CASE PRESENTATION: A 62 year old woman with a history of chronic headache/back pain, anxiety, lacunar infarction, cerebral amyloid angiopathy, hypertension, Hashimoto’s thyroiditis and diabetes mellitus was referred to the sleep clinic. She was diagnosed with OSA of unknown severity over 10 years ago. She underwent 3 follow up polysomnograms (PSG) and was on bi-level PAP in the spontaneous mode at 25/20 cm water pressure with supplemental oxygen bled in at 4 L/min at the time of presentation. In the same time interval, dependence on opioid/benzodiazepine medication had escalated. She complained of severe daytime sleepiness, falling asleep in conversation and at meals with an Epworth Sleepiness Score of 17. She had ongoing issues with imbalance,falls, cognitive impairment and chronic pain. BMI was 33. PSG revealed an AHI of 25, RDI of 37 and central apnea (CA) index of 4/hour. On CPAP, AHI was 32 and CA index 28. On Bi-Level PAP in the spontaneous mode, AHI was 81, mostly CA. On adaptive servoventilation (ASV) at maximal EPAP, AHI was 28 with persistent CA. She was prescribed CPAP at 10 cm water as most obstructive events appeared to be eliminated at this pressure, with the understanding that it was crucial to her therapy and symptoms to decrease the use of opioid/benzodiazepine medications. Over the next 2 months, she successfully decreased diazepam from 20 to 5mg daily, oxycodone ER from 240 to 80mg and short-acting oxycodone from qid to a once daily dose. Subsequent PSG showed elimination of most sleep disordered breathing/hypoxemia on CPAP at 12 cm water and no evidence of hypoventilation on arterial blood gas.