Hello Morkra :)

Nice work actually getting things this dialed in after only a couple of weeks, most people are still fighting leaks at this point (or leak rate is low). Looking at that OSCAR daily, the fundamentals are solid: AHI 4.7, only about 2% of the night in apnea, leak line basically glued to zero, flow-limit line flat, and you’re giving the AirSense 11 a full 8½-hour run. You’re on APAP 10.2–12.2 with EPR 1 and a F30i, so this is not an “under-treated train wreck” night by any stretch. On the ResMed side, the scary-sounding “Cheyne–Stokes Respiration” label is just a pattern detector, not a diagnosis, it slaps that tag on any chunk of breathing that looks a bit waxing/waning or periodic. In your chart most of that CSR shading is in one big block toward the end of the night, which is exactly when people are often in lighter sleep or half-awake and breathing gets weird and cyclical. True clinical Cheyne–Stokes is long, repetitive wax-and-wane cycles over and over with CAs overlapping the CSR, usually in people with known heart failure, stroke history, or on heavy meds; your machine can’t diagnose that by itself, it just says “this looked kind of periodic for a bit,” so you’re absolutely doing the right thing lining up a real sleep specialist and, if you have any heart history, looping cardiology in as well rather than trying to read tea leaves off the CSR flag alone.

I'd like to do a little 'apnea control' experiment to see if we can calm down the CA/CSR side without wrecking your obstruction control. I’d leave you in APAP but turn EPR completely off and set min pressure to 9.4cm, keep the max where it is now around 12–12.2, and run that combo for 3–5 nights. Right now at 10.2–12.2 with EPR 1 the machine is giving you a 1-cm pressure swing every single breath, and for some people that tiny bit of pressure support is enough to blow off just enough CO₂ that the algorithm starts calling more events “central” and is more trigger-happy on CSR. Dropping the min a notch while turning EPR off keeps a similar floor against obstruction but smooths the breaths out and takes away that breath-by-breath pressure change that can feed periodic breathing. Your numbers already show a split of CA ~2.7 vs OA ~1.8 with very clean leaks and no real flow-limit burden, so I would not be chasing centrals with more pressure or more EPR while you wait for the doc; the goal is to see if a simpler, steadier pressure profile lets the CSR percentage and CA index drift down or at least not get worse. Keep the cervical collar the same (it’s probably doing something useful for the chin-tuck) as long as it isn’t forcing your head into some extreme forward bend, and if you want more eyes on it, grab a couple of 2–3-minute zoomed-in screenshots right on one of those CSR blocks with flow rate and pressure so folks here can sanity-check whether it looks like classic post-arousal junk breathing or clean, rhythmic wax-and-wane. Big picture: don’t panic at the CSR label, keep stacking consistent, low-leak nights, try the no-EPR / 9.4–12ish experiment, and bring that data plus any heart history or med list to the specialist when you get in.

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