I apologize in advance for the length of this.
I did a split-night sleep study with PAP Titration. Their IMPRESSION narrative is as follows:
Their RECOMMENDATIONS narrative:This overnight polysomnogram demonstrates evidence of an overall mild to moderate degree of sleep-disordered breathing with a Total Respiratory Disturbance Index of 15.7 events per hour. There was no significant desaturation and there were only 6.1 arousals per hour as a result of respiratory events, indicating an overall mild impairment of sleep from sleep-dosordered breathing. While a Split-Study for CPAP titration was attempted, an optimal CPAP pressure was not identified. Despite all pressure settings tested, the patient continued to have respiratory events that started to develop central respiratory events and increasing amounts of wakefulness during CPAP titration.
So, my reading of that is that my AHI was 6 without using the machine.Given the fairly mild nature of this patient's sleep-disordered breathing, and the lack of any significant desaturation, and only 6 arousals per hour, I do not think this patient necessarily would require CPAP. Given his intolerance during this titration and the lack of an effective titration, other options for treatment should be considered... [etc, etc, suggesting other options]
I subsequently went back in solely for a titration study, since the first study never revealed any setting that made my apneas less frequent. The second test (titration test) actually made the apneas worse.
Their IMPRESSION:
Their RECOMMENDATIONS:CPAP was initiated at 6 cwp and titrated to as high as 11 csp with the patient notably demonstrating only brief and repeated episodes of sleep, with frequent prolonged periods of wakefulness, likely due to some discomfort with the CPAP device. Once the patient did enter more consistent sleep with CPAP 11 cwp, a combination of obstructive and central apneas were see, resulting in a severely elevated Apnea-Hypopnea Index (AHI) of 48, with significant sleep architecture disruption.
The patient was then switched to bilevel PAP at 15/11 cwp, and used this device for just over 3-1/2 hours, with over 2 hours of supine sleep. Unfortunately, bilvel PAP 15/11 cwp proved suboptimally effective, with continued central apneas and very rare hypopneas, with residual Apnea-Hypopnea Index (AHI)/Respiratory Disturbance Index (RDI) of 18.6 while supine and 9.7 during lateral sleep. This mild sleep architecture disruption persisted, with rare desaturations to no lower than 89%.
The confusing part about these two tests is that after the first test, their recommendation was "Given the fairly mild nature of this patient's sleep-disordered breathing, and the lack of any significant desaturation, and only 6 arousals per hour, I do not think this patient necessarily would require CPAP. Given his intolerance during this titration and the lack of an effective titration, other options for treatment should be considered."...While recommendations regarding optimally effective settings cannot be made at this time, I believe it would be reasonable to start the patient on bilevel PAP at 15/11 cwp for now, following closely for any residual symptoms or hypoxemia. It is entirely possible that the patient's central apneas will resolve over time,w ith ongoing use of CPAP.
and given that the titration test made my AHI/RDI numbers worse when actually on the machine, I'm wondering if I really am a good candidate for OSA therapy.
I have since been given a machine and started out at their recommended bilevel PAP of15/11 cwp. I simply couldn't sleep with it at those settings. Felt so completely exhausted and sleep deprived that I was minimally functional, so quit it for close to a month and told my doctor that I was not tolerating the machine and that it made me more exhausted. She advised me to give it another try at different settings. This time at the Full Auto Bipap with range of 5 - 20. I've been able to sleep with this new setting (for the last 5 days), but my AHI has not improved.
My readings for the last 5 days are as follow:
AHI=7.12, CA=4.06, OA=0.83, H=2.27
Avg pressure has been 6.05
A brief history of my sleeping is that I have not been able to sleep well for a very long time and pretty much never wake up feeling rested, and get tired fairly easily. So, in spite of the relatively low AHI numbers, I wonder if I am a good candidate for CPAP/BIPAP therapy in you guys' view. The only reason I went in for a sleep test at all was because I went on a vacation with friends and stayed in the same house, and I awoke both of them (they were in different rooms with their doors closed), and they were astounded at the sounds I was making (gasping, snoring, etc), so I got the sleep test. I was surprised it turned out to be mild, when their description of how I was sleeping sounded severe.
Anyway, any advice would be appreciated. I don't feel any better after having used the device for 5 days, and in fact feel slightly less rested than without using it. How long should I try this do you think?
