[Treatment] Obstructive to Central when using BiPAP

[dalepatterson]

This may be like looking for a needle in the haystack of advice, but I have moderate to severe sleep apnea (I used an at-home test to determine this originally, Lofta). I also borrowed a friend's O2 meter and my O2 drops to 81% at night.
The at home test did not reveal any Central Apnea, just obstructive (22 ish AHI and O2 drops a lot, and to as low as 81%). I tried using a CPAP for 2 months, and never got the events below 10, usually closer to 15-17. I decided to go see a pulmonologist, who scoffed at Lofta but said my obvious problem was that I needed more pressure (she could see the results from me sleeping with the CPAP). I bought a BiPAP, and had no increased success. I then paid for an actual sleep study. The put me on a BiPAP with a lot of wires running everywhere, and the technician tried to adjust settings throughout the night. I had a lot of Central events, upwards of 50-60 events total.
After the study she basically gave me 3 options and said I have Complex Sleep Apnea, where Centrals show up after pressure is introduced. The first option, do nothing?!? What? My O2 drops to 81%. The second option would be to get an Inspire implant. My concern there is (among many) is how can I be sure centrals won't show back up?? That's a lot of time, money and inconvenience if it doesn't end up working. The third option is an ASV machine, which should also solve the problem. I opted for door number 3. I've been using the ASV for about a week, and my AHI has been in the 7's. Better, but not great. I'm still getting woken up constantly, and last night my O2 dropped to 86 with the machine on.
Do I explore Inspire? Do I look for a second opinion? Anyone out there have a similar story who found relief?
I'm a 50 year old male who has very high LDL (207), and higher blood pressure. I exercise every day and follow a nutrition routine most people could not do. I have no body fat. I run, play pickleball (sometimes for 5-6 hours). No one believes me when I say my cholesterol is high. I'm guessing it has something to do with the apnea, and I need to get this addressed.  Attached is an image from OSCAR for one night.

[SarcasticDave94]

The ASV when correctly setup will help most get below AHI 5 comfortably.

I have used ASV myself for a 2 year block of time successfully, until my COPD got worse. So I'm familiar with what it's able to accomplish.

Attach a standard daily detail OSCAR chart set to show Events, Flow Rate, Mask Pressure, Leaks. Left side no calendar. Look at the link to OSCAR charts to see what I'm looking for.

Your attached chart does help, but the formatting isn't quite the same. Try taking a screenshot while looking at OSCAR. If you're using Windows, F12 takes the screenshot, creating the image to attach. For Mac, it's fn F12. See the link below in my signature.

Also what settings are you using on the ASV? And if you've not yet, get your personal copy of those detailed sleep study test results for all those done.

Welcome to Apnea Board.

[Sleeprider]

It will be most helpful if you post the Oscar Daily Details charts with the respiratory statistic and settings as described in the Organizing Your Oscar Charts linked in my signature. This will also avoid posting personal information you have on this report like your real name and D.O.B.

The events in your report are most likely obstructive apnea that arise from positional obstruction. We know this because your events are clustered and do not respond to pressure support provided by your ASV. If these were clear airway events (Non-obstructive), the increased pressure support on each breath would result in breaths rather than an apnea event. You appear to be using EPAP min 5.0 and EPAP max appears to be about 9.0 with PS approximately 3.0-10.0. The report format is far from ideal to provide help. You clearly need to resolve the positional issue, and perhaps increase EPAP min to a pressure sufficient to prevent obstruction. An ASV cannot do anything to force a breath when you are positionally obstructed.

[dalepatterson]

I felt like I had to come back and update/thank you.  I did bump the EPAP numbers, and also widened the PS range over the course of a few weeks.  I wasn't making a lot of progress and was getting frustrated.  A few days ago I logged back in (here and a few other forums) to reread them.  You suggested position being an issue.  I didn't really understand, but started to realize that when I wake up at night I was always on my back.  I bought a silly looking backpack widget off Amazon to prevent me from rolling over on my back at night.  It's a little uncomfortable, but I can't believe it.  I've been wearing it for 2 nights along with my ASV, and I have had ZERO events.  None.  Thank you!

[Sleeprider]

Thanks for following up. For some reason, many people seem to be affected as much by how they sleep positionally. We can often resolve problems using some simple manipulation to avoid chin-tucking or back sleeping rather than setting changes. Your input is really helpful to those that have this problem. Our Optimizing Therapy wiki (linked in my signature) includes an article on Positional Apnea https://www.apneaboard.com/wiki/index.ph...onal_Apnea I should have included that link in my first response.

[SarcasticDave94]

You can always attach a current OSCAR chart and we can see if there's setting edits that might make therapy better.

Position of sleep can affect things. Back sleeping can increase the possibility of more events. The other Positional Apnea pattern aspect can happen when you chin tuck, externally restricting the airway. Some have both against them.