Hey,

TLDR; ignore them since they’re post arousal. Increase pressure to prevent obstructions that caused the arousal. Add EPR to reduce flow limitations.

My strong suspicion is that these are Post Arousal Central Apneas, not Central Sleep Apneas. Distinguishing between the two is important to determine the next steps.

“CA” as measured by a PAP machine is a “Clear Airway” event, not central sleep apnea, meaning that your airway is open but you're not breathing. A clear airway event can occur for a few different reasons, for example when you move positions or are awake. To demonstrate this, stand up from the ground. When you’re moving, you usually aren't breathing. It can also occur during microarousals because your respiratory drive while awake is different than during sleep.

PAP machines can’t determine respiratory effort or EEG information which is technically required to determine a CSA event or arousal, but looking at the wave form of your breath leading up to the “CA” can give in indication of an arousal. If you see a spike in flow preceding the “CA” it is like a Post Arousal Central Apnea and not Central Sleep Apnea.

If it’s a PACA, you need to treat the cause of the arousal, which could be caused by many factors, including unflagged hypopneas or minor flow limitations. These often require higher pressure (or pressure support) to resolve.

Furthermore, the events seem clustered likely during REM sleep, when your airway is the least patent.

SCIENCE! Thank you ham. Such a great article. Never would have figured this out on my own. It definitely appears I have a hyperventilation prior to each CA. I was under the impression the CA's were due to the response of lowered Co2 as a result of the therapy itself. When I first stared out on apap, I had a lot of pressure plateaus but was nervous about raising pressure and inviting more CA events. Would the machine be "smarter" if it could instead classify these events as RERA's or some such?

Anyway I will try to sleep with a bit more pressure and epr tonight and see how it goes. I was ready to buy an asv or st machine to deal with these CA's.

my observation and im no expert is that a fair few of your centrals occur around mask leaks

that too was shooting me into CA land which stopped when i got my leaks under control

something to ponder maybe?

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Seems to truly answer this question is to have repeat Sleep Study in a lab.