Sierra

"It looks like the OSAs are very minimal, but the central apneas are now very high (30-60 AHI). My titration study showed virtually no central apneas."

It looks like you may have treatment emergent central apnea. This is when the pressure used to reduce obstructive sleep apnea causes an increased number of central events. I had something similar happen to me. In some cases this type of central apnea can go away after 6-8 weeks or so. In my case it did not go away. I have made some changes to limit the pressure the machine uses and have been able to average about 0.8 for AHI, but it still goes much higher on certain nights when central events happen.

If you could post a full screenshot of the Daily Report it would be helpful to see where you are at. The events bar, pressure graphs, and flow graphs are the most important and should be at the top From what you have posted it looks like you may be getting into Cheyne Stokes respiration (CSR) or if you have a DreamStation machine they call it periodic breathing (PB). A starting point to look at is to determine when central events are occurring. Then you can see if higher pressure is related to when they occur. If that is the case then you look for opportunities to reduce the pressure. In my case I believe my machine (ResMed AirSense 10) was seeing Hypopnea events and responding with increased pressure. Hypopnea can be central in nature or obstructive. If they are central then increasing pressure is not the correct response for the machine. I addressed that by limiting the pressure it could automatically go to.

Do you know why they selected a BiPAP machine? It may not be the best solution for you. I have an Auto machine but I now run it in simple CPAP mode with a fixed pressure, and do not allow the machine to automatically increase pressure. I set that fixed pressure based on what I saw when it was in Auto mode and then with just trial and error to see how low I could reduce the pressure before obstructive events started to occur.

In any case if you post a full screen it would help a lot to understand what is going on in your particular case. Where you are now with those regular CA events running up your AHI is not a good place to be.

I don't like buying the distilled water in the wasteful 4 liter plastic containers. Instead I have a couple of 5 gallon water jugs that I fill with Reverse Osmosis water from a local store. Saves me trips to the store, some money, and all those plastic jugs going to recycle, or whatever they do with that stuff. Depending on how often I clean the humidifier I can find some slight residue. When we go on vacation for a couple of weeks we just use tap water, and I have no concerns about that. The humidifier acts like a mini distillation unit, so the minerals stay behind in the reservoir. It takes a bit longer to clean up when we get back, but vinegar does the job. Pure vinegar is also a good disinfectant when used full strength. I would never consider using one of those So-Clean ozone units. Ozone is very aggressive and it is not surprising it would attack foam in a CPAP. I am surprised that Phillips has not sued So-Clean for the damage to their machines and the recall costs they had to pay.

This is the history of ResMed as I know it. Colin Sullivan started out by using parts from a vacuum cleaner and I recall a dog for the first subject. Tests in people were done by gluing the mask to the face of the subject. Sounds gruesome compared to what we have today. I also recall that ResMed and Respironics came close to amalgamating at one point, but it did not happen. Have not read the full article for a while now, so forget most of it. Seems like they spend most of their time suing each other over patent rights.

ResMed Origins

I clean my machine with pure vinegar, then Dawn dishwash soap, and then a thorough rinse with tap water, followed by a final rinse of demin water. I do not have this issue of white stuff blowing out. Vinegar dissolves any minerals which may build up in the water reservoir.

The truth will be in the flow rate graph when you expand it to reveal the detail. Either the breaths will be there or they will not. The machine is simply reporting flow rate on a second by second basis.

This is what I found in the ResMed ASV clinical manual:

"Backup rate The AirCurve 10 ASV device uses breath phase mapping to provide a timed backup rate that is synchronized with the patient’s own breathing. When the patient deviates from the ventilatory target, the ASV device aims to stabilize the patient by adjusting Pressure Support. If necessary, it will adjust the timed backup rate from one that matches the patient’s own recent rate towards the built-in default 15 BPM backup rate."

From everything I have seen of the DreamStation and ResMed APAP machines the ResMed is the superior one. I don't have much experience with the ASV machines. From the few ASV SleepyHead charts the ResMed ASV is like magic. It just makes the apnea events disappear. It is like the machine is programmed to not allow apnea (as detected by the machine) to occur, and that may actually be the simple explanation of it.

Not all believe that.

https://www.thoracic.org/patients/patient-resources/resources/adaptive-servo-ventilation-asv.pdf

Yes, at diagnosis my AHI was reported to be 37 if I recall correctly. I also believe that I incurred treatment induced central apnea events, and they did not go down with time in the auto mode. The conclusion I came to was that I was incurring significant hypopnea that was central in nature, not obstructive. The ResMed algorithm responds to hypopnea as if they are obstructive and increases pressure. The increased pressure then induces more and more central apnea. To control this, I initially limited pressure in Auto mode, and then finally switched to fixed pressure CPAP mode. I also suspected that a blood pressure medication called bisoprolol was reducing my heart rate and blood circulation. I convinced my doctor to half the dose and I think that also helped some in avoiding central apnea events. I used to have frequent Cheyne Stokes events, and now they have become quite infrequent. Central apnea is complex when you have both obstructive and central events. I frequently see an obstructive event trigger a cycle in minute ventilation. It becomes worse and worse until it gets to the point of causing a central, which often repeats. Sometimes it locks in to flag Cheyne Stokes.

In any case this is why I believe in some cases a simple fixed pressure CPAP can do just as good a job on central apnea or better than a BiPAP can.

It is easy to post images here, but they can send the post to moderation which delays them from being posted. Only put one image in a post. In Windows File Explorer just left click on the image file and drag it into an open message here.