Sleep Study and Titration reports finally vs. auto cpap 90%

[cindyh]

OK, this is LONG, but I need the experts advice here, it is really odd to see the differences..

the sleep study:

Slept a total of 332.4 minutes out of 418.2 for a sleep efficiency of 79.5 percent. Sleep latency was 9.9 minutes and rem was 79 minutes. Sleep architecture was remarkable for significant stage 1 sleep at 20.9 percent of total sleep time. There were 6.9 spontaneous arousals per hour of sleep.

Monitoring revealed 1 mixed apnea and 328 partial upper airway obstructions. On the average there were 59.4 abnormal breathing events per hour of sleep. There was an average of 136.7 abnormal breathing events per hours of supine sleep (118 minutes total supine) and an average of 14.9 abnormal breathing events per hour of lateral sleep (181 minutes total lateral). There was an average of 55 abnormal breathing events per hour of non REM sleep and an average of 58.9 per hour of REM sleep. Tehre were an additional 55.6 respiratory event related arousals (hypopneas without a OS4 percent oxygen desaturation per hour. Baseline SaO2 was 94% and the lowest SaO2 was 68%. Technicians noted light to moderate snores during sleep.

EMG monitoring revealed 27 periodic leg movements in sleep 4.9 per hour, 6 of which were associated with unambiguous eeg arousal 1.1 per hour.

SUMMARY:
OSA with an RDI of 59.4 associated with oxygen desaturation with a nadir of 68%

PLM without significant cortical arousals
No seizure activity noted on the EEG
Normal ECG
_________________________________________________________________

CPAP titration:

Nasal CPAP was administered with pressures ranging from 4 to 16 cm. The optimal pressure for resolution of obstructive breathing and snoring was determined to be 16.0 cm. At this pressure the patient slept 177.3 minutes out of 220 minutes for a sleep efficciency of 80%. Stage 1 sleep was reduced to 6.9 % of total sleep time. There was an average of 1.4 abnormal breathing events per hour of sleep at this pressure. The lowest SaO2 at this pressure was 90%. SaO2 during REM sleep was usually between 90 and 93 %. EMG monitoring unremarkable. Normal Sinus Rhythm. REcommend to treat patient with CPAP at 16 cmH2O.

__________________________________________________________________

BIPAP Titration:

Patient was unable to tolerate CPAP exhalation pressure and was brought back for BiPap Titration. Nasal BiPap was administered with pressures ranging from 4 cm to 20 cm. The effective recommended treatment is as follows:

IPAP at 20 cmH2O
EPAP at 9 cm H2O
Normal Sinus Rhythm..

______________________________________________________________________

I know the bipap titration was vague that that is all i got so far... NOW, the rest of the story.

I still have the loaner REmstar auto cpap and it is set at 8 to 18... I finally got my card reader and software in and got to look at Data.. I have had a lot of leaks, and a lot of it is from taking my mask off sometimes, but every day that I have gotten good data on, and there have been a lot of them, my 90 percent number is *********** 8 ***************

This shocks me. Rarely does it ever go to 9 and it only went to 10 once or twice very briefly. I even changed the settings on the machine 2 nights ago to 6 min and 16 max just to see what result i would get... I got 8 again for both nights... So, I need advice.... I find it hard to believe the sleep study techs were really on with what they were doing given they 16 ipap and 20 ipap difference?? Can they be off that much though, and the auto machine be right at 8? Wow, what a difference.. I know leaks will affect it, but I wouldnt think that much. Let me know what you think.. MY AHI is staying low at 1.5 or so, someitmes lower.. if you need any more info from the report please let me know.

Thanks so much, I know i have been bugging you all, just trying to decide what to do as far as all these numbers. I feel they got the higher numbers when i was on my back, which of course they had to make me do, but I don't sleep on my back. I know they said my oxygen level was dropping on my side also, so how do i know if the auto is taking care of the oxygen needs?
Thanks in advance.
cindy

[Wulfman...]

Cindy,

Doesn't surprise me a bit. In my own case, my doctor prescribed a pressure of 18 (even though my titration stopped at 16) and after I got my machine and software, I reset it to 10 and within a few nights was near the 1.0 - 1.5 AHI range. After a year, I ended up at 12 (which takes care of the snoring, too).

Last year, I set one of my autos to a range of 10 - 15 for a week and only made it to 15 for a minute and a half on one night. My snoring was what was mainly causing the pressure increases.

Theoretically, if you're breathing, you're getting oxygen. However, you don't know how much until you do an overnight pulse oximetry. If your doctor hasn't asked for one, mention it to him. It's essentially "free", but he has to write a prescription for it.....it's done through your local DME (unless your doctor has recording pulse oximeters to loan out).

Den

[Snoredog]

PLM's were not associated with cortical arousals, so you don't really have to worry about those. Spontaneous arousals are low, wouldn't worry too much about those either.

Import stuff is oxygen levels came back up on cpap. As for the pressure differences? a CPAP and BIPAP titration will produce different results. There can be many other causes that may impact that difference, medication, glass of wine with dinner, etc..

Autopap finding 8.0 cm as its 90%? Can happen, machine only responds to what it sees, a tech might respond to what they think it is.

You don't win any awards for having a higher pressure, all that does is drive up the noise factor and drive down the comfort factor.

I would suggest:

Telling the doctor & DME you would like to try the new AFlex auto. It will be more comfortable than what you have and may even offer better therapy if you use the machine longer from it.

Might as well get the latest model.

[kteague]

That would make my head spin. Have you taken your autopap reports and asked for an explanation? Of course the expected answer would be that the auto is inaccurate. Couldn't be the professionals, right?

Hope you gets things settled and begin to reap the benefits from your treatment. Just a mention - if you continue to feel bad even after sorting thru all this and getting effective treatment of your OSA, you may want to take another look at the limb movements. For some (certainly not everyone), once the apnea events are resolved, the limb movements increase. (In others, they go away.) Doesn't hurt to be aware that it can happen.

Kathy

[Slinky]

... I still have the loaner REmstar auto cpap and it is set at 8 to 18... I finally got my card reader and software in and got to look at Data.. I have had a lot of leaks, and a lot of it is from taking my mask off sometimes, but every day that I have gotten good data on, and there have been a lot of them, my 90 percent number is *********** 8 ***************

This shocks me. Rarely does it ever go to 9 and it only went to 10 once or twice very briefly. I even changed the settings on the machine 2 nights ago to 6 min and 16 max just to see what result i would get... I got 8 again for both nights... So, I need advice.... I find it hard to believe the sleep study techs were really on with what they were doing given they 16 ipap and 20 ipap difference?? Can they be off that much though, and the auto machine be right at 8? Wow, what a difference.. I know leaks will affect it, but I wouldnt think that much. Let me know what you think.. MY AHI is staying low at 1.5 or so, someitmes lower.. if you need any more info from the report please let me know. ... I know they said my oxygen level was dropping on my side also, so how do i know if the auto is taking care of the oxygen needs?

So how did you happen to acquire a loaner autoPAP? Was it ordered by your sleep doctor? Or borrowed from a friend? If it was ordered by your sleep doctor he/she may well be open minded enough to believe the data. Why else would he/she have ordered it? We're comparing two nights of data sleeping in a strange bed and place not your own vs how many nights sleeping at home in your own bed.

How rested did you feel the mornings after your two titration studies? How rested are you feeling sleeping w/this autoPAP?

An overnight oximetry on autoPAP wouldn't do any harm, just to reassure you if your sleep doctor will order it. If not, your family doctor can order an overnight oximetry.

[cindyh]

my insurance does not want to pay for bipap and the dme thought it a good idea to try the auto in the meantime, i guess maybe they have had these problems with the titration results before, they told me they had used it and adusted several people but i didnt think about numbers like this?