Finally got my titration sleep study. I have questions.

[LisaSch]

Looks like I will have a titration of 9, but want to understand my report more. At 9, with a full face mask, I had zero AHI. At 7, where I was, I was still having 12. My doctor did not seem very interested in explaining this stuff, so I may look or another doctor.

Okay, so here are my questions:
1) What is an acceptable sleep efficiency? Mine was 85.3%.

2) What is an acceptable amount of stage shifts? I had 66. I had 77arousals and 22 awakenings. Seems like a lot. I been on the mask over three weeks and still tired. I use a nose pillow.

3) What is good BPM? Mine is 52.2 BPM while sleeping.

4) During my titration study, I was adjusted about 4 levels and for the entire study I had 2 Obstructed Sleep Apeas, 1 central, 0 mixed apneas, and 12 hypopneas. Is having any central apneas good at all? Without proper titration I had 6 central apneas last time. Doctor did not even discuss this.

5) My baseline SaO2 was 97% the nadir SaO2 was 88%...where should I optimally be?

6) My husband says I do not snore anymore but this study says I do soft snoring 8.8% of the time. Not sure how much of this is acceptable?

7)My average AHI for this across all the titration levels was 2.5 per hour with 2.1 during rem. I am not sure what is acceptable...but seems good with the mask on...this was a study with full face mask.

What is Wake up after sleep? It says 62 minutes. Does that mean I do not sleep for over an hour after I wake up? That seems a lot.


Would love feedback.

[sawinglogz]

Ah, a woman after my own heart: on top of all the numbers and wanting to understand all of them!

I'll address them shortly, but first things first: don't accept the Escape machine. It's a "brick" and provides absolutely no efficacy data. All it can report is how many hours per night you use it (for insurance requirements). Nobody, your doctor included, will be able to tell how well it's working. You'll all be flying blind. At best they'll ask you how you're feeling subjectively.

See http://maskarrayed.wordpress.com/ for details and don't take "no" for an answer. Especially given your desire to understand and take charge of your treatment, you need a data-capable machine.

[oak]

yes, insist on a data capable machine. you wont be sorry. got to stand up for yourself as a patient. somebody stuck you with a brick, no doubt for profit.

[sawinglogz]

1) What is an acceptable sleep efficiency? Mine was 85.3%.

This is pretty subjective, and probably skewed by a night in the lab. What was the total time? The percentage just means that if you spent 8 hours being observed, you were asleep for 6.8 of them. That sounds pretty good to me, especially in the lab.

2) What is an acceptable amount of stage shifts? I had 66. I had 77arousals and 22 awakenings. Seems like a lot. I been on the mask over three weeks and still tired. I use a nose pillow.

Had you been on the mask for three weeks when you had the study, or have you been on it for three weeks since?

77 arousals and 22 awakenings is high, but again that might be due to being in the lab. I don't know about stage shifts.

3) What is good BPM? Mine is 52.2 BPM while sleeping.

I don't know about typical female rates, but that sounds like it's in the right ballpark. What's your resting waking rate?

4) During my titration study, I was adjusted about 4 levels and for the entire study I had 2 Obstructed Sleep Apeas, 1 central, 0 mixed apneas, and 12 hypopneas. Is having any central apneas good at all? Without proper titration I had 6 central apneas last time. Doctor did not even discuss this.

It depends how they scored the central apneas. We all have central apneas when we transition between sleep stages. In theory the person reviewing your lab results should throw out any such "transitional" central apneas, but it's possible they didn't.

Do you have a copy of your lab results with charts? If so, you'll see the centrals marked, along with your sleep stages. If they're happening in the middle of a sleep stage, they're probably real. If not, they probably aren't.

That said, they usually don't worry about anything lower than 5 centrals PER HOUR. If you were at 6 for the whole night (or 1 with titration), it's not likely to be a big deal.

5) My baseline SaO2 was 97% the nadir SaO2 was 88%...where should I optimally be?

Different people vary. I'm usually 97% awake ant 94% asleep. 88% is the "magic" number that they consider clinically significant regardless of how rapidly your percentage dropped.

When did you experience the 88%? When you were properly titrated, or not?

6) My husband says I do not snore anymore but this study says I do soft snoring 8.8% of the time. Not sure how much of this is acceptable?

Shouldn't really matter, except as a precursor to an apneic event. If you're using an auto-titrating machine, it might flag vibratory snores (not even really audible as a snore) or flow limitations and increase pressure to avert a possible apnea. Did the study notice any hypopneas?

7)My average AHI for this across all the titration levels was 2.5 per hour with 2.1 during rem. I am not sure what is acceptable...but seems good with the mask on...this was a study with full face mask.

They consider anything below 5 AHI to be "cured", since even normal people can be as high as 5.

But the actual AHI number is far less important than how you feel. You might have an AHI of 10 and feel great or an AHI of 2 and feel rotten. Again, a data capable machine will let you see more than just a bare AHI and give you some ideas of why you feel good one night and bad another.

What is Wake up after sleep? It says 62 minutes. Does that mean I do not sleep for over an hour after I wake up? That seems a lot.

I'm not sure. Maybe the maximum duration of sleep?

[Pugsy]

What is Wake up after sleep? It says 62 minutes. Does that mean I do not sleep for over an hour after I wake up? That seems a lot.

No, all it means is that 62 minutes after you went to sleep initially, at the onset of the night, that you woke up from sleep.

When you have time you might want to start reading some of mollete's chapters.
search.php?keywords=%22CPAP+Basics+-+%2 ... mit=Search

[LisaSch]

It is late so I will reply more in the morning. I am getting an auto machine...with data. My doctor told me auto machines were old school. He said it was better to use the titration level they figured out. I said, humor me...we can turn off the auto for now. Seriously, is he for real? I have read that auto is the only way to go here. I think he may have inflated view of his value. He who did not read my report before stepping in the room and who did not have my report in his hands. I had to ask him for a copy. He said he had not done his "review notes" yet. After 2.5 weeks? I seriously need a new doctor. This process has taken me two solid months to get my levels and good machine. And I had well over advanced sleep apnea. I will say that at 7 for over almost two months I am still waking up tired. I cannot wait to try 9.

[LisaSch]

Here are my responses:

2) I was using it three weeks prior to second test, however on second test I was on a full face mask the entire night.

3) My resting/working BPM is: Average during sleep was 52.2. Highest was 74 during sleep. Wake was 58.7.

4) I wish I could paste this in here but getting an electronic copy is like pulling teeth. They won't mail it even if I give written permission. What I see is the CA is during a long bolded line episode of sleep. On the bolded line of sleep at the same moment is a thin perpendicular line.

5) I am still not feeling super energized yet. It has been 5 weeks now. Maybe when I use my new pressure this will improve.

[Super Iridium]

It is late so I will reply more in the morning. I am getting an auto machine...with data. My doctor told me auto machines were old school. He said it was better to use the titration level they figured out. I said, humor me...we can turn off the auto for now. Seriously, is he for real? I have read that auto is the only way to go here. I think he may have inflated view of his value. He who did not read my report before stepping in the room and who did not have my report in his hands. I had to ask him for a copy. He said he had not done his "review notes" yet. After 2.5 weeks? I seriously need a new doctor. This process has taken me two solid months to get my levels and good machine. And I had well over advanced sleep apnea. I will say that at 7 for over almost two months I am still waking up tired. I cannot wait to try 9.

An automatically-adjusting, data-capable machine is "old school"? Sorry but this guy is an idiot. Is he known as a reputable, experienced sleep doctor, or just someone who's recently discovered this field as a way of making more money? Because this kind of sounds like someone who's just learning about the machines and the terminology for the first time.

[LisaSch]

He is an ENT and not sure how long he been doing the sleep thing. He says sleep is the key to many illnesses so was big to push me to get the study. I am glad for that. However, I think he misses the boat after diagnosis and does little to explain anything.

[hyperlexis]

He is an ENT and not sure how long he been doing the sleep thing. He says sleep is the key to many illnesses so was big to push me to get the study. I am glad for that. However, I think he misses the boat after diagnosis and does little to explain anything.

I wouldn't discount his expertise offhand -- people have been doing well for years and years on straight CPAP with a proper titration study. That's the whole point of doing one, after all. I think perhaps he may mean it is old school, or less desireable to just hand someone an auto machine in place of doing a proper titration -- which happens a lot. Perhaps there have been some recent clinical studies showing that a CPAP following a titration has better results than an Auto machine without a titration? It is certainly possible. Doctors do keep track of such developments.

To your question, no, the Auto machines are actually not, per se, necessary. They can be helpful for some, but they are not the new standard of care, unless someone has a study showing otherwise. I have an auto machine, but have never had a titration study, which I regret. It has taken months and months to try to ascertain the basic pressure range I need to be at. And that is hit and miss, using the help of my DME's respiratory therapist checking my data chip. The machine, on auto, varies levels pretty widely at times. Sometimes for no apparent reason. My start pressure is now 7 (originally 4). Today my 90% pressure was about 10.5. Yesterday it was near 13. Such discrepancies often make me doubt its overall accuracy and effectiveness. I still don't feel completely well rested many days. Remember, pressure changes during sleep on an Auto machine can, in fact, partially wake one up. So it's not a magical cure.

If your MD insists on CPAP I would ask for at least a data capable CPAP machine -- so your MD can at least check your numbers and adjust as needed. So if you can, at least get that. If you can get a data capable auto machine for the same cost, then definitely try to do so, and run it on straight CPAP for the MD's desire, at least to start -- but you shouldn't lose any sleep over being treated with a CPAP after a carefully done titration study.

[LisaSch]

thank you for your thoughtful replies...