Bad Sleep Study Results

[ladyhazuki]

I was diagnosed 2 years ago and have been using a standard CPAP at 12 pressure level. Due a weigh gain and not sleeping well, I recently had a split sleep study. When I went to the sleep study, I was severely congested and took 2 Sudafed...it didn't really help much. I'm a nose breather no matter what happens and the tech said I never opened my mouth. I was also told that I was pretty consistent around 16, but had an episode that required 20. As a result, I was given a script for 20. I managed to get the PCP to Rx a Resmed Autoset, but I've been having trouble ever since. First, they had the range set at 4 - 20...obviously that wasn't right. It took a week to get it corrected, and a now a new Rx for 16 - 20. I've read the forum and it looks like it's fairly standard for a 4 pt difference in pressure for these types of machines. However, I can't seem to get to get to 16..I managed to get to 15, which woke me up. As a result, I figured out how to adjust the settings and change the base pressure to 12, turned the ramp to 45 min, and set it at 13.6 - 20.

I used Sleepy Head to evaluate my latest results. Based on the 13.6 - 20 (my max was 5.2), which resulted in an AHI of 0.48 with 1 CAO and 5 OAs. Based on the Leak graph, it looks like the events occurred due to leaks. It possible that I just had a bad night at my sleep study? It just seems like AHI 0.48 is really good. I' also a bit concerned about how much attention the insurance, DME, and PCP pays attention to our reports...will the CPAP police to show up at my door and tell me I'm playing with the dial and confiscate my CPAP? I've had the new machine for about 2 1/2 weeks and was told they'd "evaluate' me at 30 days...although I'm not sure 'they' are. I feel a little bad about messing with the settings, but frankly I think we should have a bit more control. Any advice is appreciated.

Thanks!
LH

[palerider]

I' also a bit concerned about how much attention the insurance, DME, and PCP pays attention to our reports...will the CPAP police to show up at my door and tell me I'm playing with the dial and confiscate my CPAP? I've had the new machine for about 2 1/2 weeks and was told they'd "evaluate' me at 30 days...although I'm not sure 'they' are. I feel a little bad about messing with the settings, but frankly I think we should have a bit more control. Any advice is appreciated.

typically the only thing the insurance company cares about is your "compliance" which is medical speak for "are you using the machine"... (typically something like 4+ hours a night 70+% of the time).

they really don't care at all whether it's WORKING, (ie, letting you get rest) just whether you're using it.

[palerider]

Based on the 13.6 - 20 (my max was 5.2), which resulted in an AHI of 0.48 with 1 CAO and 5 OAs. Based on the Leak graph, it looks like the events occurred due to leaks. It possible that I just had a bad night at my sleep study? It just seems like AHI 0.48 is really good. ... I feel a little bad about messing with the settings, but frankly I think we should have a bit more control. Any advice is appreciated.

we here are pretty much all about helping people educate themselves so they can have more control, no matter what the (as archangel puts it) 'medical mafia' want to try and make you think.

yes, your sleep study is a one night, possibly worst case scenario, (strange place, wires, noises, distractions) snapshot of how things are, and may not be realistic.. very good that you got an autoset, because you can do a large part of the whole 'figuring out the right pressure for you' with it fairly easily.

sounds like you're on the right track.

[Nick Danger]

Hazuki, either your DME or your doctor may complain about you changing the settings. When they do, just hang your head, give them an embarrassed smile, tell them the original settings weren't working for you and listen to their lecture. Then, if they change your settings and your results get worse, change them back to what worked. Be prepared for future lectures.

That's the approach some of us take.

[Pesser]

I was also told that I was pretty consistent around 16, but had an episode that required 20. As a result, I was given a script for 20.
LH

I am assuming that you mean 16 of pressure and 20? If that's the case why would anyone give you an RX for 20? If you required that every night they would have given you a bipap!

[Pesser]

we here are pretty much all about helping people educate themselves so they can have more control, no matter what the (as archangel puts it) 'medical mafia' want to try and make you think.

Mafia is the right word for it!

[The Latinist]

I used Sleepy Head to evaluate my latest results. Based on the 13.6 - 20 (my max was 5.2), which resulted in an AHI of 0.48 with 1 CAO and 5 OAs. Based on the Leak graph, it looks like the events occurred due to leaks. It possible that I just had a bad night at my sleep study? It just seems like AHI 0.48 is really good.

I am confused. Why are you assuming that your sleep study results are wrong rather than that your therapy is working? The latter would be my assumption.

How about posting a screen shot of a typical day from SleepyHead? That would give us a good idea of how your pressures are moving and how much pressure you need? Also, what's are your median and 95% pressure stats since you started your new settings?

[Tatooed Lady]

You could also take responsibility when talking to the doctor/DME like I did, and flat out tell him/her that you've altered your settings a) so you can sleep, b) because you're following your treatment through software on your home computer/laptop and can see what's working and c) if you don't USE it, you won't BENEFIT from it (and they don't get paid). Once you start telling them that you are keeping close tabs on your numbers, and what you're looking for as far as numbers you're happy with, or what you're not...and especially if the settings you putter with aren't SUPER far from what they originally set, they shouldn't have anything negative to say.

My DME listened to what I told her, probably with her jaw hanging the entire phone call, then said she'd call the doctor to recommend an Rx adjustment based on what I had told her.

If you understand what you're doing and why you're doing it, stand your ground and take an active part in your therapy.

[ladyhazuki]

How about posting a screen shot of a typical day from SleepyHead? That would give us a good idea of how your pressures are moving and how much pressure you need? Also, what's are your median and 95% pressure stats since you started your new settings?

I suppose I just need reassurance that I'm right, because it seems like a really big gap to me 13.6 vs. 20 (or the unofficial 16). I have the report from the study and it doesn't say anything other than the 20--the tech mention 16. Anyway, I thought it was nuts, which is why I asked for the Autoset machine. I'm also unsure as when to stop increasing the pressure. Should I be at zero events, or am I at a good level now and should wait and see what happens for a few days. I thought about raising it to 14.4 until I get my new mask, but I'm not sure it would help. At this point, I'm so tired that I figure it may take a week or two to finally feel rested. Here's last nights data...

[palerider]

How about posting a screen shot of a typical day from SleepyHead? That would give us a good idea of how your pressures are moving and how much pressure you need? Also, what's are your median and 95% pressure stats since you started your new settings?

I suppose I just need reassurance that I'm right, because it seems like a really big gap to me 13.6 vs. 20 (or the unofficial 16). I have the report from the study and it doesn't say anything other than the 20--the tech mention 16. Anyway, I thought it was nuts, which is why I asked for the Autoset machine. I'm also unsure as when to stop increasing the pressure. Should I be at zero events, or am I at a good level now and should wait and see what happens for a few days. I thought about raising it to 14.4 until I get my new mask, but I'm not sure it would help. At this point, I'm so tired that I figure it may take a week or two to finally feel rested. Here's last nights data...

looks pretty good, I'd say 'keep it up' leave it where it is for a few days, see how things go. usually best to make small changes and give 'em a chance to settle, instead of tinkering every night.

a graph that showed the events, flow, pressure, leaks, snore and flow limit is best, hit the ^ to turn off the calendar, the ahi graph is a waste of space.

[Nick Danger]

Looks great! AHI is low and leaks are under control. Leave it where it is and see what happens!

By the way - it looks this good and the machine never goes above 15ish to get these results!

[ladyhazuki]

a graph that showed the events, flow, pressure, leaks, snore and flow limit is best, hit the ^ to turn off the calendar, the ahi graph is a waste of space.

What is the difference between flow and flow limit? Also, why would I care about the snore graph? I tried to do my research, but some of this stuff still eludes me.

[ladyhazuki]

By the way - it looks this good and the machine never goes above 15ish to get these results!

Not going much above 15 is why I'm wondering if I had a bad sleep study...it's basically off by 5 and that's huge!

[SleepyToo2]

I'm very happy with numbers like yours. I would take a look at the one week figures (overview on Sleepyhead) when you have a week with the new settings. If the averages are looking as good as they do on this one night, I would say you have a good case to tell your physician what you have done and demand a prescription to make it right in their books (and for the DME). Only other question would be how do you feel - that may also take a little while to settle down with the new settings. Fiddling with settings is going to delay the getting used to things - if it ain't broke, don't "fix" it! Most people will have at least a small number of apneas each night - it is when you get an average greater than 5 per hour that things really go haywire. So an average of 0.59 is excellent, and 0.48 is even better!

[palerider]

a graph that showed the events, flow, pressure, leaks, snore and flow limit is best, hit the ^ to turn off the calendar, the ahi graph is a waste of space.

What is the difference between flow and flow limit? Also, why would I care about the snore graph? I tried to do my research, but some of this stuff still eludes me.

flow is your inhaling and exhaling. flow limitation is a representation of when you're having trouble inhaling, ie, your throat or something is limiting the flow. the autoset responds aggressively to flow limitations and snoring, becuase those are often precursors of apnea events, which is why those graphs are handy, they help explain pressure spikes.

a lot of answers on what's happening, and what various things can be seen here:
https://www.youtube.com/watch?v=-gie2dhqP2c