How many central apneas and hypopneas are "too many" which warrants a machine change?

I did not realize I had central apneas and hypopenas until after putting in my data to sleepqh and thought I only had OSAs.

I had about 650 OSAs in 2024, 140 central apneas, and 196 hypopneas. Unclassified apneas were 30. The numbers are similar in 2023. I didn't go back further than that.

I have been using cpap since 2021. My AHIs are generally under 1 on most days but I still don't feel energetic in the morning when I wake.

Since the beginning, I have always complained that I did not experience significant relief or quality of sleep improvement but my ENT (but mostly his physician's associate) said that even if I don't experience a mental improvement after using cpap, it will still help my heart health over the next several decades. I have been consistently using the machine as a result. In fact, I can't remember a day when I didn't use the machine except for the first couple days, and the day that the power went out on an overseas trip (1-2 days).

I have an airsense autoset 10 for her. I got that one to use the extra algorithm that I had been reading about being better for males.

Not sure if there is any other data that I can provide that may help. I do not have OSCAR, unfortunately.

My question is: should I be talking to my doc's office about getting a different type of apnea machine like an ASV or the like? I just put in an order for a new resmed 11 autoset as it's currently covered by insurance, but perhaps I need to switch it to something else?

Doctors won't normally prescribe a change in machines to a machine that can deal with central apneas until/unless the number of central apneas (that are for sure asleep centrals and not arousal centrals) amount to at LEAST 5 per hour average over the entire night and it happens pretty much every night.

It's the per hour average that they look at and not the overall number of centrals.

Hyponeas are usually fairly easily dealt with by a conventional cpap/apap machine that can't treat centrals though.
The majority of the time hyponeas are obstructive in nature.

You need to be talking to you doctor about your problem and what you want.
I would be really surprised if he/she will prescribe ASV and the other side of the coin is that you have to meet diagnostic criteria for a change in machine so that you insurance will pay....and ASV is REALLY pricey.
Just because a doctor says "we can give it a try" and he is being generous doesn't mean that the insurance company will pay for it.

Pugsy wrote: ↑

Tue Jan 07, 2025 6:21 pm

Doctors won't normally prescribe a change in machines to a machine that can deal with central apneas until/unless the number of central apneas (that are for sure asleep centrals and not arousal centrals) amount to at LEAST 5 per hour average over the entire night and it happens pretty much every night.

It's the per hour average that they look at and not the overall number of centrals.

Hyponeas are usually fairly easily dealt with by a conventional cpap/apap machine that can't treat centrals though.
The majority of the time hyponeas are obstructive in nature.

You need to be talking to you doctor about your problem and what you want.
I would be really surprised if he/she will prescribe ASV and the other side of the coin is that you have to meet diagnostic criteria for a change in machine so that you insurance will pay....and ASV is REALLY pricey.
Just because a doctor says "we can give it a try" and he is being generous doesn't mean that the insurance company will pay for it.

I appreciate the information, thanks!

Where would I look to determine whether I've had central apneas (asleep centrals and not just arousal centrals) on an hourly basis? Is this where sleephq may not be sufficient and I need to get OSCAR?

I think considering I've apparently had about 140 over the past year (central apneas; not sure if asleep centrals or arousal centrals), that would equate to 0.39 per night of sleep on average. I don't think I'd qualify at all if the necessary metric is 5 per hour.

I have mentioned to my doc's office (again, only meeting with the PA since once the ENT prescribes the machine after meeting you for the first time, they seem to be basically out of the equation) that my goal is to feel well-rested each night. They did say that cpap doesn't guarantee that (which I have read online too) for most people but at least helps from a health perspective.

zoomzoom wrote: ↑

Tue Jan 07, 2025 6:28 pm

Where would I look to determine whether I've had central apneas (asleep centrals and not just arousal centrals) on an hourly basis?

To know if your central apneas are asleep related or arousal related you have to learn how to evaluate the flow rate and look for arousal breathing and asleep breathing. SleepHQ will do that.
Your machine just measures air flow and can't measure sleep status so neither software (OSCAR or SleepHQ) will separate the 2 for you. You have to do it manually but if your AHI is 1.0 or even 2.0 and every single flagged event was a real asleep central (which I doubt) it still isn't enough to earn a different machine.

I don't have a real asleep central flagged handy but all these below are arousal related and I circled the arousal breathing that makes the central an arousal/awake central.

zoomzoom wrote: ↑

Tue Jan 07, 2025 6:12 pm

I had about 650 OSAs in 2024, 140 central apneas, and 196 hypopneas.

If you had 140 centrals in 366 days, then you do NOT have central apnea.

Also, your daily average AHI over that time period is acceptable.

zoomzoom wrote: ↑

Tue Jan 07, 2025 6:12 pm

My AHIs are generally under 1 on most days but I still don't feel energetic in the morning when I wake.

You are achieving excellent CPAP therapy. Look in other areas for improvement in cognition and energy. Those areas include sleep hygiene, moderate exercise, quality of foods, control of stress and time spent outdoors.