got my sleep lab results, and the doc's settings suck

[space45]

Ok so I got the results from my sleep lab test, they said I needed a pressure of no less then 20 cmH2o and should have a exhale pressure of 10 cmH2o, and they wanted to set my VPAP to a SPAP as they do not trust the machine to do the right thing, they trust their one nights test results with their high tech testing equipment. well I tried their settings and they suck big time, more events when sleeping and not feeling as rested in the morning. I tried the SPAP thing and bumping up the exhale pressures so the machine could get to the high pressure faster as the low pressure took way to long to build up to 20 from 10 cmH2o, so tried higher EPAP to get quicker response time that was better but still not right. so I said the hell with it and went back to VPAP, set EPAP to 17 and IPAP to 21 and PS to 4. so now I am back to getting a great nights sleep, in fact better then prelab. before the lab I was set to EPAP of 17 IPAP of 19.6 and PS of 2.6 and was getting good results. tons better then the sleep labs numbers, the only good thing to come of the sleep lab is the minimum IPAP pressure should be 20 cmH2o, I was at 19.6 with out any out side help except you guys on the forum, BTW thanks a mill for that. my AHI more then doubled on the script settings going from 1.7 pre there settings to 5.3 on their settings and I did not feel anywhere near as rested in the mornings, is this normal? how many others are getting a better sleep with machine then without but not getting the best sleep they can get because of there settings and machines not right???

remember every one wanted to sell me a CPAP, that maxed out at 20 cmH2o and no data and no way for me to get info other then compliance. add to that the local IRS wanted my settings maxed out at 12 cmH2o and did not want to set it any higher then that as most could no handle the higher pressures and they did not want to blow a sale. they did not give me any info and say anything about keeping mouth closed and not letting air escape from mouth or nothing, buying their machine would have been a big waste of money, a way over priced brick, no support, no full face mask even when I asked for one saying I have nose blockage problems, they still gave me a nose mask saying the full face masks were to expensive to loan out.

I have to thank every one on the forum that helped and posted info on it as it was reading and learning from this forum that gave me the info I needed and got me buying a VPAP instead of a cheap brick. I have learned so much and now can make setting changes myself to get the best results for me. all thanks to you guys.

all this does make me wonder just how many others are on a machine but not getting optimal results as their care giver does not get things right. if I relied on the settings given to me by the so called medical professionals and bought the machines they said to buy I would not be getting the stellar results I am getting. I notice a big drop in feeling rested and well on their settings, and they hate VPAP for some reason, maybe it threatens our need for them. my medical professional was very eager to turn my VPAP into a SPAP and saying not to trust my VPAP as it could do scary things and go out of control. well my VPAP settings smokes their SPAP settings big time.

the long and the short of all this I guess is do not blindly trust the sleep lab settings/ scripts, and small local sales outfits like the IRS even less. get the better machines and try your own settings to see what works. in the apnea treatment game, the higher end machines are the best over all value. even if you do not need the high end setting you will never know till you try it out. also blindly trusting your script settings and advice from your medical pros seams to also be a mistake. your the best one to know what works best for you. you have more invested in the out come of your treatment and need to be in control of said treatment.

has anyone else found the sleep lab settings way worse then the setting they have found themselves?
what good is treatment when even the pros can not get it right? the script was way wrong for me. totally out to lunch.
all I can say is I am so glad to have found this forum and have gotten so much form it. I would not be feeling as good now with out the info and help from this forum.

thanks again for all the help and info
Stan

[Julie]

You know, I think what happens a lot with doctors (and other people) is that patients come in with problems that don't look to have easy answers... everything looks right, except the patients have trouble, so the doctor, wanting to help, to do something, suggests they try something new. Now he's 'just' a doctor, not an actual genius, and can get tired like anyone else, so while he might have e.g. suggested you get a new study, or he might have stayed up all night looking for some obscure answer, instead he suggested you try a new setting. It didn't work, so you changed things back (at least you have the ability to do things apparently work alright. Isn't that ok? Doctors are human and don't have second sight, so maybe he tried, the result wasn't great, but maybe he just didn't have a better answer right then.

[space45]

You know, I think what happens a lot with doctors (and other people) is that patients come in with problems that don't look to have easy answers... everything looks right, except the patients have trouble, so the doctor, wanting to help, to do something, suggests they try something new. Now he's 'just' a doctor, not an actual genius, and can get tired like anyone else, so while he might have e.g. suggested you get a new study, or he might have stayed up all night looking for some obscure answer, instead he suggested you try a new setting. It didn't work, so you changed things back (at least you have the ability to do things apparently work alright. Isn't that ok? Doctors are human and don't have second sight, so maybe he tried, the result wasn't great, but maybe he just didn't have a better answer right then.

I do not understand what your getting at, this sleep lab test was my very first, and I was getting very good AHIs with my own settings, even the doc was impressed by what I had done on my own, with the help of the forum, I did tell the doc I had help from a forum. there was no obscure problems or needing any obscure answers. he could have left my setting alone and suggested going up to a minimum of 20 cmH2o from my 19.6 I had already had it set to. if VPAP was working so well for me why insist on setting it to SPAP?

I did not come in with problems at all, I had got the machine and set it up and found my own settings before even seeing the sleep doc for the first time. he was impressed with what I had done and for some reason did not remember it the next visit when the new setting were loaded into my machine. why mess with what is working? I was getting stellar results with my own settings and did not really need there help at all. their only help to me was they said I had no other sleep problems, I disagree with that but we will leave that one alone, and their saying I needed a minimum of 20 cmH2o for proper treatment.

so all in all they helped some. but they were trying to fix something that was not broke, and the tech was over eager to make my VPAP into a SPAP and did his best to scare me into never putting it back to VPAP. his scare tactics ran off me like water off a duck, but he still was very eager to make sure he did his best to scare me into thinking SPAP was the way to go and that VPAP was dangerous and should not be used at all.

I had no problems with trying out the new settings, just they sucked big time and was wondering how many trust the docs settings and never question them. I would not be nearly as well so quickly if I followed the docs settings. I may not have felt anywhere near as well and gave up thinking this whole CPAP thing did not work, I am now eager to go to bed and wear the mask as I know what a difference it makes to how I sleep and what a good nights sleep mean to my well being . the docs setting not nearly as good, I would be lagging big time, and with 3 month between sleep doc visits it would take forever to get things tuned in, if ever.

[VikingGnome]

Sleep labs never get a best setting for anyone. How could they? They observe as you sleep in an artificial environment for a single night. I had a split study so they titrated over only 4 hours. The doc told me they ran out of time at 14 so just prescribed 15 for me. They ran out of time because their tech was an idiot. I had been on CPAP at 10 for 12 years. Logic would tell you to start the titration at 10 and go up. But no. He started at 4 and wasted a lot of time going from 4 to 10. I had no REM sleep during the 4-hour study. So it is totally predictable that the setting prescribed was not going to be sufficient.

Using careful study of my sleep data, I carefully titrated myself up to pressure to realistically controlled my apneas and hypopneas in my normal sleep setting and with REM sleep. I was at pressure of 18 on CPAP when I returned to doc for annual checkup. I brought along plenty of data and detailed graphs supporting my assertion that I need VPAP instead of CPAP. With pressures approaching 20, I had trouble exhaling. Also, CPAP machine max is 20. I've been on VPAP now for 8 months. My pressure is 22/18 and I have only 1 or 2 events the entire night.

[space45]

You know, I think what happens a lot with doctors (and other people) is that patients come in with problems that don't look to have easy answers... everything looks right, except the patients have trouble, so the doctor, wanting to help, to do something, suggests they try something new. Now he's 'just' a doctor, not an actual genius, and can get tired like anyone else, so while he might have e.g. suggested you get a new study, or he might have stayed up all night looking for some obscure answer, instead he suggested you try a new setting. It didn't work, so you changed things back (at least you have the ability to do things apparently work alright. Isn't that ok? Doctors are human and don't have second sight, so maybe he tried, the result wasn't great, but maybe he just didn't have a better answer right then.

the only thing I can see about what your getting at is my disagreeing with sleep doc about not having any other sleep problems. the doc was not into talking about it at all. my sleep tests were clear of any other problems other then my OSA and so he did not want to talk about anything else. I had all my VPAP machine data with me and they were not in the least interested in it. quick in quick out, set my machine to what their test results said with a sales pitch about how they trust their data by far over my machines data and the scare of not messing with things and out the door, felt more like processed meat then a person. he has his rutine down pat. he is very prissy and feminine. he is not the most helpful of docs and is very much more interested in saying "next" then helping you very much or engaging in any conversation at all. I asked questions and he did his best to side step them. funny thing is he is the only sleep doc for hundreds of miles east and about 250 miles west, not sure how far north, but I would say much further then west as they have nothing for med stuff up there, most get flown to Vancouver for anything out of the norm. I talk to someone near where I was born, I asked why are you all the way over here? she said he was the closest sleep doc, I said WOW, that is not good. like a 8 hour + drive. some in our province would be even further then that, much further.

[Julie]

Oops - thought the doctor was arbitrarily fixing what wasn't broken (and I guess he was). I hadn't realized you hadn't complained in the first place... that's what I get for reading too fast

[space45]

Sleep labs never get a best setting for anyone. How could they? They observe as you sleep in an artificial environment for a single night. I had a split study so they titrated over only 4 hours. The doc told me they ran out of time at 14 so just prescribed 15 for me. They ran out of time because their tech was an idiot. I had been on CPAP at 10 for 12 years. Logic would tell you to start the titration at 10 and go up. But no. He started at 4 and wasted a lot of time going from 4 to 10. I had no REM sleep during the 4-hour study. So it is totally predictable that the setting prescribed was not going to be sufficient.

Using careful study of my sleep data, I carefully titrated myself up to pressure to realistically controlled my apneas and hypopneas in my normal sleep setting and with REM sleep. I was at pressure of 18 on CPAP when I returned to doc for annual checkup. I brought along plenty of data and detailed graphs supporting my assertion that I need VPAP instead of CPAP. With pressures approaching 20, I had trouble exhaling. Also, CPAP machine max is 20. I've been on VPAP now for 8 months. My pressure is 22/18 and I have only 1 or 2 events the entire night.

at 17 and 21 with a max of 25 on my VPAP I to am having around one and some times no events all night while I sleep, the machine would go up to 22.3, with my settings at 17 and 19.6 with max at 25 I had around 3 or so all night and the machine would hit up to low 23s.

if I ran your pressures I would guess the machine would not go higher at all but stay at 22, I should try it. I have had it hit a high of 24.8 but that was when the settings were lower, the more I raised the settings the lower the high would go.

BTW they wanted to do a split night with me and I said why? we know my non machine number suck big time and all we need is to find my proper numbers for the machine, they agreed and so I was on the machine the whole night, but they did start low, so low I felt like I was suffocating, so I rang the bell and asked for her to start at much higher pressures, they did and things were fine. the gal was very nice that did my sleep lab.