I had a closer look at your OSCAR data and have done a little bit more google research. The first thing I need to say is that I am a retired mechanical engineer and not any kind of medical professional. I draw my experience from reviewing my and my wife's data, and many others from this forum and others. With that context these are my thoughts, in no particular order.
That period of time where you had the very high respiratory rate is likely called Tachypnea or Nocturnal Tachypnea if you were asleep when it happened. It seems to be fairly rare but has been seen in people being treated with a CPAP. Possibly it happens in others, but without a CPAP or titration test equipment, it is never recorded. You can google it, but I am not sure in your case that it has an obvious cause. If you were awake, it could be simple anxiety, and I am not sure one can get anxious when asleep. If it is anxiety there are a number of drugs that can be used, but one should question if they should be used. I have taken an Ativan single pill before cataract surgery to deal with anxiety, but I think using it on an ongoing basis can be addictive. You mentioned Ambien, and that would likely be less addictive, but may have other side effects. I take a beta blocker, bisoprolol, for blood pressure control, but I understand it can be used, off label, to control anxiety as well. If you feel it is anxiety these are things to discuss with your doctor.
The areas flagged by your CPAP as CSR or Cheyne-Stokes Respiration, are more of a concern. I suspect those are quite disruptive to your sleep, and they may be resulting in low blood oxygen levels. You could consider getting an oximeter that clamps on your finger and gives a record of O2 levels during the night. SleepyHead and I believe OSCAR can accept the data from some of these meters so you can correlate events like the CSR flagged times to O2 levels. I believe OSCAR should give you some information on which meters it can accept data from.
With respect to it actually being true Cheyne-Stokes Respiration I am not so sure. Have a look at this simplified illustration comparing CSR to another condition called Biot's. True CSR has a smooth waxing and waning pattern, while Biot's does not. I do not see that in your example. It is more of a sudden increase and then some waning back to nothing.
Here is an example of what I think is true CSR from my personal data back in 2018 when I was having issues with it and central apnea.
Notice the smooth waxing and waning which starts even before the CSR green areas. The other big difference is that you are having obstructive apnea events between each while I am having central apnea events, which is no obstruction, just me not wanting to breath. I don't know much about Biot's other than it is rare, and your pattern does not fit it exactly either. Not sure if it is associated with OA or CA events. I think there is a good possibility that what you have is simply obstructive events with gasping periods for air between each one, and not Biot's either. That would be very disturbing to your sleep.
So this all said, I think for the short term, I would focus on more pressure in auto mode to see if the obstructive events can be prevented with more pressure. If my theory about you gasping for air between each obstruction should stop too, if the obstruction is prevented.
The part about doctors is complicated. I am in Canada and I am sure the overall system is different here. I have just gone to a sleep clinic where they give you a home test kit to take home. They send the results out to some cyber doctor somewhere that is supposed to be qualified to read them. Then they want you to buy a machine for $2400. Since I have no insurance for CPAP, I just bought my machine on line for about $800 and have done everything myself since then.
If you are in a situation where your insurance will cover it, I would try to find a pulmonologist that has sleep apnea experience and show them the results you are getting. If increased pressure does not solve things you need to get to the bottom of what is happening. At some point you may need to get a cardiologist involved too.
But for now give the 15/20 auto pressure setting a try. If it helps but still jams out at 20 cm, then you probably will have to pursue the BiPAP alternative with the hope a bit more than 20 will help. They go up to 25 cm. The extra pressure support from the BiPAP is not looking promising as you did not get a significant improvement with the EPR at 3 cm.
Your test in Auto at 15 min and 20 max should be very informative as to what possibilities there are. The cervical collar is still worth trying too. It may provide relief from the rapid sequencing of obstructive events.
I had a hard time falling asleep last night (I usually don't), I took a nap in the afternoon which I probably didn't need after getting low AHI's. the night before. Layed on one side or the other the whole night w/collar. *I zoomed in on event that woke me at 03:50 Any idea why my Resp Rate is "clipped" at the top? I changed Y to 60, I think it was at 50. *The time is off by an hour, do you know how to correct it?
Concerning leakage: I can find no obvious leak with ear or feel test. I am a mechanic, and used to listening and feeling for air leaks. I tried a Dead Head test (thumb over end of hose) but OSCAR didn't register anything. Could try old mask when I have a chance (Vitera gel). Vitera has a dozen or so holes in front with obvious flow coming out. I don't feel anything coming out near swivel with AirTouch F20 on.
Friday night forgot to put SD in: In recliner w/collar and took TR Melatonin and 25mg Benadryl to relieve sinus pressure. Yes, I have taken Benadryl in past to help with sleep. Slept thru night.
Sat Night laid on one side or the other w/collar and took TR Melatonin and 25mg Benadryl to relieve sinus pressure . Woke up and ended taking mask off and falling back asleep for an hour or so in recliner (no data). *Resp Rate: after scrolling over, never went over 50. Last OSCAR graph for Thurs Night, gave it the illusion that it was "clipped" @ 50. *My CA's were 15, 25 & 18s
Too bad about leaving the SD card out. I do that every once in a while too. Not sure what to make of the leak rate not going to zero. Are you sure in the machine menu that the mask type is set to full face? If it is an actual leak it would almost have to be damage to the mask somehow. I see that ResMed recommends replacement of the memory foam seal once a month. That would be expensive as I recall they want a good price for it. I only replace the silicone seal on my P10 mask once every couple of years. The other possibility is some damage to the vent system on the pivot point, or misalignment of the parts... But, as I say the leak is not high enough to interfere with effectiveness of the machine. Here is an example of what the leak chart looks like on my machine.
If you think things are fairly stable at these settings it may be time to try adding back in some EPR. I would suggest an EPR setting of 1 cm to start with. And, you will have to switch the type back to full time. The hope would be that it may reduce hypopnea some without causing the OA frequency to go up. It reduces pressure on exhale, so you will get 15 cm on inhale and 14 cm on exhale.
Settings = 15 cm minimum, with EPR at 1 cm full time
I'll contact the sleep center I have a relationship with now and see if they'll give me a P10 to try. I need to give my nose a break. They gave me the F20 setup for free to try (well actually nothing is free). CPAP setting stay the same, except for mask type?
Yes, ClimateAir tube. It was set to Manual w/Tube Temp 78 deg, Hum Level 3. Starting point for Auto? Right now humidity in house 36 after adding humidifier.
I am "pretty sure" I woke up last night 2.5hrs in (1pm CST). No obvious signs on charts. Stayed laid down on side the whole night.
The qty 1 CA I had was 16s
These results look pretty good. Since the EPR of 1 cm did not do bad things and your hypopnea seems lower, I would try EPR at 2 tonight. Leave everything else the same.
If you switch to the P10 the only thing you need to change is the mask setting to Pillows.
If you go into the Clinical Menu and scroll down you will come to a section called Options. Under that if you set the Essentials to Plus instead of just On, the User menu available without going in the Clinical Menu will be enhanced. In the enhanced User Menu you can set both the Humidity and Temperature to Auto. And while you are in the Options section you may want to turn the SmartStart On. I use that so my machine starts automatically when I put the mask on. It is just a convenience feature.
And when I was checking the Clinical Manual I found this illustration. It shows pretty much exactly what you were getting and was being flagged as CSR. I knew I had seen this pattern of breathing somewhere but couldn't find it. Here is the illustration. The important part is that you were not having true CSR, but just rapid frequency OA events. This now appears to have been solved with the cervical collar...
Started the night with the AirFit P30i Nasal Pillow Mask with Med cushion (small & med included in Starter Pack with Small Frame) & mouth taped. Med cushion appeared to fit ok in nose. Technician said to keep head gear on "loose side", that pressure would tighten it up. Obvious leak issues and woke up "hard" & glancing at my AirSense 10, it shown Red Face & AHI of 2+. Tightened Head Gear & had a hard time falling asleep, couldn't really put my finger on what felt odd, in hindsight maybe like nasal mask wasn't giving enough air before sleep mode. Went back to what I knew, changed mask setting and put F20 back on.
***Just discovered I didn't set machine to right setting.... I had it set to Nasal, while User Guide says set to Pillows....from what I got out of tech, this was to be Nasal while others I got were Mask. I wrote down Nasal Pillow for P30i and Nasal Mask for others...
Technician was helpful with giving me 5 masks to try,,,only 1 nose only. The other 4 covered mouth and went under nose.
I didn't have time to do leak test, but did order new hose & reservoir (comes with seals).
Tech didn't seem confident the Nasal would work for me (or they didn't have a lot of Nasal's in stock). Tech agreed that there may be leak somewhere, saying that Full Face allows for different leak rate than nasal.
