DO You Have Confidence Your Sleep Study Is Accurate?

[riverdreamer]

Hi Riverdreamer;.... Along with you equipment you list 4-15, and nine - Is that the pressure you are using.
Jan

Actually, my pressure is 8.6 - 15 on auto. Resmeds allow you to set by tenths of a unit of pressure. I was originally titrated at 7, but that titration only had 3 minutes of REM sleep. My apneas are most likely to occur early morning, when I am in the longest periods of REM. Set at 4-15 as recommeded by the sleep doc, it was not catching enough of the events. I raised it to 7-15, thinking if my titration was good, that should work well. It wasn't till I raised the lowest number to 8.6 that I had consistently good nights. While I was still dealing with throat congestion, I tried raising it higher, but it seems I don't really need it any higher than where it is now. Most nights the 95% pressure runs somewhere between 9 and 10.5 at the top, and my AHI now is almost always under 5, with AI no higher than .5. So, I have it higher than titrated, but lower than I thought I was going to end up, while dealing with the flare in my health issues.

I am sure things will be unstable sometime again in the future. I may have to raise the lower pressure again, if things go south. The software was a big help in deciding what to do. I had centrals during my original sleep study, so I was looking very carefully at the details of when I had apneas, and how the pressure was responding, to make sure I wasn't creating more trouble by raising the pressure too high. So far, it seems to be helping more than hurting, at this pressure, but I have the equipment to change things if needed as my health changes. For now, the range in the auto is able to adjust to more minor changes from night to night. It really only fluctuates 2-3 points a night.

I hope you can find the info you need, to help you get your treatment on track. There is lots of good info on this board, so somebody should have the idea that will help you out!

[SaltLakeJan]

Hi Joy D.
Well, Joy D. I have followed your posts, and with all the knowledge you have from your career and just being you, I am not surprised you could get an accurate sleep study with only two hours sleep.

This is O.T. and I was going to send you a PM, but this is my opportunity. You recently replied to a post, with some information regarding pink junk. It was a bacteria as I recall. When I clean my bathroom counter, I get a pink tinge around my bathroom sink it is right at the edge when it was set in place. I wash the counter every day, and use a household wipe
to finish the job. Joy, hope you can get back to me.

Jan.

[SaltLakeJan]

Raj wrote

There are so many artificial conditions during a sleep study such as electrodes taped all over one's body, sleeping in an unfamiliar environment and on an unfamiliar mattress, knowing that you are under constant observation etc. that I think it's a minor miracle or at least largely good luck when any such studies prove even close to the money.

My answer to your question is no.

Raj: That is as well said as anything I have heard describing a sleep study.

Jan

[Kiralynx]

Jan,

You might like to look at my "3 Charts" posting:

viewtopic/t40856/Then-and-Now-3-Charts.html

and compare my second night at home at the titrated pressures, with five months later, after my pressures were adjusted based on data from my machine.

I think you can get snap shot of one night, to get in the right vicinity... and the rest requires work on the part of the CPAPer, and their medical professionals. Which is why data-capable machines are very necessary.

[SaltLakeJan]

Hi Catnapper,

We haven't been on the same posts for quite a while. Nice to see you again.

Although your sleep study could be described in Gerald's words "Crappy" You wrote:

My first sleep study was not right, and my basic cpap machine was set too high. Those first few weeks were dreadful. I talked the doctor into prescribing a specific auto-pap and then I adjusted it to be more comfortable and effective.

Over time, I managed to get an auto bi-pap,

Now you have successful therapy with AI1 of 1 or less. It is my goal to emulate what you have done. Congratulations.
Jan

[SaltLakeJan]

No, I don't have any confidence that my last sleep study is in any way accurate. When I woke in the morning, I had to fight the MASSIVE leaking around the mask. The leak was not mentioned in the study report. Need a new sleep doc.

Hi Howkim:
I hope with the information you have picked-up from the this forum, you will be able to find a sleep doctor who can help you. I wish I had known - what I know from this forum - before I even consulted a sleep doctor. There has to be a way to find a good one. The best to you.

Jan

[SaltLakeJan]

Lou C wrote:

In a word NO. I came out of my study with pressures recommended at 14cm , chin straps or full face mask, and dire predictions. Never got more than 3 hours without giving up.

After reading here, and fighting the DME & sweet talking the sleep doc, I got an automatic machine and Mirage Swift II. I reviewed my smart card with the doc last week. Typically using 9-10 cm, minimal leakage, avg 8.2 hrs a night, almost no mouth breathing. Doc said go away for a year before you come back.

Lou, Congratulations, you found the place for help, and went after what you needed. The icing on the cake was when you doctor said he didn't need to see you for a year. Thanks for your post.

Jan

[SaltLakeJan]

Bob himself wrote:

I can tell you that sleep architecture data collected from a single night in the lab is pretty close to useless. Our standard practice was to throw out the first two nights of data before tabulating baseline data. So I don't put a lot of trust in these one-night studies. A single night in a sleep lab, wired up for the polygraph, is about as far from a representative night of sleep as a person is likely to get.

A REM latency of 306 minutes or 419 minutes with no REM would be very unusual. My first guess would be that the sleep scoring was inaccurate, for whatever reasons.

Bob

Bob himself, the answers I have received on this post have helped me realize the basic truth of sleep studies - Your answer made it clear the sleep doctor and the technician do as much as they realistically can do in one night. They give us an educated guess of what our sleep conditions were the part of the night we slept. Without this forum, helping us understand the reality of what we get - none of us would get close to getting therapy. With my previous UPPP surgery, I don't think any of the information I received on my last sleep study is even close to what I need to keep my airway from collapsing. I did not understand that until I realized that had not been addressed. Thanks for your views, Jan

[SaltLakeJan]

Hi Kathy,

You are such a caring person - I would like to meet you someday. And I am sure you girls did as well as mine did with the ironing stacked up in a basket, Some of mine got pulled out and ironed when the next smallest girl needed a new dress.

But Kathy my thought is regarding your last post re: sleep study......

Jan, I was just thinking how some of us got loaner apap machines to recheck our pressure needs. Wonder if you could get a loner of one of the data machines that report centrals, or maybe one that treats centrals would be better if it reports any that it treats. .

Kathy, you were absolutely inspired to think of them. I'm not sure they loan machines from my DME - (They are very cooperatiive now - but somewhere in a city the size of Salt Lake, they will do that. I am going to start pushing my doctor toward that goal. My sleep therapy is not improving - I believe it is because of the UPPP surgery and the how much pressure would be required to fill that giant hole in my throat with sugnificant posisitive pressure to keep my airway from collasping.

(By the way, can I blame my late bedtime tonight on you? Figured I'd join you in reading some research on PLMD. That was over 2 hours ago.

Kathy) Did you find anything of interest Kathy,

You have given me several suggestions that has helped me - One was when I had a pressure of 7, and was feeling like I had an empty hole, just above my sholders, and wondered if my brains had blown out. You posted to me that my 7 pressure could be hazardous. I upped it, and felt better. Thanks for your help.
Who couldn't have gone to be earlier anyhow cause I ate dinner too late and now have to wait to take my bedtime meds.

[SaltLakeJan]

Kira wrote: [quote=Jan,

You might like to look at my "3 Charts" posting:

viewtopic/t40856/Then-and-Now-3-Charts.html

and compare my second night at home at the titrated pressures, with five months later, after my pressures were adjusted based on data from my machine.

I think you can get snap shot of one night, to get in the right vicinity... and the rest requires work on the part of the CPAPer, and their medical professionals. Which is why data-capable machines are very necessary.[/quote]

Kira; Thanks for bringing this to my attention. The Thread was almost dead, and I had missed it. the charts certainly illustrate why we need data capable machines.

I am urging my doctor to decide what type of machine I need to deal with the huge hole in my throad. I had UPPP surgery in 2002. The ENT trimmed all the excess tissue in my throat, and took all the other tissue down to the bone. This has left a hole in my throat about the size of a train tunnel - I am up to a pressure of10 on a ResMed 8 Elite ll, and that isn't enough to keep my airway from collasping. Appreciate the Post. Jan

[Kiralynx]

Jan,

I'm no expert at this, but I'm wondering if what you need isn't a bilevel -- one pressure to help hold your throat open, and another pressure to help deal with the events.

Others are far more knowledgeable about machines and things than I am. But if the single pressure machine you have, good as it is, isn't doing the job.....

[SaltLakeJan]

Oh My Gosh Kira - so that is why bi-level means. Dah.I thought it was like a second generation auto - I had no idea it operates with two pressures at the same time.

Kira wrote:

I'm no expert at this, but I'm wondering if what you need isn't a bilevel -- one pressure to help hold your throat open, and another pressure to help deal with the events.

Others are far more knowledgeable about machines and things than I am. But if the single pressure machine you have, good as it is, isn't doing the job.....

I am not the sharpest tool in the box when it comes to understanding all or any of the scientific aspects of sleep apnea.
Political Science, American History, Children's Rights,& Individual rights, as diverse as they are, have more meaning to me than a hobby - they are more than an avocation to me, (gardening is a pleasureable hobby - when my back isn't acting up.) I am passionate about the other four. in our area, I am well known for my stinging Political Letters to the Editors, on both sides of the politicial spectrum.
My kids pickup the newspapers, and see another letter from me, and say, Mom is at it again.

Kira, it is a good thing I have a friend like you to point me in the right direction. Our own health comes before the fun and games.
Thanks so much, Please help point me in the right direction, and I will be paying more attention.

Jan

[Kiralynx]

Jan,

Well, like I said, there are doubtless folks who can explain it better than I can.

But bilevels are two levels -- EPAP (exhalation pressure) and IPAP (Inhalation pressure).

If I'm not totally spacey, and I beg one of the experts to correct me if I'm explaining this badly! then you'll always have the EPAP pressure going, but when you inhale, the pressure will go up to the IPAP while you are inhaling, then drop to the EPAP when you exhale.

It's kind of the reverse of a CPAP machine with exhalation relief, which drops the pressure on exhalation.

Bi levels can be set farther apart, although there are parameters which work better in terms of spacing EPAP and IPAP.

Again, if I remember correctly, it's the EPAP that is meant to prevent apneas. IPAP tackles what tries to occur in spite of that. So:

EPAP is meant to prevent apneas -- by holding the throat open enough to prevent full closures.

IPAP is meant to prevent the lesser flow limitations, hypopneas, and residual snores. Not apneas.

Now me, I was titrated at 10 and 14. Except that I started throwing central apneas during the titration. (Bet that made the techs happy!)

So, I ended up with my very fancy Bipap Auto SV which has a very fancy algorithm to handle centrals and a raft of other complications.

The Bipap Auto SV has EPAP, MinIpap (minimum Ipap) and MaxIpap (maximum Ipap).

When they first set my machine up, they set EPAP and MinIpap to 10 and MaxIpap to 14. Because no one took into account the fact that I had my mouth wide open during the titration because I could not swallow against the EPAP of 10.

The result was the first chart on the "Three Charts" thread I pointed you to earlier.

Since I'd gotten the card reader and software, and had looked up my leak rate for the mask I was using, I knew there was a problem, but it took me a bit to figure it out -- because there was no way in Hades I was going to use a full face mask! And that's the standard recommendation for mouth-breathing. I tried taping, and my apneas went up from the stress and claustrophobia.

Then I realized I was waking up... and that I was having clusters. So I started noting the time I woke, gasping and unable to swallow against the machine's pressure, and checking in the morning to see if it matched the clusters. They matched.

I called the RT and explained the observations. She got a prescription and changed the EPAP to 6, and I've been fine ever since, once I figured out my Brandy Keg device for dealing with mouth breathing.

If I understand what I've read here (I try very hard following SWS, SAG, DSM, Sir Banned, and others!), then the EPAP keeps things open for me, and the Inspiration pressure wobbles back and forth between 10 and 14, attacking apneas and hypopneas as it goes. Since I have the centrals, though, it just pops up to the higher pressures long enough to clear an event, and then drops right back down so as not to cause a central.

I think.

Clear as mud?