No equipment yet, but here's my sleep study results...

[Tash]

Apparently, because my primary doctor was kind enough to write my prescription for the APAP, the holdup in getting my equipment is Gentiva must get "authorization" from Cigna (insurance) because I haven't tried straight CPAP first....(I was hoping if my doctor wrote the prescription, they would just fill it - how naive of me... )

Anyhow, I did receive a copy of my sleep study- I would scan it, if I knew how...So, instead, I will type what I think is important, and we'll see if I'm right...

"The baseline portion of the study was for 209 minutes and the patient slept for 200 minutes for an excellent sleep efficiency of 96% (normal >85%). Sleep onset was slightly early (8 minutes). Latency to Stage REM was normal at 96 minutes. Sleep staging was notable for the presence of sleep stages 1,2,3 and REM sleep. The sleep tech noted moderate snoring.

The patient demonstrated on overall Apnea + Hypopnea Index (AHI) of 22 events per hour (normal < 10). This included 73 obstructive hypopneas. Respiratory events were significantly worse on the patient's back (supine AHI =43), as well as during REM sleep (REM AHI=48). Oxygen saturations were typically in the 95% range, with cyclic desaturations to 88-90%. The lowest oxygen saturation was 82% during REM sleep.

After documenting sleep disordered breathing, CPAP therapy was initiated and titrated from 5 to 13 cmH20. The optimal CPAP pressure was 8 cmH20, reducing the Apnea + Hypopnea Index to 4.8 events per hour, including REM and supine sleep. On optimal CPAP pressure, oxygen saturations improved to the 95% range. Sleep efficiency improved to 100% and REM sleep occurred. The patient tolerated CPAP well <NOTE: no mention made of my total intolerance once the chin strap was applied!!!> and indicated a willingness to try CPAP as home therapy. No significant PLMs were seen. Analysis of ECG data demonstrated normal sinus rhythm (heart rate range of 54-71 bpm) with no significant arrhythmias.

Impression: 1) OSA, moderate to severe (supine, REM sleep)
2) Successful CPAP titration "

So, what do you all think?

[Tash]

oops, my REM AHI= 48

[Ric]

I think just about everybody, if not in fact EVERYBODY who needs CPAP would benefit from APAP. Theory being that your sleep study was only YOU on a given night. Every individual has a range of physiological states, some of which may affect your breathing patterns and apnea events. You may be quite different on another night, physiologically. Or on the same night at different times. Your state of hydration, fatigue, nutrition, anxiety, attitude, the type of bed, pillow, noise, allergies, weather, humidity, variations in weight, exercise level, and on and on and on and on.... LOTS of things can affect the amount of pressure required to compensate for the delicate balance between the forces of pressure required to move air in and out, and the forces blocking that convection of air.

It is just SILLY to prescribe someone a CPAP and think that it will work equally well even the next night, or next year. APAP is able to dynamically detect changes in breathing and airway pressures and compensate accordingly, right then and there when you need it.

I was titrated at 7 (in-H2O) in the SA, but have since had apnea events lasting over a minute that required up to 16 (in-H2O) to compensate. Of course my insurance only pays for CPAP, no matter what the prescription. So I sprung for an extra $150 to "upgrade" to an APAP. Glad I did. And glad I have a primary care physician who is waaaay cool and supportive of doing this. I was determined to get an APAP as the first machine, and not mess around with the bureaucracy. And pretty glad I did.

If I had a CPAP set at 16, that would be incredibly annoying for one who normally doesn't need that much. And a CPAP set at 7 would be useless for the severe and most critical events. The C-flex part is nice, takes some of the work out of exhaling.

[Guest]

Hey, sounds like a successful study and titration! Looks like you only slept for 3 hours, is that right? An AHI of 22 with 73 hypopneas, and how many apneas?

8cms is a good pressure in that it's not a difficult pressure to exhale against, so that's a plus.

I agree, chinstraps are intolerable to me too. What mask did they use? Was it comfortable? What mask did you order?

[Tash]

Ric - so just eat whatever the extra cost is upfront to get the APAP? At this point, I don't know what my insurance will say, but if that is an option, it sounds like it's worth it in the long run...

Guest,
Yeah, 3 hours before they woke me for the CPAP. The report breaks down the hypopneas ("This included 73 obstructive hypopneas") but doesn't say how many apneas.
At the study, I used the "Comfortgel" - was ok until the chinstrap was applied, then it leaked like a sieve.. won't use it again. Asked for a Ultramirage FF mask, will buy a nasal mask and nasal pillows with my own money (hopefully I can do ok with the FF mask for a while, with Xmas this month, it's a bad time to be spending extra money..."sorry, honey, you couldn't have any presents/toys, mama needed to breathe while she slept... two year olds just don't get it )

[Cpapper Incognito]

[quote="newgal"]Ric - so just eat whatever the extra cost is upfront to get the APAP? At this point, I don't know what my insurance will say, but if that is an option, it sounds like it's worth it in the long run...

Guest,
Yeah, 3 hours before they woke me for the CPAP. The report breaks down the hypopneas ("This included 73 obstructive hypopneas") but doesn't say how many apneas.
At the study, I used the "Comfortgel" - was ok until the chinstrap was applied, then it leaked like a sieve.. won't use it again. Asked for a Ultramirage FF mask, will buy a nasal mask and nasal pillows with my own money (hopefully I can do ok with the FF mask for a while, with Xmas this month, it's a bad time to be spending extra money..."sorry, honey, you couldn't have any presents/toys, mama needed to breathe while she slept... two year olds just don't get it )

[Tash]

CI,
Good to know. I will keep it in mind. I am waiting to hear from Gentiva what the damages will be as far as cost. Overall, if we can swing it, I would like the APAP - I am a little leary of the report saying 8 is my number, when the report doesn't even mention the difficulty I had once they put the chinstrap on (in fact, the report doesn't even mention the chinstrap, except in the recommendation for the nasal mask "with chinstrap". It then says, "...if the nasal mask with the chin strap is not well tolerated (WHICH IT WASN'T DURING THE STUDY, so I don't know why it would be otherwise!)consider a fittling for nasal pillows." Anyhoo. If we can swing it, my plan is APAP, let ins. buy the FF mask, and buy nasal mask and nasal pillows on my own. (The best laid plans, eh?)

[Guest]

I give up. Whats an obstructive hypopnea? I thought there were only 2 categories: obstructive apneas or hypopneas

I'm confused, as usual.

[Tash]

Guest,
I rechecked the report to make sure I typed it right. It says: "The patient demonstrated an overall Apnea + Hypopnea Index (AHI) of 22 events per hour (normal < 10). This included 73 obstructive hypopneas..." etc...

I dunno.

[Colorado Jan]

I'm confused too. I must not be thinking straight at all. AHI of 22 events per hour? For three hours? Which would be 66 events total...but 73 of which were obstructive hypopneas? Oh well....

I don't remember, Newgal...did you check with BillMyInsurance.com? Do they work with your insurance? Maybe you could get your apap that way. OR....check with your insurance to see if they would reimburse you if you purchased it directly. That would get you the Apap. See how that works out financially for you.

Otherwise, I agree...really the mask is most important at this point. If money is tight put your money there.

Geez, you've been waiting a long time for this, haven't you? I hate it when things move along so slowly...

Jan in Colo.

[Sleepless on LI]

Newgal,

My only comment to add would be, it's great that even though your apnea is classified as moderate to severe, that all it will take is, according to your study, 8 cms. to keep your airways open. That is a blessing for which you should be very glad. 8 is an easy number to tolerate and not so low as to cause you any distress, such as feeling you're not getting enough air. Also, your oxygen levels were restored to normal at that level.

I think, too, if you can get the auto, get it from the start. As Ric, I believe, had stated, your situation can change from night to night and this can help take care of those fluctuations.

Best of luck and continued success.

[IllinoisRRT]

[quote="Colorado Jan"]I don't remember, Newgal...did you check with BillMyInsurance.com? Do they work with your insurance? Maybe you could get your apap that way. OR....check with your insurance to see if they would reimburse you if you purchased it directly. That would get you the Apap. See how that works out financially for you.


Geez, you've been waiting a long time for this, haven't you? I hate it when things move along so slowly...

Jan in Colo.

[kf7tt]

I give up. Whats an obstructive hypopnea? I thought there were only 2 categories: obstructive apneas or hypopneas

I'm confused, as usual.

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): Hypopnea

Guest,

The obstructive apnea, as I understand it, is the soft tissue in your throat collapsing. A Central apnea is the brain not sending the signal to breath. A hypopnea (in our lab) is an 80% decrease in the airflow signal along with a 4% drop in oxygen level. I hope that helps. ---- Duane RRT, RPSGT

[Guest]

Thanks Duane. So are you saying there's no such thing as an obstructive hypopnea-- or is the defintition of an obstructive hypopnea an obstructive apnea with desats?

[kf7tt]

Guest,

I believe there are hypopneas of obstructive and central in nature. Although when scoring the sleep study in our lab we don't differentiate between them.

When we score a study for respiratory events we use to following definitions:

Obstructive apnea = at least 80% decrease in airflow at least 10 seconds long, with signal from both effort belts(chest and abdominal), with or without decrease in oxygen level.

Central apnea = no signal from airflow, or effort belts, at least 10 seconds long.

Hypopnea = 20% decrease in airflow or effort belts with a 4% decrease in oxygen level

When figuring AHI the apneas and hypopnea are equal in importance.

I hope this didn't muddy up the water to much.

Duane