Just received sleep study results with CPAP

[WldWcnWmn]

After "failing" my initial sleep study on August 3rd, I was called in to do another one with CPAP titration on August 20th. I just got the results today - of course I read the thing, but I have no idea what any of it means, and the graphs while cute and all, are just as confusing (if not more so) than the dictated report. I think I am getting a cpap machine tomorrow - as I spoke with a DME provider and they said they received my information from the hospital (sleep center) and would be calling me later in the week to "get started". I am a little over anxious about the whole thing, would any of you care to enlighten me on the key points of the study I should focus on? Here's what I think is important - but have no idea what it means: on August 3rd.... AHI 21, REM AHI 46, oxygen desaturation to 72%.
On August 20, cpap titrated at pressures from 4cm to 12cm of water. The patient was observed primarily at CPAP 12cm for the majority of the study, from 12:44am onwards. There was some mild persistent flow limitations and rare respiratory events observed at CPAP 12cm, but there were still oxygen saturations as low as 90% at this pressure. While she does well at this pressure in the lateral positions, it is possible she may benefit from somewhat higher pressure if supine. There did appear to be mild occasional respiratory events associated with arousals but no significant oxygen desaturation at this pressure. The overall AHI throughout the study was reduced to less than 1, and there was no desaturation below 90%. There were zero periodic leg movements scored. Electrocardiogram: Normal Sinus Rhythm. Impression: There is evidence of obstructive sleep disordered breathing that improves with positive airway pressure (ok, that I understand). It is suggested that the patient start an autoadjust CPAP at pressures from 12cm to 20cm of water. Compliance data and oximetry may be obtained at these settings.

so, what's AHI? and is 72% oxygen desaturation low? and, the RT at the medical equipment place said he wanted to use a resmed S9 with a heated coil in the tubing something or other and a swift fx mask. All I knew to ask him from reading the boards over the last week was did the machine give full reports (he seemed shocked I asked) and he said "yes". I asked if I have to find a humidifier and he said, "no, one's with the machine." Panic mode has officially set in. Do we like this machine, do I have a choice? I think I have to speak now, or forever (at least the next five years) hold my peace. Please throw down some input... all is greatly appreciated.

[Pugsy]

Don't let the DME give you a ResMed with the word "Escape" anywhere on it.

AHI..AHI (Apnea Hypopnea Index) is the number of apneas and hypopneas per hour. Or an index for sleep apnea. 5-20 mild, 21-50 moderate, above 50 severe.
Other acronyms here that you will want to become familiar with.
wiki/index.php/Category:CPAP_Definitions

Yes, Oxygen at 72% is low but apparently didn't go below 90% during titration study..so that is good.

Your sleep apnea is worse in REM stage sleep... this is common. Mine was much worse in REM.

Sounds like he wants a range of pressure from 12 to 20 APAP... Be careful there is an Escape Auto (APAP) but it only gives AHI data nothing else..no leak..no pressure... no flow.. You don't want it. You will want the S9 Autoset.
Given the stated range I don't see how they could issue the S9 Elite which is straight cpap.

The S9 Autoset is a great machine. Software to see all the data is easily available and easy to use.

So sit back, take a deep breath and start reading...huge learning curve but not impossible to master.

[archangle]

All I knew to ask him from reading the boards over the last week was did the machine give full reports (he seemed shocked I asked) and he said "yes".

WARNING: DMEs ALWAYS LIE about whether the machine gives full reports, records full data, etc.

If it's a ResMed S9, do NOT!!! accept an "Escape" machine. It only records when you turn the machine on and off. The "Elite" machine records full data, apnea events, leaks, and waveforms of your breathing all night long.

It's like going into the hospital for a heart attack. The good ones are like having a heart monitor attached to you recording data all the time. The bad ones are like having someone come in once a day and listen to you with a stethoscope.

If it's a ResMed Auto machine, S9 "AutoSet" is the good one, even better than the Elite. "Escape Auto" is the bad one.

Look right next to the power button on the top of the machine. It should say "Escape, Elite, AutoSet or Escape Auto."

Do NOT let them trick you into accepting the wrong machine in a hurry. You can probably find another DME if necessary. Your insurance will probably charge you the same for any machine.

Remember if it says "Escape," immediately stand up and run out the door screaming and try to escape. Same for "Escape Auto."
If it says "Elite," they're treating you like an elite customer. "AutoSet" is good, too.

[WldWcnWmn]

Thank you both for the replies... I had to go look up "AHI" I guess I will have to look up a lot of acronyms now. Oy, my brain hurts. Thanks so much for the clarification from "Elite" and "Escape" I will definitely write down and take this information with me tomorrow to the DME.. . I swear, all I heard today was "heater in the tubing...blah blah blah.... minimal rainout...something or other" I do not think I am equipped to handle this meeting tomorrow - but I will stay up tonight and read the boards and jot down your recommendations. Thank you so much; I feel kinda' not so smart today

[Pugsy]

You will probably like the heated hose. Wish I had one. Not so important right now but in the winter with cooler room temps the likelihood of condensation in the hose (rainout) increases significantly. The heated hose greatly minimizes the chance of rainout. Snorting water up the nose at 3 AM and listening to the gurgling of water in the hose...doesn't do a whole lot for good sleep. Don't mean to scare you... it isn't a lot of water.. just enough to be annoying.
So you will like the heated hose.

When you are ready for the software check out Uncle_Bob's signature..while there pick up the clinician manual. It also will help with terminology as well as the machines secret hidden set up system.
memberlist.php?mode=viewprofile&u=38643

The software tutorial
http://montfordhouse.com/cpap/resscan_tutorial/

S9 video
http://www.cpaplibrary.com/machines.html

That should keep you busy for a while..

[robysue]

For a wordier tutorial concerning the data (and acronyms) on your sleep study reports, read my Understanding the data in your sleep test rest report.

There is a lot of learning to do.

Try to read through Janknitz's What you need to know BEFORE you meet your DME before you meet with the DME to get you machine.

As others have already told you, the Resmed S9 AutoSet is a nice machine that records full efficacy data so you will be able to tell how well your apnea is responding to treatment as well as determine whether leaks are an issue. The S9 Auto Escape does NOT give you enough information about the AHI and provides NO leak data whatsoever. My advice is to politely insist on the S9 AutoSet and to politely refuse delivery of an S9 Auto Escape. Do not sign any papers indicating you are refusing treatment. Simply tell the DME that you now realize you need to contact your insurance company yourself to verify exactly what your coverage is and that if they cannot provide you with an AutoSET, you plan on using a different DME that works with your insurance companay.

Good luck

[rested gal]

The ResMed S9 AutoSet is an excellent machine. It's the brand and model I've chosen to use, when I use "autopap."

As the others mentioned, do not accept a ResMed S9 Escape Auto.

Be sure the machine has the word "AutoSet" written on top.

I was pleased to see that the autopap will be set at 12 - 20. That's a smart doctor and DME to be setting the minimum up that high...high enough to probably prevent most events (apneas and hypopneas) right from the get-go. Way too many doctors and DMEs think it's good to set an autopap wide open 4 - 20 to "let the machine find what pressure you need", but a very low minimum pressure can let too many events happen while an autopap tries to respond to flow limitations and snoring vibrations. Autopaps are designed to work their way up slowly in response to breathing becoming more limited. They are not designed to yo-yo way up and way down abruptly.

Your doctor and DME are wise to plan to set the minimum at a pressure (12) that was already found in the sleep study to be very effective for you in the positions you slept in at the study. The doctor knows the jury is still out regarding whether 12 is enough if you turn onto your back, since you apparently did not sleep "supine" at the study, or at least not for long enough. He wants to be sure there is more pressure available to you if you do ever turn onto your back AND happen to be in REM at the same time. "Supine" (on your back) and in REM (rapid eye movement sleep - dreaming sleep) both at the same time, is usually worst case scenario -- when most apneas and hypopneas hit most people who have OSA. The autopap set for 12 - 20 is a very good idea.

I'd have probably set it for 10 - 20 in case there were a lot of times during the night when 10 or 11 would be sufficient pressure. But 12 - 20 is certainly a wayyyyyy better way to set an autopap for someone the sleep study found needed 12, than the usual 4 - 20 pressure range so many doctors order for an "autopap trial" following a sleep study.

oxygen desaturation to 72%

That's bad.

CPAP 12cm, but there were still oxygen saturations as low as 90% at this pressure

90% is good while sleeping.

The overall AHI throughout the study was reduced to less than 1, and there was no desaturation below 90%. There were zero periodic leg movements scored. Electrocardiogram: Normal Sinus Rhythm.

All those things are great! You are made for "CPAP." And it was made for you.

[WldWcnWmn]

Ya'll are the best. Thank you so much for the hand holding. I just got off the phone with the DME, they have an S9 AutoSet for me - no "Escape" or "Elite" in the title.... just AutoSet. I have an appointment in half an hour to pick it up, get a tutorial and mask fitting. I am kind of excited to get a decent night's sleep as I was up most last night. Anyone ever come home from their first DME visit, new contraption in hand, and immediately opt for a nap for the sake of equipment testing? I may just do that - not that I need the rest or the oxygen or anything.

[fiberfan]

It sounds like you are getting a great setup. Taking a nap or doing some cpap practice when you get home is a great idea. Like others have mentioned, the climateline hose on the S9 is a wonderful invention.