When to switch to BPAP or ASV?

[PaulaO2]

So with my non-wheezing A10, I'm noticing the central events are continuing. I've always had them, just never high enough to do anything about it. The CI is never higher than 5, usually less than 3. In the beginning, I had a LOT of pressure induced central events so we had to move to treatment pressure in stages. Since I was given a brick at that time, and had no way of knowing it was otherwise, I don't know how it all worked out until I got the S9 Autoset myself years later.

My settings are 15 - 20.
My 95% is between 17 and just under 19.
The max each night is usually between 18 and 20.
My AHI varies between 2 and just under 5.
CI is usually about half the total. Event time is from 10 to 17 seconds.
HI is barely there.

I take a LOT of medication, so one of them could be the cause. I had a migraine yesterday and took what I call the "Hammer" (rizatriptan / Maxalt) and went to bed. I slept about 5 hrs. The AHI for that session was 2.16 and all of them were central. I can list my meds here if anyone wants a gander.

So my questions are:
1 - While I am assuming this is kinda normal, and I am assuming since they are under 5 all is well, I am still concerned. Should I consider switching to a BPAP or even an ASV to address this?
2 - I am in the process of losing weight (heart insists on it) and my hope is my pressure needs will decrease. I am fairly certain the CI will not decrease with the weight loss but they might with the decrease in pressure. Should I wait it out? But we''re talking a year or more most likely (slow weight loss is best)
3 - am I worrying about nothing?

           

[Walla Walla]

Your pressures don't really hit 20cm much, so I don't think you need a BiPAP right now. The CA's are not that bad numbers wise. I guess it would depend on how long their lasting and what your O2 is doing. If it's dropping your O2 a lot an ASV might come into play.

[PaulaO2]

I'll start using the oximeter again, then. Totally forgot about that.

The events don't last long. 10-17 usually.

I've also started lip leaking again lately. Yay. I'll get a new cushion for my simplus.

[SarcasticDave94]

FWIW: this may have been criteria specific to my former Pulmonary Doctor, when I was going from CPAP to BPAP he stated that the PSG tech would change over to BPAP when my pressures equaled or exceeded 15. Mine did exceed 15 in the titration, so I was issued a BPAP via his script. Of course, BPAP wasn't the right answer for me due to massive amounts of centrals. That made me begin the ASV path.

My PSG for the BPAP had 124 centrals vs 24 obstructive BTW. My ASV has me stabilized regarding AHI, which averages 1.8 with about 5 hours sleep per night. Though not the greatest nightly sleep average on hours, it's many times over improved after the ASV transition, which was a max of 4 hours overnight. Even so, I still nap in the early afternoons. I blame/credit my terrible back diseases and COPD for the daily naps.

[sonicboom]

You may find this article helpful, written by a doctor, in determining whether any of the meds you are taking might be effecting your sleep and AHI:

How Prescription Medications May Affect the Risk of Sleep Apnea
https://www.verywell.com/how-medications...ea-3014683

Since you have the A10 now turn on UF 1 and 2 in SH and see how many of those events you are having.

[PaulaO2]

Great article. I do see an increase in CI when I take my narcotic more than once in a day. It is one of my PRN meds.

[PaulaO2]

Dave, I've not had a sleep study except my original ones. Perhaps I should think about getting another.

[sonicboom]

Great article. I do see an increase in CI when I take my narcotic more than once in a day. It is one of my PRN meds.

Per the article referenced above:

"Opioids result in increased respiratory pauses, irregular breathing, and shallow breaths. They may cause central sleep apnea."

[SarcasticDave94]

Dave, I've not had a sleep study except my original ones. Perhaps I should think about getting another.

Obviously your call on that, but it may not hurt excepting on payment, etc. I have had my fill of these in a short period due to CPAP to BPAP to ASV. I had 4 total PSGs starting with the diagnostic then titration (non-split study) in 2015, then the last 2 in 2017. First was a plain diagnostic/exploratory PSG to indicate apneas or not as I remember it that is. The other 3 following were titrations. YMMV and all that.

[SarcasticDave94]

Thanks for the link to the article, sonicboom. It was interesting to see mine were not on the listing. I went over to the article they had on central apneas. Again, interesting info.