Central Sleep Apnea AHI numbers too high

[Sleeprider]

One of the long standing truths we have discovered about this is, "central apnea is consistently inconsistent". It is very hard to test for it and even harder in a titration test because the events do not correlate to pressure. So during a CPAP titration test, a patient can be found to "resolve very well with CPAP therapy" (from your test). The problem is, good results are fleeting and inconsistent. In science, a theory is only proven if the test result is repeatable, and that is the problem with your CPAP therapy. It is inconsistent and leaves you with moderately high central events, chronic fatigue and other symptoms you can better describe than I. Good luck with your pursuit of ASV, and we remain here to help as needed. As I said, if you decide to self-treat we can show you that path too.

[vinegarben]

Regarding the concept that "central apnea is consistently inconsistent" two practical questions come up: 
1. How "reliable" is the interpretation of a sleep titration study when they change pressures every (let us say) 20 minutes or so. As an example, if the AHI at a pressure of 12/6 is 60 and 14/8 is 4, is that likely a "real" response to treatment or is the AHI a reflection of the randomness of central apnea events that you describe?  Are sleep doctors generally aware of this inconsistency when they interpret the titration study and make treatment recommendations based on the titration study results?
2. Over what period of time (days or even even weeks?) would someone with central apnea want to wait to see if a particular change in machine settings is actually helpful?
Thank you for your insights!
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[Sleeprider]

Vinegarben...see, that's the rub. Titration studies are designed for obstructive sleep apnea where a strong correlation of pressure to events is usually reliable. With central events, it's simply not. People with central apnea can show hours of no events and then have 20 events regardless of pressure. It's amazing to see this in titration studies. There is no question I can titrate you in CPAP to have efficacy with CPAP, the problem is you might have AHI of 8 at 5 cm, 12 at 6 cm 21 at 7 cm, 2 at 8 cm, 30 at 9 cm, 0 at 10 cm, 1 at 11 cm, 40 at 12 cm, 32 at 13 cm, 1 at 14 cm, 0 at 15 cm, 0 at 16 cm, 44 at 17 cm, 10 at 18 cm... When the whole study is done I say we found efficacy at 14 cm. Good luck with that! And we see this error repeated over and over.

Full nights on a machine tell us more than most clinical trials. If patients could interpret CPAP data and self-titrate, there would be no need for clinical titrations. There are obvious financial interests at stake that kill that approach. We can pretty much tell in 2-3 nights if therapy is effective or if a different approach will be needed.