Need some advice

Hi all,
I am a 48 year old ,I have probably had sleep apnea for twenty plus years.I started my cpap journey in march. I had a sleep study, two hours into the study, I was placed on Cpap, I had ahi of 56. The tech placed a Full face mask on me, and i couldn't stand it do to being clostrophobic(when she was attaching the wires on me, i explained to the tech I was clostrophobic,she put the full face mask with forehead strap anyway) I lasted 5 minutes, before i had a panic attack and ripped the mask off. They sent me home . They scheduled me a second sleep study two months later. Knowing I had a bad case of clostrophobia,I did my research ,on this forum,and others and found a mask I thought I could tolerate. I settled on the liberty mirage. Had my second study, I was diagnosed with complex sleep apnea (i didnt get the results from the sleep dr.,but from the lady that called on the phone)I guess the cpap induced central Apneas. They cleared my OSA at a pressure of 23. Then I started having central apneas, and for reasons I can't explain, they kept cranking the pressure up to 29. That was the longest nite of my life, just tring to breath against the pressure. I never slept at all the last two hours of the study, I was just trying to survive one breath at a time.
It took about 3 weeks before I heard back from the sleep center, they said I had afib and needed to see a heart dr immediately , they got me in three days later. Heart checked out ok, dr said my sleep apnea is probably the cause of my afib.
The sleep center wanted to do a third sleep study(that my insurance won't pay for). I said I wanted to talk to the sleep dr before I did any more tests, so I could get a clear idea of what my situation was. That took two months, I got in to see him in early October. He was a very good and caring neurologist , he looked at my study, said I need a study using bipap starting at 8/12, and then asv Probally.Since my insurance won't pay for a new study until January, he ordered a cpap at a pressure of 8. I also have to sleep on my side, Apneas,much less on my side.
I've been on cpap for 27 days now,it's been a bit of an adjustment, and a mask change, I am finally sleeping thru the nite.
My ahi numbers are kinda high, as high as 36/hour, the last few nights it is around 17/hour, with 1 to 4 ca/hour.
I know my numbers are not good, but I feel good, I felt good from the first night of cpap use,even when I was waking up 6 or 7 times a night. I have no more day time sleepiness and naps, and haven't fell asleep driving since I started cpap. It's literally changed my life.
Sorry for the long post, but I thought some back ground would be appropriate . My question is this, should I start increasing my pressure, to see if my ahi numbers will get better. Also if I get used to higher pressure, I might survive my next study. Lol.
I go back to the neurologist in January. Should I just wait for his opinion.
Thanks,
Tim

If you have more centrals than anything, or even just quite a few throughout the night (not just when drifting off or waking - big difference) higher pressures will provoke more of them. I understand your neuro's reasoning for putting you on 'plain' cpap (or even autopap) rather than bipap short term, and that you're going to be seen again. I wouldn't crank up your pressure until you know more about what's going on... don't think it will address your centrals or afib that much more.

I agree that increasing your pressure could induce more central apneas.

Why won't I think in this case you're going to need bipap and possibly ASV to handle the complex apnea.

I know what you mean when you say that the sleep study was one of the longest nights of your life. I also found my two sleep studys to be very challenging. stick with your treatment.

If you increase the pressure it might make the centrals worse...so you might be trading OAs for more centrals.
You might also be able to reduce the OAs and not increase the centrals depending on how your body responds. Sometimes there's a fine line where you can compromise a little. Keep the OAs reduced a little and not trigger the breathing instability that comes with the centrals and complex sleep apnea.
Your centrals are running 1 to 4 per hour...if it is more often 4 per hour then you probably don't have much wiggle room but if it is more often 1 per hour...you might have a little wiggle room.
You most likely can't get your AHI down to 5 or below but maybe single digits or cut it in half??? that's a big maybe.
If you increase your pressure and your centrals sky rocket...not the thing to do and if you do increase it...just a little and watch those centrals real close. Tiny increases.

I agree with Pugsy. You might want to try to increase your pressure just a little bit. Do it slowly and monitor the data. You might find it drops the apneas enough without increasing the central apneas. Also, if you have EPR enabled (and most DMEs to enable it) you might want to try to turn it off. That often increases the apneas and hypopneas. You will find, while it makes breathing a little easier, if you have a very tight tolerance before having central apneas, then this might help reduce the obstructive apneas and hypopneas without increasing the central apneas.

In the long run, as your doctor has noted, an ASV unit is probably where you will need to be. However, every now and then BiPAP is all that's needed to avoid the central apneas and reduce the obstructive apneas. If that's the case, that's what you want. BiPAP is both easier and cheaper (for you and the insurance company). But if the sleep study shows you need an ASV unit, the good news is that it is very effective.

Anyway, sorry for the struggle you've had to get to this point. The good news is that you understand that you and you alone must advocate for the health care that you receive. All too often the system does not work -- unless you help shepherd it along.

Do keep us updated.

Thanks to everyone for the good advice. I think I will probably just stay at the pressure I'm at. I downloaded sleepy head, but I haven't figured out how to interpret the data. I will be sending my data card in soon, hopefully it won't take long to get feedback ,and a new direction from my DR. Maybe the data from my machine will convince the insurance company to allow a new study sooner.
The thing that concerns me, is during my second study, my oxygen level was as low as 66%. From what I understand this is very dangerous. I thought about getting a o2 sensor.
I have been 100% compliant, and intend to stay that way.i don't use the EPR setting, and I no longer use the ramp . If I didn't have a data capable machine, I would think the therapy was working great. I feel better then I have in a very long time, it shows that CPAP therapy really works , I hope to get to a point where I am "fixed".
Thanks again for giving me advice and support.
Tim

Hi all, I have an update and a question.I have slowly increased my pressure to 13, this reduced my ahi to about 8 per hour,without my centrals increasing.I switched to the swift fx, i was using the Quattro fx,but leaked like crazy. I do have mouth leaking issues ,I started using pap cap chin strap, and staring to get my leaks under control. My ahi is still a little high,but still feel pretty good.
I got in to see the sleep doc in January , I had all my data , questions written down, I was prepared. I had researched my condition,I went thru over 700 pages in the archive on this site, looking for similar conditions and others experience and advice. This was well worth the time and effort, I now know quite a lot about sleep apnea. I first met with the sleep tech, I asked questions about my my first two sleep studies, he basically said the the first tech should have never put a full face face mask with a a forehead bar on someone that is claustrophobic , she screwed up. The second study, the tech cranked the pressure up to 29/25, and kept it there for over two hours. This he said there is no explanation for this, they screwed up. I then met with a fellow from the sleep center (not sure what a fellow is, I assume a doctor ) . He was very impressed with my knowledge of my condition. He said Cpap patience know very little of their condition, "you know more about this, then 99% of any patient he's met". He was impressed with my sleep logs,data and being proactive with my treatment..I want to thank everyone on this site, espeacally Pugsy, I learned so much from others posts, and great advice from all the members here.
I then met with my "very caring neurologist",he was not impressed , with me changing my pressures, actually he was pissed. He wanted to know how and why I decided to increase my pressure. I explained I did it slowly, monitored my results, and started lowering my results. He didn't seem to very interested anymore.
I asked about a third study, he said I did not need one. This kind of took me by surprise, but he prescribed an auto machine. I asked for a bi level machine, he said no. He was going to have the machine set at 12-20, and told me not to mess with the setting. I told him I wouldn't .
It took 5 weeks to get my new machine ( s9 auto) . I left it at 12-20 the first night, tough night. Machine ran at 18, the second night I changed it to 13-15, this was better, I've slowly been raising the pressures up, to get used to the higher pressure. I am now at 14.4-17.4, the machine is running at the top of the range most of the night. My apneas are getting shorter in length of time, and around 5/hour. I'm making improvements, but I seem to be more tired. I am experiencing more mouth leaking and air in my stomach, disturbing my sleep. Since I have not reached my upper pressure yet, I'm wondering if a bilevel machine might be better suited for my needs?
What ive learned from this oddessy, is that sleep apneas is a silent thief, and you don't know your being robbed. Cpap has given me a new life. The best advocate for your health is you, know your condition, and be proactive. This forum is awsome, and all the people that have posted here, or giving advice, have been invaluable. Thanks to all. Tim