an example of a lower pressure night, all seems well for a few nights, then hovers around 5-7ahi, this happens, for most pressures I've tried
https://sleephq.com/public/78dd4fc1-e7b ... 064ab68e3d
https://sleephq.com/public/0aa87eeb-2db ... 8d4b15c97f

You need a crash course in figuring out asleep breathing vs awake/arousal breathing.

From the Nov 4th report. NONE of these do you actually appear asleep.
Your have to look at the breathing immediately prior to the flagged event.
Asleep breathing is very rhythmic and regular when compared to awake/arousal breathing.








Here are a couple of real asleep flagged OAs. From one of my old reports. See how the breathing never really changes either before or after the flags?



Here with these examples I circled the asleep breathing in red so you can see how regular/rhythmic it is when compared to the later breathing which is all over the place.


Same time frame but not zoomed in so close. If it isn't circled in red...I wasn't asleep.

Wow ! Very insightful Do you suggest I keep going with my current settings?

I see no urgent need to go changing the settings because I am not so sure that the settings are the problem.
The problem is the sleep quality itself IMHO.
I don't know that changing the settings will fix the sleep problem.
I think that you will see that the nights where your AHI is lower are the nights you probably also sleep better.

I know the ADHD meds aren't known to cause centrals but they are well known to mess with sleep quality itself.
They cause centrals indirectly though...they cause poor sleep and the poor sleep increases chances of false positive flagging while awake or semi awake.
Perhaps have a chat with your doctor about the meds...maybe alter dosage or time of dose might be considered.
Google your med/Ritalin Slow Release....see if it causes some sort of insomnia...I am betting it does.
Yep..I knew it before even looking it up but here...proof. Your reports look like sleep maintenance insomnia to me....I recognize it because I see it too in my own reports almost every night.
https://www.nhs.uk/medicines/methylphenidate-adults/

headache
feeling aggressive, irritable, depressed, anxious or tense
trouble sleeping (insomnia)
loss of appetite – this can lead to weight loss or poor weight gain
stomach ache
dry mouth
feeling or being sick

Also remember that you can have arousals or awakenings that you don't remember.....but the flow rate graph for breathing will give it up every time. BTW it's normal to have some arousals (remembered or not) and we don't expect a perfect sleep breathing graph all night long.
For one thing it's normal to wake after the completion of a REM sleep stage.

That said....I have done a lot of experimenting with pressures over the years because I just like to experiment.
I always learned something...either I learned what a great idea I had or I learned that idea was a total failure....but I always learned something.