BIPAP 18/10 ASV NOT tested, sk for a re-do?

I have had centrals from mu initial sleep study. The come in clusters of 30-50 for about an hour, with durations in the 15-25 range. The AHI spikes in the 25-40 range with 60-70& of them as centrals. The normal pattern is two clusters, one around 2:00 the other around 5:00, and I am usually awake by 6:30.

I went for a second sleep study and they want to take me from APAP with a 6.8 -12 range NEVER going above 10, to a BIPAP with 18/10.

They DID NOT do asv or ST tests.

From all I have read, higher pressure will not help the centrals......

Should I press for a third sleep study to see if a lower pressure ST or ASV machine would control the centrals?

I wanted to try the PR S1 Auto BIPAP so the EPA and IPA could float independently... The DME says that it does not record the centrals, so she recommended the resmed machine, if I wanted to be sure that the centrals were under control. ....... is she correct?

Your insurance company may require that you "fail" bipap before they will pay for an asv.

That being said, my third overnight study was for both bipap and asv, so that the doctor could order an asv after two weeks of increasing AHI while on the bipap.

Of course, I was only on the asv for a total of 20 minutes during the titration, but that's a whole other story....

Respironics PR S1 BiPap machines call centrals "clear airway" events and they are clearly identified on the reports.
Respironics elected not the put themselves in a position of calling them "centrals" and ResMed did but they are indeed flagged.

Give me a few minutes and I will get you a copy of the reports to look at. They are flagged as "CA" events which for Respironics means "clear airway".

BTW I happen to have both machines the PR S1 BiPap Auto and the S9 VPAP Auto. In your situation with your aerophagia issues, I would think the PR S1 with its floating pressure support might be more comfortable. They both give great therapy but they go about it differently. For me..I like them both but I actually prefer auto mode with the larger fixed pressure support. It is an awake thing which is really rather silly. Bear in mind I pretty much have zero issues with aerophagia though.

Edit to add images of my report. My PS is only 4. So not much room for it to roam. First report is from SleepyHead and second is Encore. If you can't see the entire image just right click mouse over the image and choose "view image".
Encore report is a bit weird because of the blank spot from a short test. In SH I omitted that short test. Can't do that with Encore.

Thanks, I will switch back to the PR S!, which is what I was initially looking at..... I will give it a few weeks. My )2 numbers are not to bad, the probelm is connected sleep, I am still waking up a few times a night, usually when in a cluster,,,,,

While it's frustrating at first, remember that you've had years of poor sleep. Your body is accustomed to those patterns. It will take weeks, if not months, for your body to adjust to xPAP therapy.

However, as a note, if you continue to have central apneas do push for an ASV test. As others have noted, some insurance companies insist that you try CPAP then BiPAP before you attempt ASV therapy. It costs a LOT more than the others. And let's face it, if you don't need ASV, that's a real plus.

One thing you might want to consider is to get a pulse oximeter that you can use to keep track of your O2 saturation. If it continually drops during the night that can be one more piece of evidence that you bring to your sleep doctor.

And don't just ignore the central apneas. Untreated central apneas can cause unmanageable high blood pressure .. and that among other things can cause kidney damage. I know. I now have chronic kidney disease (though now stable) because my previous doctors would not help me address my central sleep apnea. As a result, I would awaken with horrible headaches. I took Ibuprofen to handle the headaches. Unfortunately unmanaged high blood pressure and Ibuprofen is a prescription for kidney damage.

So, don't ignore it and assume it does not matter. Central apneas are just as bad .. and in some ways worse (because too many doctors just ignore it).

Hope that helps.

Thanks for the comments....
O do have a o2 meter, and even on CPAP my o2 level dips to around 88 sometimes to 85.... In my first sleep study it went down to 74...... So not to bad.

After a lot of hemming and hawing..... I took my DME recommendation and went with the resmed machine. She would let me have what i WANTED, BUT SAID IT WAS ALWAYS HER FIRST CHOICE for bipap machines. I am on rental, and will try it for 30 days. I will probably then see or switch for 30 days to the PR machine. If either controls the centrals, then that will probably be it. We will see how I do on the pressure.

I left the card at home, and will have to look tonight and see how things went. I woke up at 4:00 AM with a loud leaking mask... will try another mask tonight. I expect it may take a few weeks to get use to the new machine....

I WILL press for ASV if I do not feel better. His view is that my overall ASH average is down from 27 on my first study to around 8 on CPAP. My O2 is above 90 except for a few short drops to the 85-88 range (2-3 drops that then went back up). HE said that the deciding factor is how do I feel, and only I can decide that.

Honestly I feel better, but not as good as I was hoping, so we try bipap. If I do not feel better, or have problems with high pressures, then I will look at st or asv to see if that will work at a lower pressure.....

so it continues.

I just found out that I bought the CPAP, as well as the auto VPAP...... so I may have to re-think, not sure if they will let me swap it out within 30 days. .... may have a new remet so auto cpap available..... we will see