Help re-titration

[Mebake]

Help Please, Just got my results from my re-titration and they recommended a pressure of 24 from my old pressure of 14. This seems a bit drastic. The information from the machine is 30 day Avg of 1.5. I understand that I do not have all the data. But the report said 52 events. I will have the report on Tuesday and will upload. I never felt comfortable at the study. The pressure of 14 never seem to be 14. They used a long flimsy tube. I was just kinda wondering how freaked out I should get. I t has been a year and ½ since my first study. Can things change that drastically? I have Apreia and It’s kinda a pain to get my card read. Looks like I may need a new machine and to start tracking my data. And I will be switching to Linecare. Any thoughts would be helpful

[Julie]

Get the data tracking machine ASAP! Depending on how long that flimsy hose was, it could make a difference, though of how much I'm not sure.

[Mebake]

Get the data tracking machine ASAP! Depending on how long that flimsy hose was, it could make a difference, though of how much I'm not sure.

It seem to be really long

[Hawthorne]

Wow! That's a huge difference, especially if you have been on therapy on an ongoing basis. That tube length could really skew the pressure! That could be why it didn't feel even like 14 and also why they had to crank the pressure so high.

I had a re-titration in 2008, after 6 years on cpap and had a terrible night. I hardly slept but they said that my pressure should go from 10 cm DOWN to 9 cm. That was ridiculous since I had been using an auto (that I bought out of pocket along with the software and reader) after a week long in home titration on an auto. The home titration said I should be at 11 cm. I had been using my auto set on an auto range of 10.5 cm to 13 cm and getting AHI of below 1 almost every night.

I'm still doing that and getting those low AHIs and a great leak line.

For the first 6 years of cpap, I had a straight cpap machine. I am really glad I bought the auto and the software!

If I were you, I would definitely get a data capable machine with software as soon as you can. IF your pressure was REALLY at 24cm though, you should be on a Bipap.

You really need to check that report out. Getting it on the forum would be good since there are people here who will help you interpret it all and get you on the right track.

[steelheadid]

I think you really need to check this one out. My first titration showed 147 events per hour, 142 api and 5 hpi, and after going in to have my pressure set it was only recommended at 12. I have since adjusted it to 14 after working with my therapy and sleep doctor. So under this assumption that you are dealing with OSA only the number they are giving you seem high.

[Mebake]

[Wulfman]

Do you "normally" sleep on your back? (supine position)


Den

[kteague]

If your machine provides treatment data for Apria to retrieve, then it's available to you too with software. You're showing an M Series Pro, which is a data capable cpap.

They should make up their mind - did you have trouble tolerating cpap or did you tolerate it well. I'll let others weigh in on the specifics, but I would have reservations jumping to such a high pressure that still didn't prove therapeutic. Some general observations...
1. They instruct that you should have a machine with a smart card to report compliance data. That's all they care about with such a high recommended pressure with remaining high number of events?!
2. They recommend using c-flex for exhalation relief. At 24 that's all they recommend?! They note that they tried bi-level settings for patient comfort, which I'm guessing just means they set up the bi-level to mimic c-flex. I can't believe they didn't recommend an official bi-level titration. But if it comes to that, I wouldn't have much confidence in their ability to provide a quality one.

Maybe I'm being hypercritical, especially for a layperson, I don't know. Just know I can't find any words to encourage you to trust this study because they just don't feel right. C'mon, tech type folks, offset my comments if I'm out of line and just being difficult today. Need something besides feelings to go on.

[Wulfman]

If your machine provides treatment data for Apria to retrieve, then it's available to you too with software. You're showing an M Series Pro, which is a data capable cpap.

They should make up their mind - did you have trouble tolerating cpap or did you tolerate it well. I'll let others weigh in on the specifics, but I would have reservations jumping to such a high pressure that still didn't prove therapeutic. Some general observations...
1. They instruct that you should have a machine with a smart card to report compliance data. That's all they care about with such a high recommended pressure with remaining high number of events?!
2. They recommend using c-flex for exhalation relief. At 24 that's all they recommend?! They note that they tried bi-level settings for patient comfort, which I'm guessing just means they set up the bi-level to mimic c-flex. I can't believe they didn't recommend an official bi-level titration. But if it comes to that, I wouldn't have much confidence in their ability to provide a quality one.

Maybe I'm being hypercritical, especially for a layperson, I don't know. Just know I can't find any words to encourage you to trust this study because they just don't feel right. C'mon, tech type folks, offset my comments if I'm out of line and just being difficult today. Need something besides feelings to go on.

I'm glad to know that I'm not alone.
This report seems awfully screwy to me. I can't see where the "Final pressure" (24 cm.) was the "best pressure"


Den

[echo]

They picked 24 out of the air or because it's the last one they tried!? It also seems screwy to me, though i'm not one of the "tech types".

I find it strange on many levels
- there were other settings that resulted in 0.0 AHI and low RERAs
- AHI seems to jump at exhale pressure >= 17cm except at 21cm, for whatever reason, where it's 1.5
- time spent on various settings seems bizarre - they spent more than TWO hours at 21, only five MINUTES at 24 (probably due to the wake-up), and somewhat random durations at the other settings
- overall Sp02 seems low on all settings even when AHI=0. lung problems? (although "lowest o2" may not mean much, i would have preferred average?)
- O2 for 14cm not given
- nothing less than 14cm was tried, is that normal?!

Are they looking more at how the sleep architecture was stabilized rather than AHI?? We don't have that info so...

Something does sound strange here. I'd try to get the full report if you can.

[timbalionguy]

Few people here have pressures that high, especially without a significant underlying problem. And I agree with everyone here that C-flex (especially!) does not 'cut it' for patient comfort at those pressure levels. My gut feeling is you need a re-titration at a different lab.

[Wulfman]

Help Please, Just got my results from my re-titration and they recommended a pressure of 24 from my old pressure of 14. This seems a bit drastic. The information from the machine is 30 day Avg of 1.5. I understand that I do not have all the data. But the report said 52 events. I will have the report on Tuesday and will upload. I never felt comfortable at the study. The pressure of 14 never seem to be 14. They used a long flimsy tube. I was just kinda wondering how freaked out I should get. I t has been a year and ½ since my first study. Can things change that drastically? I have Apreia and It’s kinda a pain to get my card read. Looks like I may need a new machine and to start tracking my data. And I will be switching to Linecare. Any thoughts would be helpful

I'm a little confused......
According to your profile, you have the M Series Pro.......which is a fully-data-capable machine. It also is capable of some summary data through the LCD. Do you or do you not have the software and card reader to download and read your card?
Do you check at your summary data in the LCD?

If your AHI average for 30 days is 1.5, why did you have another sleep study? That's a pretty good number.

PS. Do you have mouth leaks under control? (I see you're using a nasal mask and chinstrap)


Den

[Mebake]

Well here is the follow-up. My new DME provider did a 6 month download and my AHI was 2.6 for an average. They also think the study was a bit screwy. On Wednesday night they set my machine at 20 only because it does not go any higher. Worst experience ever thought my head was going to explode and was not able to keep any leak under control mouth, mask. Did not sleep a wink. Went back on Thursday and after discussing it with my Pulmonary Diseases doc who by the way did not interpret the study. We would try an AUTO Bi-Pap for 2 weeks before fighting with the insurance company. And do a down load and check my data. It has been almost 2 years since my last study and we wanted to get a recheck. Both my MD and Resp therapist thought the report was crazy and did not feel it was appropriate to put somebody on a continues pressure of 24. Does any body know of someone on a straight pressure of 24? I have also come to the conclusion I must have a better idea of what is going on with my treatment and track my data. Once we settle on a machine I will invest in the reader and software. Also used the Auto bipap last night and my god what a difference. I already know the answer but why is not everybody on an Auto? (Money). I have to saw my first couple of experiences with my local Lincare office has been exceptional. Booooo Apria

[Slinky]

It is amusing how a second local DME provider will bend over backwards to please a new patient they know has walked away from a previous local provider.

Personally, given your data prior to this new (and questionable) titration study I'd stay at my previous setting unless you felt like your therapy was getting less effective. Even then I would be inclined to only go up 1-2 cms at a time for a week at a time and checking my data at the end of each week in relation to how I felt.

HOWEVER, if you can "milk" an APAP outta the situation by all means I would do so!!!

[Mebake]

Another question. It looks like I will be able to pick my machine. I was thinking the Resmed S9 Auto or the Resperonics System one any Ideas any body. The Resmed is a little bit more money but for the long haul the price is not important.

Thank You All