Terrible LOFTA Sleep Results

Here's the Summary and Diagnosis:

Obstructive Sleep Apnea (G47.33) - Severe based on pAHlo=67.7 and 02 nadir of 83%

Central Sleep Apnea (G47.31) - Moderate based on pAHIc=22.3
90 RDI events per hour
AHI 90.
Recommended BIPAP set max IPAP 25, min EPAP 6, PS 4 cm H20 with heated humidity and mask/interface fitting.

Note: My doctor got ahead of the sleep test and ordered me a Airsense 11, which is giving me 2-5 AHI. Which compared to the non CPAP numbers look pretty good.

With that said, the results came in suggesting a BIPAP machine! Why is that?

Any advice overall would be very helpful, as I just received these results and I'm in shock at how bad they are.

Yeah, that's pretty bad, but still eminently treatable.

Your obstructive apnea can be treated using ordinary CPAP or APAP (automatic pressure adjustment). However this type of machine won't give consistent results with the central apnea. Many people on CPAP will see quite good results one night and terrible the next.

This is why they've recommended a "bipap". That's actually Philips' term for a bi-level PAP machine. The generic term is bilevel. There are various types of bilevel, each optimised for a particular condition. The distinguishing factor is they all allow a higher pressure as you inhale and a lower pressure as you exhale. The difference in pressure is called pressure support (PS). An ordinary CPAP with exhalation pressure relief (EPR) acts like a limited bilevel, but the effective pressure support is typically limited to 3 cmH2O. (The actual mechanics of pressure support / EPR are a bit different but that's a more detailed discussion). So your doctor needs to know which particular bilevel machine he's ordered, and why.

The gold standard for treatment of central sleep apnea is adaptive servo-ventilation ASV. This differs from an ordinary bilevel as the pressure support can be varied on a breath-by-breath basis to maintain a uniform ventilation. If you have a central apnea and just stop breathing, the ASV will rapidly increase pressure support to get you breathing again. These machines are expensive and the experience of many people in the US is that insurance companies will make you jump through hoops to get one. You may get adequate treatment with a lower-level "bipap" such as the Resmed Aircurve 10 VAuto, but an ASV can pretty much guarantee an excellent outcome.

Re: Your Lofta sleep study. Was that a Type iV sleep study that did not actually measure air flows? I think Lofta (the DME) uses WatchPAT equipment, but I could be mistaken.