Help with My sleep study

[CarolinaBlueMax]

Hi guys any suggestions would be appreciated. With these numbers would you use an Auto Bi-Pap, Auto or something else...Looks like to me, I either stay awake and have an AHI of O or set between 8 to 17 and have no centrals but my fair share of Hypopneas and apneas.....

Any thoughts would be welcomed ....My sleep Doc wants me to do another study @ 2500.00, plus follow up visit/study....I am thinking what if it is about the same as this one, the only result would be, this out of work Custom home builder has $ 2500.00 less to spend on equipment.. I am looking to buy a new machine. I was using an Resperonics Bi-Pap Pro until the Airlines killed it. I was set from 8.5 to 16 ish ipap I think and was doing so so... I have been using a Resmed Auto 25 as a loner from a friend, but have not been able to dial it in very well. I have it set at 10 ipap to 16 ipap ( i can't breath much lower than that but I might try lowering the bottom number to 9 ) with pr support at 0 I have not had allot of luck with it on bipap grrr my best results have been AHI of 3.4 and average is 4.5 and at these levels i feel like I am walking in quicksand by mid day.. I have read all the great reviews on the s9 and it sounds great if I could find a sweet spot to set it on. I am not sure the Bi Pap is serving me that well although the Resperonics did seem to breath well for me or with me...Oh I'm tired, LOL I should write these kinda things in the morning...
In the Doc's defense this is a couple yrs old.

[montana user]

your bi-level pressure of 16/12 looked pretty good, except no REM sleep on that pressure. Im not sure why they did not raise the bottom number when they raised the top one (IPAP/EPAP)? They stopped the EPAP at 12 but continued to raise the IPAP, anyway the 20/12 looked good with some REM sleep. An auto Bi-level might be ok if the EPAP setting isnt too low. I understand the cost issue, but another study might not be a bad idea and hopefully if the tech tries bi-level he will keep the split a little closer together. do you have COPD by chance?

[CarolinaBlueMax]

Montana thats what my Doc Titrated me at (20/12) but I questioned the 18 centrals.. and the fact that in the morning I feel like a huricane near survivor. Oh and no on the COPD.

[OCSleeper]

Hmmm...I'm not sure I'd be using this particular sleep lab. The normal protocol is to raise EPAP until OA's cease, THEN raise IPAP to eliminate HY's (hypopneas). The tech seems to be using doing just the opposite. The reason for the COPD question is that you're basically being 'ventilated' whenever there's more than a +5 cm difference between IPAP and EPAP. In the absence of having reduced respiratory capacity (as in COPD or related conditions), I'd have to question the competence of the lab. If the Doc didn't catch or admit to the error (if he was involved with the original study), I'd head for the door and employ some medical folks who are little more qualified to earn your wad of cash.

A "hypnogram" chart (which plots arousals and the appropriate sleep level over time) would be very helpful if that is available. That chart would also indicate your "sleep architecture" as well as indicate how the REM cycles (around 3-6 occur each night) are arranged. (Looks like you had at least two REM cycles during the study).

It would also be nice to see in what position you were sleeping over time--on the side, back, etc. It's hard to say exactly what was preventing you from getting down to Level 3/4 and how this was affecting REM. The oximetry data notes the NADIR or low point in your blood oxygen level, but leaves out the average. Hard to tell what's going on here. If this is your typical pattern, I don't know how you're staying awake during the day.

Also note that you were still having OA's at an EPAP of 12 (albeit 20/12). Would have been nice if you had been titrated first at 14/12 and then moved to 15/13 to see if that eliminated the OA's...and THEN move up the IPAP above 15 only if the HY's were still around.

Your current AHI average seems much better than what you were getting during that old study. Was it your intent to operate the machine in APAP mode? The pressure support of 0 implies that. If you could post the data from your loaner machine, that would be very informative.

If it were me, I'd be RAISING, not lowering the min pressure. Min=11, Max=17 would be where I'd start (keep the max lower than 20 to avoid centrals). If you don't feel better, then try raising the min after a few days each time. You might also want to try setting the PS in the range of 2 to 4 to see if that has an effect.

I'm not discounting having a sleep study or using a doctor to help you...but use one that's competent. If your original bi-level machine had helped you to feel better then I'd keep tweaking your current machine with the support of others on this forum. But...if you have NEVER had effective therapy in the past, then I'd go in for at least a bi-level titration with a better lab.

RESMED/RESPIRONICS machines are excellent, but operate using different algorithms. Which machine is best depends on several factors which are well-discussed on other threads in this forum. The machine that works best FOR YOU is the best machine! Personally, I think everyone deserves an AUTO BiPap as a starting point. Way too much time and money being spent on CPAP machines gathering dust. (To me, a fixed pressure CPAP machine is simply an expensive nightly torture device).

[LV Sleep Tech]

How long ago was this study done?? By looking at the report I am not sure why they went to bilevel, I would have stayed on CPAP, I think you might have been over titrated (too much pressure) I would find another place and have a repeat sleep study. If you dont have insurance I would go to a hospital and see if they have a IC program ( ingendent care).

[CarolinaBlueMax]

Thank you guys so much for your comments, it is just good to know I have some comrades that know the hose side of the story and have my back! My study is 5 yrs old, I know I need to do a new one. I have been reluctant because the lab that my doctor uses is associated with her network and I have lost my faith in them. In her defense when she finally looked at the whole study her jaw dropped and offered to pay for a new study on my behalf but I was so pumped that she had agreed to prescribe an auto bipap that I took my victory and ran. I am going to talk to her this Monday and see if the offer is still standing or if she could have the lab look at the study and offer to make it right. Do you guys think this is a reasonable request? Should I just bite the bullet, sign up for a new study and insist that we do some research on who the tech is going to be ect.

I am trying to grab the data off of my smart card form my resperonics machine with my infineer 3500 reader but I can't put my fingers on my software from my old machine...I will keep hunting. It also doesn't look like the resmed software is compatible with my reader....Hey we are having fun now!

I did get an Ahi 0f 7.5 with only 1 oa with settings of ipap max 17- epap min 12 with ps 2 tonight I am going to try ipap max 17 epap min 11 ps 0 straight apap and move up the next night.... Or what do you think I need to do to reduce hypopneas....BTW machine reported average ipap 13.8

[jweeks]

Any thoughts would be welcomed ....My sleep Doc wants me to do another study @ 2500.00, plus follow up visit/study....I am thinking what if it is about the same as this one, the only result would be, this out of work Custom home builder has $ 2500.00 less to spend on equipment.

Hi,

Being a custom home builder, you probably know how to negotiate. When I needed my sleep studies, the rack rate that was quoted was $3200 plus $1200 to read the data. I was out of work, mainly because I couldn't stay awake at work. I started calling around, and I found that the major cardiac care center in Minneapolis offered me a 47% discount off of the rack rate. I came up with a package deal where I paid in advance for about $1400. And this wasn't at Joe's Gas Station & Sleep Clinic, this was at Fairview Southdale Cardiac Center, a very highly respected hospital.

Even if you have to pay the $2500, it is worth it. Just think how expensive it would be to fall asleep driving and have an accident. You could end up spending tens of thousands of dollars, or worse yet, kill a family member. The $2500 is worth it, even if you beg, borrow, or steal it.

BTW, it took 3 sleep studies before they found a treatment that worked for me. It is not unusual to have to go back more than once. It is worth it. The past year since I found an effective treatment has been absolutely fantastic.

-john-

[jnk]

If I had a relatively recent (last five years or so) titration that ruled out other sleep troubles and proved I do OK with pressure, I would do the rest self-titrating at home, myself.

I would start with the Auto 25 set to auto mode with PS at 4, Min EPAP at 10, and Max IPAP at 20 or so, and then see what happened for a few weeks, making sure my leak was under control. I would ignore my AHI at first. AI is all that matters at first on that machine. Once I had tweaked Min EPAP to get AI consistently below 1.0, I could always tweak more from there if I felt the need, such as increasing or decreasing PS to tweak HI. But that would be down the road. And I wouldn't worry about relatively high estimated AHI on that machine, as long as I felt OK and my AI was below 1.0.

[CarolinaBlueMax]

John thanks for the input, It never dawned on me to shop around and or ask around on who the better sleep labs might be and to negotiate the fee..BAM! Nice, my fellow hose head! I believe I have been in a bit of a fog lately, thanks for kicking the lights on for me...

[unadog]

I think the actual rate that my insurance is paying my university sleep lab fir my sleep studies Is a bit under $1,000. The billed rate is higher, but of course they actually "allow" 40% to 60%

The problem is that the insurance companies insist that no-one be billed a lower rate than they are. Then they negotiate a discount from that.

I don't quite know how, but it seems like if you were a member of "Joe Bobs Insurance Plan", your plan should get ghat same discount! Some states, local groups, etc. have special groups like that.

Look at used equipment. I bought a Respironics Bipap Auto (older tank version) with humidifier for $200.

Or, maybe, go right to a used ResMed or Respironics ASV for around $1,000 or less? That should be able to handle just about anything you could throw at it. Maybe a better investment than a study if it was either/or?

I paid out of pocket for my equipment because I couldn't wait for insurance to le me fail CPAP, etc before they moved me to an ASV. Being out of work because of health, I also looked at potential income from being able to work, vs. wasted time waiting for gd insurance to act.

Good luck!
Michael