My Experience So Far (and thoughts on changes to therapy)

[Esq.]

I don't think the titration study shows very much of value.  The technician moved pressure in 2-cm increments and cherry-picked  period of 60 minutes as the most effective.  You had equally good results at a pressure of 7.0 with higher SpO2 and a longer trial.  You had only 1 hypopnea at a pressure of 10, but due to the short trial time, AHI appears high.  I actually see the onset of CA with pressures above 8.0 with a higher incidence of hypopnea.  Personally, I think  your best result is 7.0 and the test shows a potential for CPAP pressure induced centrals above that pressure.  The objective of CPAP is to treat obstructive apnea and obstructive hypopnea.  In this study the hypopnea are not classified, but my interpretation is that you are treated for obstructive events at all pressures, and you avoid central induced events at 7.0.

Bottom line is the conclusions of this study are not that clear, and it cold be interpreted several different ways.  My recommendation would be fixed pressure at 7.0 with no EPR.  The PSG results really confirm what we have seen in your Autoset results, that events really are central, and that higher pressure and pressure variation makes it worse.  You are treated at low pressures, and do not have obstructive events.  The big caveat to all of this is that I would want to have a discussion with the doctor and encourage him to acknowledge in his recommendation that the CPAP titration shows a tendency for you to replace OA with CA which may infer CPAP induced complex apnea syndrome.  You may not need advanced treatment using ASV at this time, however your record should reflect some thoughtfulness about what these results REALLY show.

Sigh. Thanks for the thoughtful input. My sleep doctor is a pretty well-respected guy, so I'm disappointed that he did not put more analysis into this. Fixed pressure at 12 didn't sound like the right solution, and as mentioned above, it sure felt pretty terrible. I'll go with a lower fixed (and no EPR) and see what happens. I'm inclined to go fixed 8 for a few nights, check centrals, reduce to 7.8 for a few nights, etc., until I find the fixed number where CAs are reduced (hopefully) and OAs stay minimized.

The plus is I seem to do a lot better with aerophagia when pressures are below 10, so maybe I can get rid of that issue entirely with lower fixed pressure.

I'll also go into my next follow up (in November) prepared to talk through this and make sure he sees potential CPAP induced complex.