Should I be considering an oxygen concentrator?

[gainerfull]

I don't see a need for higher minimum pressure with only one single OA event.  If anything I would try a lower minimum pressure at 13 with auto pressure that has a maximum at 16. There just isn't obstruction here to justify higher pressure.

Thanks for the recommendation, I tried out 13-16 APAP + EPR 1 and here are the results. Still having oxygen desaturations but the overall oxygen level looks more stable than I'm used to seeing.

[Sleeprider]

Each of the OA events arose out of the minimum pressure of 13, so we may want to increase that a little. Otherwise the flow limits were less and CA events seem the same to a little higher than past charts you have posted. I think another night at the same settings should help us make a decision based on trends since your results have been variable in the past. Comfort and improved O2 are good signs.

[gainerfull]

Started working with a new sleep doctor trying to figure out my sp02 desaturations overnight and he ordered a new sleep study but only a standard CPAP titration. In my original sleep study it's documented that I had 65 central apneas over 5.7 hours of sleep but it was from 9 years ago.

I pushed back during my last appointment and asked that we put in an order for a bipap titration but received skepticism that it would be approved through insurance. As a compromise the doctor agreed to ask for a low threshold for bipap titration as part of my cpap sleep study. It also seemed like both he and the respiratory therapist were overwhelmed by a knowledgeable patient advocating for themselves.

Would I be shooting myself in the foot by agreeing to complete the basic CPAP titration even with the compromise? Is there any value in going through a standard titration that I'm missing? My fear is they titrate me around where I already know I'm good on constant pressure, my RDI scores prevent me from learning anything new through a bipap titration and my central apneas remain.

I've seen advice to just buy a bipap from a trusted source and see if it works but hesitant to shell out $1,300 then have to force feed the data back through the system.

[Sleeprider]

Your central apnea issues have not been severe compared to obstructive events. I doubt a titration in either CPAP or BiPAP will reveal a better solution. Your oxygen desaturations are not low enough or persistent enough to qualify for supplemental oxygen, and at this point the SpO2 data is of questionable value. As a result, your doctor and clinic are simply looking for the magic pressure that meets efficacy. The medical community usually caters to insurance, and does not readily diagnose or recognize central apnea issues when presented at the relatively low level your results indicate. In their mind, you need to "fail" CPAP to move to higher levels of therapy. Your apnea does not follow a pattern that correlates to pressure or EPR/pressure support, and the AHI is within an acceptable range for efficacy. If your test protocol does not specifically instruct progression to ASV you will fail BiPAP.

I'll be very honest about your question above. I think a test will not result in what you're looking for, but will be a self-fulfilling prophecy for the medical team that told you they were "skeptical". There will be an hour or more where CPAP pressure demonstrates sufficient efficacy to recommend a pressure for that meets all the protocol requirements. You will be right back where you were before the test. I don't see a better solution than what you called "force feed" the data from a successful therapy mode back through the system. A titration test is not going to allow for the experimentation that actually improves your results.

[gainerfull]

I appreciate the insight - why do you say the sp02 data is of questionable value? I've been experiencing memory loss and only started to see hints of recovery when I started consistently tracking my sp02 values overnight and taking steps to improve them. Mainly I've been focused on keeping 100% of my sleep at 90%+ sp02 and optimally 95%+. Now, I can't explain why they drop but it could be a combination of my severe sleep apnea and perhaps allergies. I'm not necessarily trying to solve my central apnea problem as much as find relief from the memory problems and these central apneas represent a path I haven't fully explored yet. I have already seen a neurologist, been scanned and have done the memory test and passed with excellent results. I've even had an ultrasound done of my carotid arteries looking for flow differences.

Do you have a gut feeling of what I should ultimately be after? Will I have to privately fund a bipap then perhaps an asv to find the answer I'm looking for? How are people that have central apneas pre cpap therapy optimally treated?

[Sleeprider]

I don't personally have issues with your SpO2 pulse-ox data, but it would not be accepted as evidence of a problem in qualifying for supplemental oxygen or even for determining medical necessity of ASV. The medical system that limits the diagnosis of complex sleep apnea and reimbursement for advanced machines is clearly designed to make those diagnoses and devices nearly impossible to get. A majority of sleep specialists seem to have no interest in anything but being a CPAP mill, and everyone has obstructive sleep apnea and gets a simple CPAP complex patients are often seen as a nuisance and told to look elsewhere. Your issues are a little hard to review and define because all the images used to describe them are now gone. It would be helpful to see how you have attempted to titrate or optimize your therapy and the results of the changes made so far. I'm sure you could get better results using something like the Resmed Aircurve 10 Vauto which allows us to adjust trigger sensitivity and intercept the occasional central events.

There are tremendous obstacles created by insurance and the sleep medicine specialty to make it very difficult to demonstrate medical necessity for anything other than CPAP. In fact establishing that proof will cost many times more in testing and physician appointments than the machines actually cost. Sleep medicine is mostly run as a way to make a lot of money with minimal effort. The specialists basically sign-off on technician reports and could script their patient interactions, which are as brief as possible. In your case your AHI is "good enough", and a doctor is not going to go to a lot of effort to get you more advanced therapy that will cost him a lot of time and effort to justify.

[gainerfull]

Here's a sense for the different settings I've been trying. I get mild aerophagia with pressures over 13cmH20 so I've been trying lower pressures in CPAP mode to find the minimum therapeutic pressure but cannot seem to find a pattern that I can reliably repeat results. I'm happy to screenshot & share any of these time periods to see if we can find anything worth experimenting with.



I had to go to a bunch of doctor's appointments to rule out essentially ever other cause of the memory issues and have been reading tons of threads on here which prompted me to pick up a Wellue sp02 ring. On my second night I found the following: (zoomed in on the big sp02 desaturation)





^ Here are the o2 stats for that night

Lowest o2 = 87%
Drops >4% = 6
Drops per hour = 0.6
Drops >3% = 22
Oxygen Level Range = 87-98%

Oxygen Level Distribution
95-100% 6hr 28m
80-94% 2hr 50m
<90% 23m

All this time I'm thinking as long as my AHI is good then I'm good to go but I find out that I've been starving my body of oxygen and not even knowing it!

Here's my best sp02 night so far:



In order to achieve this I have to use afrin to open up my nasal passageways which is not sustainable given the side effects. I've also not been able to maintain the same sp02 concentration despite leaving the settings the same. I've zoomed in while looking at my data at the start of each desaturation event and there is usually a central apnea that precedes it which is why I've been focused on them.

[gainerfull]

If I consider buying my own bipap from dotmed what's the best approach? Should I target a aircurve 10 vauto or an asv machine?

[Sleeprider]

Your CA event rate is less than 2/hour which we can usually target using a high or very-high trigger sensitivity with a Vauto. The ASV actually has fewer settings and for minor central apnea seems less effective and more disruptive to sleep. I would also suggest Craigslist or Searchtempest search app and Facebook Marketplace which can do a broad area search for the machine you're looking for. The main precaution is to be sure the seller has the machine in their possession (ask for a photo of the run-hours), and to use a secure payment method if you cannot transact in person. Never use the "gift" option in any payment to save the seller fees as you also give up any recourse if the sale is not as expected.

[gainerfull]

Just got the results of my CPAP titration and they titrated me where I titrated myself at 14cm H20, shocker.

Luckily during the titration I had a desaturation like I've been experiencing and they didn't have an explanation for it. I also get quite a bit of aerophagia at this high of a pressure so they agreed to order a bipap titration. I'm also going to see a pulmonary specialist as well to rule any of those factors out.

With the aid of flushing out my sinuses w/ saline solution and using azelastine hydrochloride and sleeping on the wedge pillow I've been achieving pretty good results over the past couple of weeks. Is it reasonable to expect that a bipap can help lower the amount of arousals I'm experiencing (evidenced by the heart rate spikes) even if they don't coordinate to events that qualify for identification? (> 10 sec)

What I've noticed is my best sleep is when have very little to no sp02 drop and my pulse change events are < 200 over an 8hr period. If I zoom in near the heart rate peaks I usually see what looks like sleep disordered breathing.