Central Sleep Apnea, Anyone try supplemental O2 via nasal canula

I am a retired Chem. Eng. , age 80, with identical issues. Could not tolerate CPAC due to difficulty exhaling against pressure. Will be trialing bi-level , at sleep Docs advice, but he has discounted good evidence issue is primarily central.
After CPAC fail and waiting to figure out next steps I bought supplemental generator ($US300). I wear Wellue ring and have since starting down the apnea avenue so I could watch what was happening.
I also have PVC (premature ventricular contractions) and some Cheyenne Stokes breathing pattern. Cardiologist checks (stress, echocardiogram) show heart is fine so far.
Lateral sleeping, using 500 mg Quinine and breathing strips (deviated septum) while using 2 litres/min of 78% O2 is delivering fantastic results. Under 5 /hr. over 4%, drops. Some nights as low as 0.2 drops/hr. O2 mostly between 95-99%, seldom any under 90%.
I shallow breath but the O2 gets in enough to stop the loop gain problem.
I consider my problem under control (my blood has lots of O2 all night) but I will still do the bilevel trial primarily to learn more.
$300 O2 concentrator vs. $2500+ irritating uncomfortable bi-level (or worse, servo) seems a better solution for my situation.
Happy to share more once I am ok in this site, if helpful.
Good luck

If you really do have essential central sleep apnea (CSA), a bi-level, BIPAP, is unlikely to help you. Over at apneaboard.com, which I urge you to visit and to spend some time searching and reading threads that arise about CSA, we routinely tell CSA sufferers that they ought to be using an adaptive servo-ventilator (ASV) which typically cost about twice what a CPAP does. If it matters to you, we also urge people to carefully consider buying a RESMED AS11 series if it's going to be PAP therapy because their algorithm works best for most people over the Phillips Dream Machines. ASVs are ASVs, so pick one that works.

As you probably know, with your history of dealing with problems of a nature, CSA is not related to oxygenation, but to hypocapnia. What happens is the machine you're using, incorrect for you or incorrectly configured, is flushing too much CO2 out of your blood, so your sensing circuitry for hypercapnia doesn't kick in when needed....so you stop breathing for extended periods. We breathe because our CO2 blood concentrations exceed an upper limit, not because of a dearth of oxygen.

I am very happy to see you are taking a methodical approach to this, and that you are having success. What you haven't stated is that you have had a full polysomnography with an over night stay in a sleep lab. Your case probably warrants it, and not a 'home test' that may have been suggested by someone whom you have seen.

My PA put me on an oxygen concentrator before I was diagnosed with sleep apnea and put on a CPAP machine because sleep doctors are exceedingly rare in my area. I tried to find a sleep doctor in several other locations but was always sent back to my home area because I live at a very high elevation. When I did finally get the sleep apnea diagnosis, my sleep doctor recommended I connect the concentrator to the CPAP machine when I was home. For travel to lower elevations I apparently did not need supplemental oxygen--I am testing that theory now while visiting a coastal area. I am still very new to all of this but you might consider whether your home location is a factor.
LS

I initially took a home test (Sept.) followed by a week trial of Resmed Airsense 11 which I did not tolerate due to exhalation anxiousness. I was scheduled for poly (Nov.) with report mid. Dec. While waiting I bought a Wellue ring (using since Sept.) . I also bought an O2 concentrator received in late Dec.
Poly report 5 obs, 2 mixed and 35 central. Hypopneas 240, for AHI 51.3/hr. , SpO2 nadir. 78%, Cheyenne Stokes present, moderate PLM index 41/hr., frequent PVCs.
I do not think the bi-level is the answer but will do the free trial, 3 weeks usage, then overnight poly titration.
Meanwhile using O2 I see 4%+ events always under 5 and a few under 1 per hour. O2 mostly over 95%, seldom under 90%.
I see the issue you point out of suppressing CO2 using O2 (set for 2/l per hr.). That puts out 78% O2. I will play a bit with that but with only oximeter data how to measure results may be tough for a layman.
My basic question is "if low O2 is harmful to heart and tissues, even if high O2 suppresses CO2 and affects the O2/CO2 cycle (and apparently prevents loop gain cycles) why should I care. In other words as long as O2 is high what's the harm. I am concerned I am missing something.
Regards

I am at sea level (Vancouver) but do very short visits to Calgary (1100 m., 3610 ft.).
Will be trialling bi-level myself . If O2 needs to continue that will be a future decision. Best of luck.

What you are missing, possibly, is what I was missing. I didn't know I had severe OSA until my cardiologist sent me to various imaging facilities, and finally to a sleep lab when none of them showed any abnormalities or ischemia. The polysomnography showed I had severe obstructive sleep apnea, and THAT is what caused my atrial fibrillation.

Disrupted sleep, for any reason, is poor sleep...hardly sleep at all. Each time you have an event, whether merely a RERA (respiration effort related arousal), a flow limitation, or an outright obstructive event, and it lasts for more than 10 seconds, your machine will duly note it and it will become part of the record next morning. To that end, if you ever find yourself using a RESMED again, consider going to apneaboard.com and downloading the (safe, constantly improved) freeware called 'OSCAR'. It will allow you to remove the SD card from your PAP machine, insert it into a slot/reader/ and OSCAR will look for it and ask if it can download the data (you'll have to create an account in OSCAR first). You're an engineer, you're used to reading data and making sense of it, and you use graphic depictions for their value as well. OSCAR offers all of that, and then some. You'll find it interesting from its rendering of your recorded data and maybe be able to adjust your machine's settings to get AHI (apnea/hypopnea index) as low as mine, which is an enviable 0.6 average, week-to-week, month-to-month, now running on 7 years.

Eureka! (Or any similar Greek exclamation) . My sleep guy was saying lots of OSA and hypopnea and I should do a bi-level. Looking at my O2 aided sleep I did not see it and questioned the OSA diagnosis.
In my rush to get to a "cheap" (its the engineer in me) but effective (my blood O2 looks great) result, I feared I was missing some essentials of the process!
I did join the Apnea Board a while back and am familiar with the Oscar software so will certainly use it if I wind up with Resmed (bi-level or ASV or "whatever") .
Your help has been what I neede to help my understanding.
Thanks a bunch.
Regards

I have had 5 complete sleep studies in a sleep clinic.
I started with a Lung doctor because I thought it was a lung problem with O2 being low a lot and I told him I think I have Central Sleep apnea. My O2 ring would show O2 going from 98 to 88 in a cycle every 15 seconds of so while I'm awake but almost falling asleep. He told me to throw that thing away. You need a home sleep study, and I told him, don't bother I need a full overnight study in a sleep clinic which he did finally order. Within the first hour of the sleep clinic Tech came in and said I had severe sleep apnea and slapped a mask on and spent the rest of the night trying to find what pressure would work. Results said central sleep apnea with some obstruction. Doctor called me by phone and said he was ordering an CPAP. I said NO, I need to discuss the results. At appointment I said I want to see the data. All he had was printout. I said I need to see the graph. He said no one ever asked before and he then came back and said he doesn't have it. I basically got in fight with him and did manage to get an appointment to another doctor in group who was the sleep specialist. She also wanted me to start with a CPAP machine. I then got appointment with a sleep clinic at a university hospital setting, figuring they had access to anything I might need such as neural exam etc. I would meet with an intern first, then the head of the department. I said I wanted them to study me the whole night, do not interrupt and try to control it.. They did that and also added a CO2 sensor (Sleep clinic #2).
Also came up with Central Sleep apnea with some Obstructions and decided to use a BIPAP. I went for a 3rd sleep study where they would try to titrate what pressures to use on the BIPAP. Turns out I had a bleeding hemorrhoid and my hemoglobin was like 7.2 but they did not have any of this information.
They ordered a BIPAP and I used it for 6 months. my events (AHI) were between 20 and 30 all the time. They refused to let me try supplimental O2.
I was getting Cheynes Stokes events with no breath for 20-30 seconds at a time. They then wanted to eliminate RLS problems before getting into a new machine and order a home test just to check leg movments etc.
They finally felt an ASV machine would be best but my insurance required a sleep lab test which showed it would work. So I had a 4th sleep clinic study. They finally ordered a RESMED 11 ASV with setting at Epap 13-15 PS 4 - 10. First night my AHI was 2.14 with the ASV machine while the the night before with the BIPAP my AHI was 37.13
I actually felt better the next day, not sleepy etc.
The only problem was that the pressures were so high, going to 24 as needed that the mask would leak. Making it tight enough to stop the leaks was to much to were like that all night. Still working on that. getting better.
At this point in time (Jan 2025) I'm playing with the setting on the ASV machine trying to find a sweet spot that will keep AHI low and Also O2 levels up. I tried using lower pressure setting while allowing it to got up if needed.
7-11 4-17 for example. This kept AHI within around the 5 range but my o2 ring showed o2 between 90-100 with a little to 85. With the high pressure settings the o2 was 95-100.
So to put it all together. Central Apnea are controlled with the RESMED ASV machine. Actually there are no central or obstructive apnea and what does show up are Hypopnea which,l I think, is an artifact of how the machine is suppressing the tendency to go into the Cheynes Stokes pattern.
I'm still interested in trying some O2 but so far they are not interested and seem happy with the results of the ASV.
I did convince one of the doctors to do a Pulmonary Function Test.
FVC was good. actually above expected.
LVM was above expected abut FRC was barely above LLN
DLCO-c and DLCO/VA was barely above LLN while VA was above expected.

attached find Lung Function Test Pages.

Bi level is probably not the answer.
If you have central Sleep apnea then the ASV machine would be the best.
I don't know enough about just using O2 but my doctor would not try it.
Its a very complicated system with all kinds of feed back loops. Loop gain etc.
With me, everything would be going good, nice in and out flow and then something would disturb it (?? leg movement??) and a big breath would come in and the system would over react then over react to that so you end up with big overshoots up and down and finally, stop breathing all together. eventually, one of the back up systems kick in and you start breathing again, but possibly back into the cycle again. Thats what happens with Cheynes Stockes pattern. The ASV machine watches you and then trys to predict when you are going to overshoot and intercept it. Its pretty wild to see what it tries to do. I have good insurance but I would buy an O2 concentrator if it would help. Insurance would only pay if O2 drops to like 75 or someting.