Sleep study pressure variation

[capbanks]

I didn't really know what to put in the subject line. But, I've had a cpap machine for over 12 years and use it religiously. The pressure setting as determined by the sleep lab has always been between 12 and 13 over 4-5 sleep studies. I mentioned to my primary care doctor that I was getting very sleepy in the afternoon and he set me up with a titration study to see if my pressure should be adjusted. I went to the same sleep lab as I always do. The results came back and it was determined that my pressure should be lowered from 13 to 7. To me, that's quite a difference. I guess what I'm asking is this normal? Physically, nothing has changed like weight since my last titration study. For what it's worth, the technician refused to give me the pressure she found worked best or how many apnea events I had which is opposite from my past experience. As long as I'm complaining I should mention that I didn't feel like I got a very good sleep and tossed and turned all night which is not normal. In the morning she mentioned how restless I was and when I told her it was because of the uncomfortable bed her response was that I should have told her because she could have adjusted the bed. It turns out they use Sleep Number beds but I was not told that fact before crawling into bed. DUH! I got an email asking for a review from the hospital and I kinda let her have it for that omission.

So, is it possible the large swing in my numbers are a result of the uncomfortable bed??? Maybe I didn't get into REM or something?

I just received a new cpap this afternoon with the new settings and have not had the chance to try it out.

Sorry for being so long winded.

[palerider]

I didn't really know what to put in the subject line. But, I've had a cpap machine for over 12 years and use it religiously. The pressure setting as determined by the sleep lab has always been between 12 and 13 over 4-5 sleep studies. I mentioned to my primary care doctor that I was getting very sleepy in the afternoon and he set me up with a titration study to see if my pressure should be adjusted. I went to the same sleep lab as I always do. The results came back and it was determined that my pressure should be lowered from 13 to 7. To me, that's quite a difference. I guess what I'm asking is this normal?

*gets out soap box*
As to sleep studies... they may be "The GOLD Standard", but they are, in many ways, woefully inadequate if you think about it.

You're in an artificial environment, all wired up and less comfortable than normal.
It's *one night* and likely only part of that night. reading any titration report, you'll see that "oh, your good pressure was 12cm, you slept for 45 minutes at that pressure!"

It's a simple fact that sleep varies from night to night, you'll have better and worse days with the same exact settings. Yet the "gold standard" is a small number of minutes tested on one night.... a brief photograph taken during the marathon run that is your sleep.

It's not surprising that sleep studies are sometimes quite wrong, what's surprising is that they're ever right!
*puts away soap box*

Fill in your profile, so we know what kind of machine you have, and whether it has easily attainable data, if it does, then we'll tell you, and tell you what to use to read that data, and see if the sensible thing can be done, ie, figure out what's going on based on your *normal* sleep, at home, in your bed, with your machine, without all those wires and that uncomfortable bed.

[chunkyfrog]

And once in a while, "somebody" chooses to cover their ample hiney,
and add a couple or three cm to the RX, forcing me to endure way more
pressure than needed for months on end.
Probably on some silly whim.

[raisedfist]

Palerider is spot on. I've had two sleep studies done for bi-level and the prescribed pressures are not even close to one another. The first one was good because instructions on what to do were given by the director himself after an initial sleep consultation. The second was awful and was a waste of a night. The best thing you can do is examine the data, and also read the clinical titration guides that ResMed and Philips Respironics publish, which give you some foundational information.

[klm49]

I didn't really know what to put in the subject line. But, I've had a cpap machine for over 12 years and use it religiously. The pressure setting as determined by the sleep lab has always been between 12 and 13 over 4-5 sleep studies. I mentioned to my primary care doctor that I was getting very sleepy in the afternoon and he set me up with a titration study to see if my pressure should be adjusted. I went to the same sleep lab as I always do. The results came back and it was determined that my pressure should be lowered from 13 to 7. To me, that's quite a difference. I guess what I'm asking is this normal?

*gets out soap box*
As to sleep studies... they may be "The GOLD Standard", but they are, in many ways, woefully inadequate if you think about it.

You're in an artificial environment, all wired up and less comfortable than normal.
It's *one night* and likely only part of that night. reading any titration report, you'll see that "oh, your good pressure was 12cm, you slept for 45 minutes at that pressure!"

It's a simple fact that sleep varies from night to night, you'll have better and worse days with the same exact settings. Yet the "gold standard" is a small number of minutes tested on one night.... a brief photograph taken during the marathon run that is your sleep.

It's not surprising that sleep studies are sometimes quite wrong, what's surprising is that they're ever right!
*puts away soap box*

Fill in your profile, so we know what kind of machine you have, and whether it has easily attainable data, if it does, then we'll tell you, and tell you what to use to read that data, and see if the sensible thing can be done, ie, figure out what's going on based on your *normal* sleep, at home, in your bed, with your machine, without all those wires and that uncomfortable bed.

Guess I was lucky because when I changed Sleep Dr.'s and had a second titration done they upped my pressure and my numbers were much better. I thimk eventually with Pugsy's help we would have got to the same place. The reason I had to change Dr.'s was because the first Dr. quit taking Medicare and I convinced 2nd. Dr. that I was having desaturations with my pulse Ox report. While my AHI drom first Dr. weren't bad I never could understand why they stopped the titration when my AHI got under 5. Guess I was lucky!

[Pugsy]

Guess I was lucky because when I changed Sleep Dr.'s and had a second titration done they upped my pressure and my numbers were much better.

You know that old saying "even a blind squirrel finds and acorn every now and then"

Sometimes the titration sleep studies do get it right. Mine didn't but that was because I slept so poorly that I only got 6 minutes of REM over the entire night (8 hours) and REM is where I have significant changes in pressure needs. We simply didn't have enough time in REM to establish pressure needs. I had the titration sleep study from hell.
What they found I needed worked very well for non REM sleep...I have to give them credit for that but totally useless for REM sleep.
There just happened to be a combination of problems that led to me just having a horrible night's sleep totaling 156 minutes over the entire night with 6 minutes in REM. Big waste of my time and insurance money and I ended up having to do my own titration at home with the apap.

Titration sleep studies do work sometimes though...all depends on if you have an idiot tech (I did) and if you can actually sleep well with all those wires attached in a foreign environment (which I didn't even with Ambien in my system).