Sierra

Still much better than where you started. The one thing I know for sure is that CA events are unpredictable. At what elevation above sea level do you live at? People at higher elevations and especially like very high ones like Denver can have a higher frequency of central apnea. We are at about 2,000 feet and I do notice a reduction in CA frequency when we vacation at sea level in Mexico.

The yellow and blue times in the bottom left are just the length of time for each "session" in the total sleep.

What I see is that around 0:25 flow limitations increased and the machine responded by increasing pressure. An OA event at 3:45 increased pressure again. At 5:50 or so, flow limitations caused pressure to bump up again. For the most part CA events are happing at the lower pressures. If the significantly higher frequencies of CA events continue you could try small steps down in both min and max pressures. On the Overview tab there is one graph of the Total Time in Apnea. If you keep an eye on that, minimizing this time is also a good thing to do.

That looks very good. You also seem to have gotten your leaks under control too. I would watch for the ratio of CA events to OA events. This one is fairly high in favour of CA events. If that continues you may want to consider moving down the min and max a bit - like 0.4 cm each.

I got into high quality audio back in the 80's and have maintained my system over the years. I think I may have "The Magic Flute" on Deutsche Grammophon vinyl.

OSCAR lets you see all of the events by type and exactly when they occur during the night, and at what pressure. If you have the machine in AutoSet with some room for it to increase pressure above 4 cm, then you will see if there is any attempts to increase pressure and for what reason. I think this will you some idea as to how close you are to having zero events.

If you have a SD card in your machine, all the detailed data should be there, so you can go as far back as you want to look at individual nights.

My thoughts based on very ad hoc observations is that it seems to be non linear when going in the other direction. OA does not tend to decrease until you hit a critical point when the airway opens reliably with the pressure and then it goes down quite quickly. That is kind of the basis for a titration test when you get diagnosed with apnea. They look for that switchover point and set the pressure a bit above that.

You might get a better indication of how things are trending by using a min of 4 and max of 7 and then look at the results using OSCAR. It would be an encouraging sign if the pressure pins at 4 cm and reliably stays there overnight, with no hypopnea, OA, CA, or flow limitations.

I can only really guess, but I think you may have good odds of testing below 5.0 for AHI. But, the only way to find out is with a sleep test where they use zero pressure instead of the 4 cm which is the minimum on an APAP.

That is excellent. And the really good news is that your results seem consistent from night to night. 6:54 minutes would be your total time with the machine on. Just above the green CSA label on the left side of the screen. The bottom left if you scroll down further than what your screen shot is showing will list your "sessions" which are the individual times without breaks. It looks like you had three sessions. If a session is a wipe out there should be an on off switch beside each one where you can include it (green) or not (red).

I would suggest leaving your settings like this for a while. Feel free to keep posting and I will give you my comments.

I have lost track of how many people I have helped. I see I am at over 3,000 posts. Most turn out well, but not all do. Sometimes you just cannot get the CA events down to a reasonable number without OA events going too high. There is an ASV machine that sometimes has to be resorted to in the difficult cases. Good to see that along with the cervical collar you have gotten down to a good space with just the APAP.

With 10 min and 11 max a ramp start pressure at 9 should be fine with the ramp in Auto for time. That is what I use and find it quite comfortable. One of the tests I do to set the ramp start pressure is to take quick deep breaths when it is in ramp to see if the flow responds quickly and you get no feeling of air flow restriction. For me 9 cm is what it took. I am amazed that some sleep clinics send their patients home with the machine having the out of the box settings; 4 cm min, and 20 max. Trying to go to sleep with only 4 cm pressure would make me feel like I was suffocating.

I suspect you must be in an environment where the humidity is higher. The device on my desk says the humidity is 33% here. With a 7.5 hour sleep I use nearly all the water with Climate Control in Auto and humidity set at 4.

All considered that is a very good result with the lowest amount of central apnea that I recall seeing in your results. Your OA events are actually higher than the CA ones, so we have reached the point where it does not make sense to try going lower. My thoughts are there are two different ways you could go at this point. One would be to leave the maximum pressure at 11 cm, and increase the minimum pressure from 9 cm to 10 cm. The hope would be that CA events do not increase but OA events go down just a bit more. This is probably the fastest way to get to a final stable setting. It may be just fine to leave the machine in AutoSet and let it adjust pressure in this fairly narrow range.

The other way to go would be to switch to CPAP mode on your machine and go with a fixed pressure. One of the methods used by some sleep clinics to avoid the cost of a full in clinic sleep test where they titrate the pressures is to put the machine in AutoSet for some time and then go to a fixed pressure equal to the 95% pressure point indicated in Auto. In your case for this night this 95% pressure was 10.6 cm. You would run that way for a week or more to see what you get for a longer term average. Then you would try a pressure on each side of that pressure for a week at each pressure. This is fairly time consuming, but that is the way I went to settle on my fixed pressure of 11 cm.

Your choice as to which way you want to go. You of course could try both ways to see which works better. We do have to sleep every night, so there is nothing but time for testing. You seem to have reached a very stable condition which is much better than where you were when you first started posting.... The soft collar seems to have been the silver bullet in your case.

In the last three years or so, I have had two bronchoscopies, and 2 cataract surgeries. None of the anesthesiologists asked about sleep apnea.

Millions of people have sleep apnea and 8 of 10 are undiagnosed.

https://www.cbc.ca/radio/whitecoat/sleep-apnea-canada-challenges-diagnosis-cpap-machine-1.7108832

I find that the shorter I sleep the lower my AHI score. When I get apneas they seem to get concentrated to the last part of my sleep, especially if I try to oversleep. I consider 7 to 7.5 hours per night, ideally in one stretch, to be the best for me. What I have read is that we need to build up sleep demand during the day, and get one good sleep at night. Naps during the day should be avoided, but I confess to dozing off in front of the TV from time to time. But, I never lie down on a bed during the day. I also avoid all caffeinated beverages after 10:00 AM. I also try to avoid all liquids after about 8:00 PM to reduce the need to get up during the night. That works most nights but not all...