Auto-setting vs titration study?

Hi there,

I'm very new to the realm of sleep apnea, having just been diagnosed a few weeks ago. I had a sleep study done a month ago to address the sleep disturbances I've been experiencing for the past two years. These include night terrors, hallucinations, and movements during REM sleep. I have been acting out my dreams sometimes, and sometimes getting up and leaving the bed.

The sleep study showed mild to moderate apnea, with the moderate apneas occurring during REM sleep. The sleep center was supposed to do a split study and perform the titration aspect if they found apneas. They did not do any titration during the study (so I was surprised when my sleep doc told me they found apnea). My doctor guessed they ran out of time in the study. They did not diagnose anything else (ie REM movement disorder, my doctors hypothesis for my issues) but I also didn't have any events that night.

At this point, I'd like to get a CPAP. I don't have the stereotypical features (daytime drowsiness, fatigue) but having lurked here a bit, I think I have some of the less publicized symptoms (lots of getting up to pee, increased anxiety, memory and cognition issues). None of them are terrible, but it's enough that I'd like to try the treatment. And it may treat the sleep disturbances I've been experiencing. Plus, my family has high risk of heart disease and hypertension, so I'd like to reduce those risk factors as much as possible. My doctor has offered to prescribe a machine that has auto-settings (I'm sorry I don't know the exact term!) or to have me go back for another sleep study to do the titration. I'd like to avoid another sleep study if possible- I still owe $1,500 for the first one, and it's frustrating that I'd have to go back just because they didn't do their job correctly. But if it's the best way to ensure I'm getting the proper treatment, I'll do it. My question to you knowledgeable folks is: would the machine with the auto-settings be sufficient? (I've also sent my doc this question, but while I wait to hear back, I thought I'd seek outside counsel.)

Bluloo wrote:Hi there,

I'm very new to the realm of sleep apnea, having just been diagnosed a few weeks ago. I had a sleep study done a month ago to address the sleep disturbances I've been experiencing for the past two years. These include night terrors, hallucinations, and movements during REM sleep. I have been acting out my dreams sometimes, and sometimes getting up and leaving the bed.

The sleep study showed mild to moderate apnea, with the moderate apneas occurring during REM sleep. The sleep center was supposed to do a split study and perform the titration aspect if they found apneas. They did not do any titration during the study (so I was surprised when my sleep doc told me they found apnea). My doctor guessed they ran out of time in the study. They did not diagnose anything else (ie REM movement disorder, my doctors hypothesis for my issues) but I also didn't have any events that night.

At this point, I'd like to get a CPAP. I don't have the stereotypical features (daytime drowsiness, fatigue) but having lurked here a bit, I think I have some of the less publicized symptoms (lots of getting up to pee, increased anxiety, memory and cognition issues). None of them are terrible, but it's enough that I'd like to try the treatment. And it may treat the sleep disturbances I've been experiencing. Plus, my family has high risk of heart disease and hypertension, so I'd like to reduce those risk factors as much as possible. My doctor has offered to prescribe a machine that has auto-settings (I'm sorry I don't know the exact term!) or to have me go back for another sleep study to do the titration. I'd like to avoid another sleep study if possible- I still owe $1,500 for the first one, and it's frustrating that I'd have to go back just because they didn't do their job correctly. But if it's the best way to ensure I'm getting the proper treatment, I'll do it. My question to you knowledgeable folks is: would the machine with the auto-settings be sufficient? (I've also sent my doc this question, but while I wait to hear back, I thought I'd seek outside counsel.)

An APAP (Auto-CPAP) will also do straight pressure CPAP. So, it's preferable to get an APAP. That way, you have more options to try.
If using insurance, a high-end APAP has the very same insurance code as the most basic CPAP. So, if your insurance is paying, get a quality APAP.
Many/most of the forum members use Philips/Respironics or ResMed machines. Some have other brands, but those two are the "big guns" on the market.


Den

.

"I'm very new to the realm of sleep apnea, having just been diagnosed a few weeks ago. I had a sleep study done a month ago to address the sleep disturbances I've been experiencing for the past two years. These include night terrors, hallucinations, and movements during REM sleep. I have been acting out my dreams sometimes, and sometimes getting up and leaving the bed."

These are symptoms of some medical neurological illnesses, worth discussing with a neurologist.

avi123 wrote:"I'm very new to the realm of sleep apnea, having just been diagnosed a few weeks ago. I had a sleep study done a month ago to address the sleep disturbances I've been experiencing for the past two years. These include night terrors, hallucinations, and movements during REM sleep. I have been acting out my dreams sometimes, and sometimes getting up and leaving the bed."

These are symptoms of some medical neurological illnesses, worth discussing with a neurologist.

The sleep doctor I'm seeing is a neurologist, so I've got that covered.

avi123 wrote:"I'm very new to the realm of sleep apnea, having just been diagnosed a few weeks ago. I had a sleep study done a month ago to address the sleep disturbances I've been experiencing for the past two years. These include night terrors, hallucinations, and movements during REM sleep. I have been acting out my dreams sometimes, and sometimes getting up and leaving the bed."

These are symptoms of some medical neurological illnesses, worth discussing with a neurologist.

And, all very typical of what many of us went through before we were diagnosed with OSA and treated.


Den

.

Bluloo wrote:

avi123 wrote:"I'm very new to the realm of sleep apnea, having just been diagnosed a few weeks ago. I had a sleep study done a month ago to address the sleep disturbances I've been experiencing for the past two years. These include night terrors, hallucinations, and movements during REM sleep. I have been acting out my dreams sometimes, and sometimes getting up and leaving the bed."

These are symptoms of some medical neurological illnesses, worth discussing with a neurologist.

The sleep doctor I'm seeing is a neurologist, so I've got that covered.

avi is better off ignored, but you can't do that until you sign up and log in with an account.

My suggestion is to get a copy of your sleep study (raw data plus the summary). You ALWAYS want to have a copy of your medical records as they don't keep them forever. It also helps you work out your settings. Ask your doc for a prescription for an apap explaining that you can't afford another sleep study, so would prefer to work with him adjusting the auto-settings. Check with your insurance - if you have a high deductible, you are better off getting a unit either used or from an online retailer.

50% chance your doc will blow you off because so many of them are hung up on straight pressure cpaps or INSIST that you must have a titration (in the absence of other issues, this is incorrect). In that case, you are on your own and your best choice is to get a used apap and work with people here to get your settings correct.

You may find that some or all of your issues will go away after a couple of months of xpap. It's a good way to rule out what is apnea related and what is not.

SewTired wrote:My suggestion is to get a copy of your sleep study (raw data plus the summary). You ALWAYS want to have a copy of your medical records as they don't keep them forever.

You can say that again. On my last visit to a sleep doc a few weeks ago, after a rather long gap, I discovered that ALL of my original diagnosis data have been lost (from about 7 years ago). The wakefulness test results, sleep study report, the sonographic data, everything. The company that did the study no longer exists and they didn't pass the data on to my current outfit.

Fortunately, but only because I'm a GA pilot, I have kept every single report and piece of data from the start so that I could send anything I wanted to FAA Medical in Oklahoma as necessary. Otherwise I might have kept little or nothing.

I'm not the expert but you're getting some good advice here imo. I never did get a titration study and was prescribed an Auto CPAP (Respironics "A-Flex" type of blower) which is designed to adjust the pressure continuously to prevent apnea/hypopnea events during the night as much as possible without excessive sustained pressures. Those machines are really rather clever.

SewTired wrote:
50% chance your doc will blow you off because so many of them are hung up on straight pressure cpaps or INSIST that you must have a titration (in the absence of other issues, this is incorrect). In that case, you are on your own and your best choice is to get a used apap and work with people here to get your settings correct.

You may find that some or all of your issues will go away after a couple of months of xpap. It's a good way to rule out what is apnea related and what is not.

Any idea why a physician would be hung up on straight CPAP and insist on a titration? It's not a trick question, just genuinely curious.

To the OP: you might consider spending about $100 and getting a RECORDING oximetry, especially if you're thinking of going it alone. It needs to be recording over the whole night rather than just giving instant readings because you need to know if you have episodes of hypoxia - oxygen saturation of less than 90%, say. My oxygen saturation during my sleep study got as low as 67%, which is pretty darned bad. On a CPAP machine it should rarely if ever drop below 90.

Pneumophile wrote:Any idea why a physician would be hung up on straight CPAP and insist on a titration? It's not a trick question, just genuinely curious.

I was having a discussion on that very point with a sleep doctor that was hanging out here for a bit, and he had no idea, but guessed that they weren't up on the modern tech, or didn't care enough to put in the extra effort needed to properly set up an auto, ... stuck in the past, basically.

palerider wrote:

Pneumophile wrote:Any idea why a physician would be hung up on straight CPAP and insist on a titration? It's not a trick question, just genuinely curious.

I was having a discussion on that very point with a sleep doctor that was hanging out here for a bit, and he had no idea, but guessed that they weren't up on the modern tech, or didn't care enough to put in the extra effort needed to properly set up an auto, ... stuck in the past, basically.

If that is true of most of them it is extremely damning of the profession as a whole, because this sort of ignorance or just plain foolishness should be rooted out by fellow "professionals". It's hard to believe but then again I can't think of another explanation that is plausible. Sadly the one you suggest is indeed plausible. I shall have to ask my sleep doc when I see him. He seems reasonably professional, was trained at a respectable medical school and doesn't seem the dullest knife in the drawer either. Maybe he can come up with another explanation that is also plausible and based on actual clinical science - any chance of that? (semi-rhetorical ...)

Pneumophile wrote:Sadly the one you suggest is indeed plausible.

just relaying the gist of his musings. he, on the other hand, was playing with ASVs and thinking that they'd work for most people with almost zero chance of anything bad happening.... if only they weren't so $pendy.