I went through my first sleep study in November and due to the noisy environment didn't hardly slept at all in my estimation. Then in December I went back for a titration study, and due to my complaints about the noisy environment they tried to get me the quietest room. I slept somewhat better on the cpap and with the quieter environment but still woke often. The next morning the sleep tech said the titration had been quite successful. When I mentioned that I still woke many times (in my estimation) she mentioned that although the titration had mostly eliminated the apneas and hypopnea events I still had many arousals (don't remember the term she used). She said that any noise on the entire floor, no matter how small would cause me to wake or at least or at least stir and cause my brain waves to spike.
Well, I started on CPAP about a month ago and noticed improvement in the way I felt but was still waking many times throughout the night and not feeling rested. After getting my card reader and the software installed I noticed I was having many snore events. So I decided to bump the pressures from 7 to 8 and the snore index improved dramatically but the AHI and HI both increased while the OAI stayed near the same, so after a few days I raised the pressures to 9 and SI, AHI, HI all improved significantly while the OAI index went from around a .8 to 1.4. It still appeared to be the best compromise (in my opinion).
I've attached some of the graphs below.
Last week I had my first follow-up appointment with the pulmonologist, the only appointment since our initial meeting. When I arrived the pulmonologist I had met the first time was at the hospital so my appointment was with his partner. Well I described my problems with waking often and not feeling like I'm getting the best therapy, as well as my continued problems with stuffy sinuses, etc. I explained that I had raised the pressures slightly and explained my reason being the high snore index. His recommendation is for me to use a APAP for 2 weeks and then they will determine my correct pressures. He also recommended that I meet with an Ear Nose and Throat doctor to further investigate my sinus problems. It wasn't until I had already left the office that I realized that I've never even seen any of the documentation from either of my sleep studies, the doctor didn't present any of the findings or show me any of the data. I'll admit I was dumb for not even asking, and not being prepared with questions or at least print outs of my graphs.
After leaving his offices and thinking about his recommendations, I decided that I didn't think that the APAP would give them much more information that what I've currently collected (of course it would cover a greater range of pressures). I don't think getting my events slightly lower than current will make much of an improvement in my sleep, but I will confess that it is pure speculation on my part. After reading a few articles online about URARs (edit: this should say UARS i.e. upper airway resistance syndrome) the symptoms mirror my own problems. I feel like I never get any stage 3 or 4 sleep but I do get lots of REM sleep, of course this is more speculation on my part based on how I feel and how I think I sleep.
So to wrap this thing up my DME called yesterday to ask when I could come in and pick up the APAP and I told them that I was going to wait to do this until I could investigate other avenues, as I don't see much benefit for the cost of renting another machine and getting the results sent somewhere to be read for the doctor. Today the doctors office called and I talked to one of his assistants (I don't know her actual capacity at the office she may be an RT or ???), she wanted to know why I declined the APAP. I explained my observations and the fact I didn't think my troubles are directly related to titration (at least not what they will be able to determine from an APAP or CPAP). I also told her that I didn't want the extra costs. She told me they could get me the APAP for free, but I didn't think to ask if there will be a charge for collecting the data and reporting, etc. She warned me that although my wife and I are knowledgeable (said in a condescending tone) that we still need a doctor to set correct pressures, etc. She also said that the doctor thinks that my problems could be caused by "over treatment", which I assume means he thinks that raising my pressures from 7 to 9 is causing my waking.
Sorry for the long post but I wanted to give enough detail to explain my current condition. I should also add that since meeting with my doctor I'm trying nasal irrigation daily and found it to help moderately. I'm also going to call the sleep lab to get a copy of my sleep studies.
Now the question what should I try next? Can APAPs compensate for URARs (assuming this may be the problem)? I'm trying to find a tool to tell me how often and when I wake through the night so I can try to see if there is a correlation with breathing events, any ideas?
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CPAPopedia Keywords Contained In This Post (Click For Definition): Titration, CPAP, DME, AHI, Hypopnea, Prescription, APAP
