When to switch to BPAP or ASV?

[Mosquitobait]

Paula, if you don't need to replace your machine now (i.e. it is still working), I'd suggest holding off for a year and see if the weight loss lessens your needs. This is totally based on cost - bipaps are a lot more. If, on the other hand, you think these issues are interfering with your current sleep habits, then get the bipap.

FWIW, ibuprofen taken close to bedtime causes an increase in my pressure overnight. My doc thinks it has to do with the bradycardia. Now I take it with dinner instead of my evening snack and that stopped happening. The problem is that the alternative is a pain killer (which increases my centrals from 3-4 to 10-12 a night) and that simply isn't as effective as reducing the inflammation in the first place.

Also, a mention to everybody about ibuprofen. There are some new warnings about it, especially for those over 65, so make sure that your usage is appropriate.

[OpalRose]

A bipap won't address the Clear Airways, but it would be more comfortable to breathe with such high pressures.  

The CA's aren't excessive and could very well be caused by your meds.   As stated above, you could hold off to see if weight loss would allow you to use lower pressures.  

If you talk to your doctor, he would probably want another sleep study.  Your insurance may not cover a bipap without another study.  

If CA's increase, then the logical step would be an ASV, but we all know that from the stories of other forum members (like Dave) that it's not that easy to navigate the medical system and get what we need.  It's a frustrating and time consuming process.

[PaulaO2]

Thanks for the advice everyone!

You're right. I am seeing planks when they're only motes.

[Sleeprider]

Paula, I think it might be interesting to try a fixed pressure of 15 using your EPR of 2. Your pressures do increase on pressure limitations, but it's uncertain if the increased pressures are preventing OA. If you try the fixed pressure, we would be looking for a consistent increase in obstructive events to return to a variable pressure range. Fixed pressure may help CA events, but again it's not predictable with the use of your medications and particularly opioids. I think shooting for comfort is a reasonable goal. Bilevel without a backup is something you should only consider if you can tolerate the full EPR of 3 without increasing central events. I doubt ASV would be approved at this point with the relatively low number of events.

You have been on this forum and seen many people discuss their sleep studies. Unless you have an exceptional opinion of the capability of your doctor to design a meaningful study, I think you would find the experience and results disappointing. Sleep studies are usually very simplistic evaluations that seem to work best to tell us what we already know.