Got my sleep study reports and prescription

I was surprised they got here so soon. I would like to give you some of the info on both reports and hear your opinions since some things surprised me.

First off my prescription simply states: CPAP at pressure 9cmH2O & Humidifier.


First study:
SLEEP ANALYSIS: There was a total sleep period of 7.3 hours during which the patient slept 5.9 hours for a total sleep efficiency of 79.3%. Sleep latency was 10.3 minutes. Stage one represented 37.6% of total sleep time. Stage two 50.3%. Stage three 0%. Stage four 0% with REM representing 12.1% of total sleep time. REM latency was 196.5 minutes. The patient was supine throughout the study. Snoring was noted.
RESPIRATION ANALYSIS: There were a total of 593 apneas and hypopneas for a respiratory disturbance index of 100.5. There were 3 central apneas and 446 obstructive apneas, 77 mixed apneas and 67 hypopneas. A mean duration of apnea was 27.7 seconds, hypopnea 27.5 seconds, and the maximum duration of apnea was 61.3 seconds and hypopnea 58.8 seconds.
OXYGENATION ANALYSIS: Mean oxygen saturation was 85.8% with a minimum oxygen saturation of 35.7%! The patient spent 38.8% of total sleep time with oxygen saturation of over 90%, 36% in the 80-90% range, 11.7% in the 70-80% range, and 6.4% at 70% and below.
MOVEMENT ANALYSIS: NO significant movements were recorded.
AROUSAL ANALYSIS: There were 583 respiratory arousals for an index of 98.8.
ELECTROCARDIAGRAM ANALYSIS: Sinus heart rhythm, rare premature ventricular contractions and premature atrial contractions noticed. Heart rate varied from 70-104.
IMPRESSION: Abnormal study. Obstructive sleep apnea (severe), this patient has extremely severe sleep apnea. There are constant prolonged apneas and hypopneas occurring throughout the course of the night disrupting the patients sleep. Severe oxygen desaturations are present more often than not throughout the course of the night as well.

Second Study using CPAP titration:
SLEEP ANALYSIS:There was a total sleep period of 6.7 hours, during which the patient slept 6.5 hours for a total sleep efficiency of 96.0%. Sleep latency was 7.5 minutes. Stage one represented 6.4% of total sleep time. Stage two 48.4%. Stage three 19.5%. Stage four 2.0% with REM representing 23.6% of total sleep time. REM latency was 64.5 minutes. The patient was supine throughout the study. Snoring was noted. (The nurse had told me upon waking me that I did not snore at all and was completely silent so this was a surprise.)
RESPIRATION ANALYSIS: There were a total of 91 apneas and hypopneas for a respiratory disturbance index of 13.9. There were 3 central apneas and 33 obstructive apneas, 2 mixed apneas and 53 hypopneas. A mean duration of apnea was 20.3 seconds, hypopnea 20.8 seconds, and the maximum duration of apnea was 32.9 seconds and hypopnea 35.8 seconds. (This also surprised me as I thought with the CPAP I wouldn't have ANY apneas. The 3 central apneas too - what are those and why are they different?)
OXYGENATION ANALYSIS: Mean oxygen saturation was 96.1% with a minimum oxygen saturation of 78.5%! The patient spent 98.3% of total sleep time with oxygen saturation of over 90-100%.
MOVEMENT ANALYSIS: No significant movements were recorded.
AROUSAL ANALYSIS: There were 78 respiratory arousals for an index of 12.0.
ELECTROCARDIAGRAM ANALYSIS: Normal Sinus rhythm. Heart rate varied from 66-88.
CPAP TITRATION:This was initiated at a pressure of 4cm of water, titrated upwards toward 11cm of water. At approximately 9cm, obstructive apnea ceased. There was a rare hypopnea and central apnea. There was however a dramatic improvement in the patients respirations at this pressure setting.
IMPRESSION: Abnormal study. Obstructive sleep apnea (severe) with marked improvement with CPAP.
COMMENT: The patients sleep apnea significantly improved using CPAP at a pressure of 9cm of water.
RECOMMENDATIONS: A trial of CPAP at this pressure reading should be initiated.

So after reading all of this would you agree on a CPAP for me at the 9cm pressure. If not why and what would you suggest? Are the central apneas normal? Is it normal to still have 91 apneas in the course of a 6.5 hour sleep while using a CPAP? I know this is a long post so thanks in advance to anyone who takes the time to read it all and comment. I am beginning to trust your opinions more than anyone elses.

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): humidifier, Titration, Arousal, CPAP, Hypopnea, Prescription

The averages during the titration study don't mean too much, since the technician spent a lot of time moving your pressure up and down. Some of the bad events were at the lower pressures.

Yes, your apnea looks bad. Those low oxygen levels are bad for your health. Fortunately, it looks like 9cm of pressure will probably fix most of your breathing problems. That is not TERRIBLY high pressure, but you would still benefit from either Cflex or EPR, to make breathing more comfortable.

Many patients benefit from an automatic machine. I recommend the Respironics Auto Cflex.

Did you note what type of mask was used for your titration? How comfortable was it? A good mask fit is critical for success.

The central apneas are apneas caused by your nervous system, not by a blocked airway. It is normal for some people to have some of these. If I read your study results correctly, you had only 3 of these in about 7 hours. That is not too bad.

CPAP therapy alone cannot cure central apneas. However, it looks like your primary problem will be corrected by a CPAP.

Good luck! Try to get a machine as soon as possible. Your oxygen numbers need to come up as soon as possible. Some insurance is slow, so you might need your doctors help to get a machine quickly.

Moogy

Is it normal to still have 91 apneas in the course of a 6.5 hour sleep while using a CPAP?


I beat you!!!! I have had 97/hr apneas in my first study...
But on my second, my apneas reduced to 4/hr at 14cm... I
Just got my machine yesterday, with a FlexiFit HC431 Full Face Mask
and Resmed remplus w/ heated humidifier, but had some leaks so I
had to tighten the mask tighter than at the sleep study.. I look like
a Hindu now. Also if you use Aparrhea, they have the personality of a
cold, dead fish. They answered all my questions with, "Thats what
manuals are for" so I dont have a clue on whether i got this mask
fitting right.

imsotired, sure looks like your body has been starved of oxygen lately!
I know you will feel sooo much better once you get your machine up and going! Keep reading here so that you can avoid the pitfalls of therapy.
And, please, keep us posted on your progress!
Good Luck! You are on your way to better sleep!

With those numbers I would get my machine as quickly as possible.

Did you decide if it is cheaper to deal with Apria with your 50% copay or to buy outright?

I am curious what you decided after considering all the options and finances.

Sounds like you now have your prescription and can move in whatever direction you like although for Apria you may need one that says heated humidifier. For a cash online purchase you can get whatever you want.

Let us know what you do.

My ONLY hesitation in buying at cpap.com vs. the DME is what if the machine isn't working for me? Once I buy it here it's mine whereas is I rent (Just found out I'm obligated to rent to own for 13 months at $106 per month for just the CPAP plus the other $400.00 worth of other stuff I need to buy.) from the DMe if the machine isn't working for me then maybe they would find another that would? I'd like to have the APAP but finance wise with no insurance help that one is pretty steep and I think I'd stick with the Respironics Remstar Pro 2 w/ Cflex and integrated HH. That with a decent mask is doable financially. Now if we could get the insurance company to agree to allow me to buy here and submit a bill and they'd cover 50% I'd go for the APAP. That is the only other hangup right now. My husband is going to try talking with the ins. co. to see if he can get them to agree to that. I do realize each night/morning that I desperately need to get the machine asap!!!

I (not unlike others here) have become a huge fan of APAP. Allowing the machine to go with the flow of the ever changing requirements of your body. With CPAP. you pretty much set it and assume there will not be changes. Even if you get software to track the changes it's not as good as a machine that will forever adjust continually to them. I would also recommend, based on my personal experiences with DME's and insurance, that you ante up and get a Auto CPAP for yourself and bypass the DME's. You'll be happier in the LONG run for sure. If I knew then what I know now there's NO doubt in my mind I would have done that and kept my blood pressure lower (aggrivation wise). For overall price/performance you'll not likely beat the package that CPAP.COM offers on the REMstar Auto with the humidifier (package). Last I checked it was $709. Also if you have the extra $170 you can add the software and card reader to it allowing you complete analysis capability of your progress on the therapy. The machine comes with the card in place. Good luck.....I know you'll be better in a short while.......been there done that........

let's see rent cheapo model $1400, or buy the best $709 and get it in three days. To me it's a no brainer. Once you have apnea, you have apnea, treat it or suffer the results. Failure to treat is not a option. Jim

One other option to consider.

Rent for a month (I think that I read that the $106 is you copay?), You will know by then if you are tollerating it and it is helping (with your sleep study numbers I can't imagine that it won't help), then, take your mask, humidifier (all purchased outright from the local DME), order a machine from Cpap.com minus the humidifier, and hand the DME's back to them before the second month's rental is due.

$484.99 for your Pro 2 machine (and save the other 12 months at $106 for the same machine.

I logged off and then this thought hit me. Not to be annoying, but...

You are willing to sign up for a $106 rental on a machine and fork over $400 for other stuff total $506


when buying online you can have the machine and humidifier (Pro 2 you said you wanted)

for $544

and can add the mask of your choice for $90 to $175 = $634 - $724 (no shipping charge and the tube and filter comes with it....

Difference of $130 to $220 to have the machine in a couple days, no DME to hassle with no 2 week wait while they, "order your machine" no fighting over what type of humidifier....

And if you keep the rental to the end it will end up costing you $almost $1000 more (unless the numbers you quote are total cost not copay, then the difference is $500 more out of your pocket).

If you somehow don't like it you can sell on Yahoo auctions for a couple hundred. But I with the numbers I see on your sleep study you will like or learn to like in a real hurry.

This is for guest: the high apnea numbers on the second study (the one with cpap) can be explained in that they started at a pressure of 4 cm/H2O and worked up to 11. The lower pressures did not stop the apneas-- that wouldn't be expected, but they have to start somewhere; and 4 is the lowerst pressure on cpaps. Working up, the apneas stopped at a pressure of 9. So for part of the night, there were still a number of apneas. Since the numbers reported include the entire night, the total number of apneas and the respiratory index will be higher than if the entire night had been spent at the "ideal" pressure of 9. Note that all of the numbers are better on the second study, because some of that time was spent at the ideal pressure. Everything improved, especially respiration.