transitional/sleep onset apneas after years of PAP

[Jay51]

I agree with Dave.  Your average SPO2 during the night is 92.  That is a bit low.  Normal average from my research is around 95 to 96 (or even higher).  

Getting the correct machine is pivotal.  There is always supplemental oxygen late on if no machine can help get your SPO2 levels up higher on average.

[gaspsalot]

Thanks for all your replies! I truly appreciate it. I’m wondering how worried I should be about my oxygen desats and whether I should get a new sleep doctor. My O2 drops to as low as 70% at night — typically as I’m in the process of falling asleep. My sleep doc responded by saying he’d normally increase my pressure to treat those CSAs but can’t because of aerophagia. 

Can that be right? My OSA seems to be pretty well controlled by BiPAP (something like 1.6 AHI on average). My brain just doesn’t tell me to breathe for swathes of the night. He also gave me Ambien a few months ago for these transitional or sleep-onset apneas to make me sleep through them. I seem to have them most every night now though. 

My doc has recommended another sleep study to see if BiPAP-ST or ASV might be called for, but doesn’t seem to have any urgency about it. Is this something that can wait for months? Should I be finding a new doctor? I’ve attached some screenshots from my Wellue pulse oximeter of some of my worst nights.

[estgad]

Greetings.

I am no expert on this sleep stuff.  I have my struggles with it.  Transitional apneas was one of those struggles.  I too use sleep meds to help fall asleep.  
I noticed that you woke up in the middle of the night, so you had a second cluster of transitional apneas.  Same routine I go through.

I think a few things helped me with my transitional apneas.  The first has been time, just getting my body to adapt to the machine.
I take half a dose of the sleep meds when first going to bed and the second half when I get up over the night.  
I take the first dose 1/2hour to hour before going to bed, so for my first session I am falling asleep in less than 10 minutes.  

I found a very low epap and ipap setting along with the sleep meds and time has helped.  (currently epap 4 ipap 8.4 starting pressure) 
I am now using a 20 min ramp to help keep the pressure low while first going to sleep.    
If I can fall asleep before the ramp ends those transition clusters don't happen.  But if I don't get to sleep within 20 minutes (like last night after I got up over night) then once the machine increases the pressure a transition cluster appeared.

[Jay51]

Those SPO2 drops are still very concerning (dropping down to 80 or even a bit below even that).

If your Dr. wants to do a sleep study with Bipap ST and/or ASV, that would be good IMO.  Either one of those machines would help eliminate CA's from stopping breathing voluntarily.  ASV is specifically for CA's. A few people have trouble tolerating it.   Bipap ST is more for pulmonary/neurological diseases, but still has a back up rate that can help prevent CA's.  But, the Bipap ST (on average) is more difficult to tolerate because of it's "square wave" pressure.  Square wave is not the normal, easier to breathe, rounded breathing wave tops therapy; but instead an abrupt pressure support immediately proceeded by an abrupt fall down to epap.  Some people like the bipap ST though.  If you can try both, go ahead.

[SarcasticDave94]

Agreed. If it's Central Apnea your doctor wants to treat, for most the ASV will be better. The ASV is specifically used for CA therapy.

It's hard to separate low oxygen and high CA where I'm at. Both maybe are equally important now. If your current doctor can't handle this, try any of your other doctors willing to script what's needed. It doesn't require specialists to order these devices.