New Sleep Study Could Use some help figuring it all out!

[azmanatheart]

When I first posted a couple of days ago, and said i could not tolerate 16cm H2O in a straight CPAP, a helpful member pointed out that just because that was achieved for a short duration does not mean that I can actually tolerate it all night and every night.

I got a full copy of my report as Slinky had advised, and the info in it is quite comprehensive. I don't know if veterans of this forum want me to post the entire report; i'll spare you all that unless you say it helps, but here are a couple of interesting note about the Titration Study done on 12/0/08.

Sleep Staging;
Stage NA1- 13.5%
Stage NA2- 76.5%
Stage N3/4- 0%
Stage REM 10%

No SWS achieved (Short Wave Sleep? Delta? Restorative?)
Sleep efficiency decreased
REM onset delayed

Arousals- 113 arousals observed; 106 respiratory and 7 RERA/LIAR arousals Index is 1.3.

Impressions- OSA 327.23
The CPAP titration study was successful

Significant positional component
The Patient showed improved sleep architecture (Compared to what?)
REM supine with evidence of rebound was achieved at optimal pressure????
The optimal pressure for CPAP appears to be 16CM

I could go on, but the bottom line is this; They started me at 4 and brought me up 2cm every 20 minutes until reaching 10, which they kept me at for 96 minutes, during which I had 39 OA's and the lowest O2 level of the night at 78%, they then raised it to 12, at which point i must have rolled on my side, because the lines practically flatten out I got a little REM sleep and the OS's and the snoring all almost stop for about 2 hours, when I moved back to lie on my back and the apnea returned and they raised it to 14cm for 54 minutes, during which time I had only 7 Oa's , and then raised me to 16cm 5;10 am for a total of 31.9 minutes, during which I had 4 OA's but then turned on my side, and had a final REM. At least half of my 32 minutes at 16cm was on my side.

Somehow, they said that it was a successful titration study proving I need to be at 16cm on CPAP.

What I see is a study that shows that when I sleep on my back, I'm almost normal, although I don't how it is with no PAP pressure on, but it is certainly under control at a lower number when I am not on my back. On my back, I apnea'd all the way THRU 16.

I really don't know what to make of this right now. Seems like I should get one of those humpy foam belts that keeps you from rolling on your side and sleep with that at some level. I seems clear to me that CPAP while on my back is very dicey and risky a fraught with potential problems. I never achieved ANY REM on my back, maybe because of the OSA, but did on my side, where I must need a lower pressure to keep my throat open due to gravity.

As far as this study PROVING that the study demonstrated success at 16cm is ridiculous.
I will speak to my doctor intelligently now that I have the report, although I'm sure he will not want to hear it. I've been denied Bi-pap by the HMO because this test said it successfully demonstrated that CPAP alleviated my condition at 16cm!

Come on guys and gals, give me some AMMO

[Wulfman]

I'm not sure what kind of "ammo" you are looking for. If you have a prescription (in hand), you would be money ahead to purchase a data-capable machine......CPAP or APAP......to either prove or disprove what they are saying. I (apparently) had a flawed sleep study because I was prescribed a pressure of 18 cm. I took my prescription and purchased a data-capable machine (REMstar Pro 2) and the software from CPAP.COM and started out my therapy at 10 cm. (after trying 18 for about an hour). About a year later, I subsequently ended up at a pressure of 12 cm., but the difference in pressure only eliminated the snoring.....AHI remained the same (< 1.0) The bottom line is that I re-titrated myself on a single-pressure CPAP.....no APAP.....no Bi-PAP.....with the help of the reports from the software.

Den

[azmanatheart]

I'm not sure what kind of "ammo" you are looking for. If you have a prescription (in hand), you would be money ahead to purchase a data-capable machine......CPAP or APAP......to either prove or disprove what they are saying. I (apparently) had a flawed sleep study because I was prescribed a pressure of 18 cm. I took my prescription and purchased a data-capable machine (REMstar Pro 2) and the software from CPAP.COM and started out my therapy at 10 cm. (after trying 18 for about an hour). About a year later, I subsequently ended up at a pressure of 12 cm., but the difference in pressure only eliminated the snoring.....AHI remained the same (< 1.0) The bottom line is that I re-titrated myself on a single-pressure CPAP.....no APAP.....no Bi-PAP.....with the help of the reports from the software.

Den

That was good 'ammo' Wulfman. I'm frustrated because I don't think I should have to waste my time letting the DME people re-set my CPAP to 16cm, when I've tried it myself and cannot exhale at all. Whilte awake, I've tried vaious settings and found that I can exhale against straight CPAP pressure up to about 12cm without my face turning red from the effort.

I am afraid to set my machine myself at a high level(was at 8cm) and then go sleep while it ramps. At the same time, I'm afraid not to use the CPAP at all since I do have severe OSA and prefer not to wake up dead or worse. When I say 'afraid', it i snot indicate that I'm weak, I just don't know what the outcome will be.

I see in reading these forums that many people have adjusted to higher pressures over time with diligence and patience. I'm fully prepared to do that if it makes sense and has a chance at successful treatment. BUt since I doubt that I have a good machine for my condition, I feel like it's a complete waste and prevents me from getting started on a helpful therapy.

I can either pay out of pocket and get the best machine, or go through the process of letting the DME raise the pressure on current machine which is 2 1/2" years old, prove to them that I can't tolerate it, maybe have to go in for a bi-pap titration, wait for those results, then fight with the HMO/insurance over which machine they will allow...etc..

Although I really can't afford $500+ out of pocket in this economy, or at any time for that matter, I'm thinking that may be the best way to go.

My other concern, and I hope someone in this forum can address this, is that my last titration showed that I failed to achieve SWS or deep sleep. I don't think the Pulmonary Doc is prepared to address this, how much of a problem it is. Maybe some type of Sleep Neurologist can speak intelligently about it and what, if anything, I can do or stop doing, to attain some deep restorative sleep.

Thanks, the 'ammo' referred to something to use to argue with the HMO.
Jeff

[Georgio]

Check with your provider, there maybe a period of time before your "fail" cpap, and become eligable for apap or bipap. I know it sucks, but you will get there.

Georgio

[Chris61]

I would suggest that you take your study and machine into the doctors office have them down load the data so far and have him explain the sleep study in detail and then tell him the problems that you are having. I had some of the same problems with feeling bloated and to much pressure. After talking to the doctor he went ahead and change the setting. Here is a good book that will explain a lot of things you are looking for. The name of the book is Sleep Apnea - The Phantom of ther Night. By T.Scott Johnson, M.D. William A Broughton, M.D. and Jerry Halberstadt. DO not be afraid to talk with the doctors and the people who did the test. I hope this helps you out. Any questions just ask.

Chris