After observing 90 central apneas and no obstructive apneas during a split-night study, what should the sleep technician recommend first?

In the context of a split-night study where 90 central apneas have been recorded with no obstructive apneas noted, the presence of a high number of central apneas suggests that the patient is experiencing a disorder related to central sleep apnea (CSA). Central sleep apnea is characterized by a lack of respiratory effort during sleep due to instability in the respiratory control system, rather than an obstruction in the upper airway.

Continuous Positive Airway Pressure (CPAP) therapy is typically used for obstructive sleep apnea, where the airway collapses during sleep. However, for central sleep apnea, especially when there are no obstructive events, traditional CPAP may not be effective since it does not address the central control issues causing the apnea episodes.

In such cases, recommending CPAP therapy might seem counterintuitive initially. However, if there's a suspicion that central apneas may lead to discomfort or desaturation for the patient, initiating therapy—even if one suspects that they may eventually need a different approach—can be a prudent first step while maintaining ongoing evaluation.

More specialized treatments like BiLevel therapy, which may utilize different pressures for inhalation and exhalation, or certain medications may be considered in more complex cases or when CPAP is ineffective. The decision to recommend