Sierra

Seems to me the big issue is undiagnosed and as a result untreated sleep apnea. Yes, the diagnosis and treatment standards may not be perfect, but any diagnosis and treatment is better than none.

Are you talking about a red dotted line on the Flow Rate graph? If so I noticed on my wife's OSCAR report this morning that there is a dotted line at the "0" flow rate when the machine is off. She has a nap in the afternoon and with the long break between the nap and the evening sleep it is easy to see this dotted line. I do not nap during the day, and my breaks are short during the night if any. I think that dotted line is there too, but it is harder to see with a short break compared to a longer break. If that is what you see, I think nothing to worry about.

Seems unusual. If I get up in the night the graphs all go to zero.

I don't fully understand it either. I can go days with my AHI under 1.0, and last night it was over 3. I don't know what really triggers the CSR flagging as what I saw last night sure looks like CSR to me, but was not flagged. What I do know is that once a CSR cycle starts it can go on for some time and really run up the frequency of CA event per hour.

Apnea is when you stop breathing when you are sleeping. Any stop in the breathing of more than 10 seconds is considered an incident. Over a night of sleeping the total number of incidents is added up and divided by the hours of sleep. The apnea index represents the number of incidents per hour of sleep. 5 to 15 incidents per hour is considered mild apnea, and in most countries treatment is recommended. From 15-30 incidents is moderate apnea. And 30 or more is severe apnea. The objective of treatment with a CPAP is to reduce the incidence frequency to less than 5 per hour.

About all you can do is try lower pressures to see if that helps with CA events. The ideal pressure may be when OA and CA event frequencies are about the same. OA events tend to go up when you lower pressure, while CA events tend to go down with lower pressure. The trick is to find the happy median.

Quite some time ago I reduced my beta blocker, bisoprolol, from 5 mg to 2.5 mg as a test, and I think it reduced my CA frequency. My doctor was a bit skeptical, but agreed with it, as my blood pressure remains good. My wife uses Ozempic, but I have stuck with insulin and metformin. I also use a Libre 2 sensor to monitor things. My A1c is usually right about 6.0 or a bit less...

I am not sure it is fair to blame the CPAP. My wife uses the same machine as I do, and her AHI averages about half of what mine is, and she has hardly any CA events. See graph below. My theory is that CA events are caused by a slow response to the need to breath faster or slower to keep blood oxygen and CO2 levels constant, and a little faster heart rage might help. I also take the bisoprolol in the morning so it has more effect during the day, and less at night.

I also suffer from CA events, which form the large % of my AHI. However my AHI on average is around 0.85, and not that high. I get the occasional flags for CSR, with a long term average duration of 0.1%. See the graph below. The magenta part of the bar graph are CA events. I almost never go over 3.0 however.

I recall we have discussed this issue before, but I can't remember where you are at for machine settings. I have found that using a fixed pressure and keeping pressure as low as possible limits the frequency of my CA events. The only direct way of controlling CA events with a PAP device is to the ASV version. However, it is highly recommended that you get heart function tests before going down that road. The ASV may be just covering up a potential heart issue that needs treatment. It would be worth seeing a heart specialist in any case to see if there are any issues requiring treatment.

CSR can also be caused by altitude and there are medication treatments used for elevation sickness that may work, if you live at a high elevation, or you could use an ASV.

I am not that familiar with asthma and what impact it may have on sleeping. I use OSCAR to track my CPAP data, and I see that I have a respiration rate of about 18. My wife also uses a CPAP and runs a little lower at about 15. I am not sure what is considered normal.

I am not sure if an ASV would help or not. As best I understand it, it tracks each breath and assists in breathing if you are not breathing on your own. What do you have for a CPAP and how is it set up. With a ResMed it may be helpful to set the Expiry Pressure Relief (EPR) at the maximum setting of 3 cm. Reducing pressure on exhale and increasing it on inhale may help you breath a little deeper and cause your respiration rate to be a bit lower.

What may be of more help is a BiPAP or BiLevel machine like the ResMed AirCurve VAuto. Instead of boosting inhale pressure by 3 cm compared to exhale, it can be set up to 10 cm, and may be more helpful in assisting breathing.

What you may want to do is track your CPAP data with OSCAR and then see your sleep specialist and ask about doing a trial with a BiLevel machine to see if it provides any benefit.

If you have a CPAP and use OSCAR to look at the results in detail you can determine if what one imagines is really happening or not.

There is a website started by a pharmacist that was concerned about the use of sleeping pills especially in the elderly. It apparently significantly increases the risk of falling and breaking a hip etc... There are a lot of good tips there including the use of the CBTi process.

https://mysleepwell.ca/