Here is what a Sleep Tech Supervisor told me about my recent sleep study

I had a sleep study last week. I just got the results. The Sleep Tech Supervisor called me to discuss the doctor's suggestions and findings. I talked to them for a long time and not sure what to think or believe at this point. I've been having OA's when my machine pegs out at 15 or 16, and now they want to lower my starting pressure to 4, and maximum pressure to 14, and also change PS3 to PS4.

My previous sleep study showed the most appropriate pressure was 14/10 and titrated to 16/12. So why on earth is it lower now?
Maybe due to me wearing my dental appliance?

Here is what they told me:
1. I slept for 5 hours with 1 OA, at pressure of EPAP 5, IPAP 9, PS 4, and that pressure seemed most appropriate for me.
2. My oxygen level at that pressure was around 91% at the lowest.
3. They are lowering my settings, and told me it could be my fault that by increasing my own settings, I am causing more OA's to happen.
4. They said that all BIPAP/BI-LEVEL machines should usually have PS4, and that me using a PS3 could be causing more issues. They claimed there was no reason to use PS 3 or lower, at least for me. They did say that people with COPD though or breathing issues could use PS 5 or PS 6.
5. They are lowering my settings to start at EPAP 4, IPAP 8, PS 4.
6. They claim I am not at my PRESCRIPTION settings, and this is causing the issue.
7. They said even though I slept 5 hours, they only really need 2 hours to make and adjust settings and determine optimal pressures.
8. I mentioned about maybe tucking my neck and positional may be causing apnea's, but they had no answer for that.

I don't see how LOWERING my pressure, and increasing PS to 4, will help me? I have never heard of decreasing pressure, and increasing PS to help with OA's. As you can see from this particular night back on Oct 9th, I had a lot of OA's in a row. My machine was pegged at IPAP Max 15. This particular night my heart went into ventricular bigeminy(double beats) and I called 911 due to feeling like I was going to pass out. Almost every week, I have at least one night where I have run's of OA's like this. Other nights are okay and my AHI < 2 usually.

When I had lower settings of PS 4 in the past, that caused me to have more CA's. Plus it felt like the pressure got too low when breathing out. Having starting EPAP 4, also seems low and like I can't get enough air. The tech said just to breathe deeper. The issue with lower pressures in the past, was that my oxygen levels would dip to the low 80's, same as what happens when I have OA's.

They told me to try these settings for two weeks. If I start sleeping bad again tonight, or my oxygen level dips low, I'm not sure what to do.

Here is a sample of a BAD night I have occassionally. See how my machine pegs out? And now they want to lower settings.

you should be discussing this with your doctor. if your doctor won't see you and leaves it to the tech's, get a new doctor. the doctor is the responsible caregiver/prescriber.

greatunclebill wrote: ↑

Mon Oct 15, 2018 6:23 pm

you should be discussing this with your doctor. if your doctor won't see you and leaves it to the tech's, get a new doctor. the doctor is the responsible caregiver/prescriber.

Well the doctor is the one that reviewed the report and knows my history. He is the one that told the supervisor tech to call me and relay his suggestions. I just sent my doctor a message through his website portal, asking those questions. So hopefully by tomorrow I will get some answers from him. I went to a new sleep doctor the other week, but was pawned off to a PA and never saw the doctor. So that one I'm not going back to either. Still searching for another sleep doctor. Trying to find one that has good reviews in my area is hard.

WarpedTrekker wrote: ↑

Mon Oct 15, 2018 5:22 pm

So why on earth is it lower now?

They screwed up...

WarpedTrekker wrote: ↑

Mon Oct 15, 2018 5:22 pm

1. I slept for 5 hours with 1 OA, at pressure of EPAP 5, IPAP 9, PS 4, and that pressure seemed most appropriate for me.

Not even a whole night.

WarpedTrekker wrote: ↑

Mon Oct 15, 2018 5:22 pm

3. They are lowering my settings, and told me it could be my fault that by increasing my own settings, I am causing more OA's to happen.

Recipe for disaster

WarpedTrekker wrote: ↑

Mon Oct 15, 2018 5:22 pm

4. They said that all BIPAP/BI-LEVEL machines should usually have PS4, and that me using a PS3 could be causing more issues. They claimed there was no reason to use PS 3 or lower, at least for me. They did say that people with COPD though or breathing issues could use PS 5 or PS 6.

There's a *REASON* that the PS on your machine can be set to ZERO. These people are full of it.

WarpedTrekker wrote: ↑

Mon Oct 15, 2018 5:22 pm

5. They are lowering my settings to start at EPAP 4, IPAP 8, PS 4.

Good luck with that... see #3 above.

WarpedTrekker wrote: ↑

Mon Oct 15, 2018 5:22 pm

6. They claim I am not at my PRESCRIPTION settings, and this is causing the issue.

HAH.

WarpedTrekker wrote: ↑

Mon Oct 15, 2018 5:22 pm

7. They said even though I slept 5 hours, they only really need 2 hours to make and adjust settings and determine optimal pressures.

Anybody with any competence knows that sleep varies throughout the night, Many people need more during the latter stages of the night.

WarpedTrekker wrote: ↑

Mon Oct 15, 2018 5:22 pm

I don't see how LOWERING my pressure, and increasing PS to 4, will help me? I have never heard of decreasing pressure, and increasing PS to help with OA's. As you can see from this particular night back on Oct 9th, I had a lot of OA's in a row. My machine was pegged at IPAP Max 15.

That's because the answer to "obstructives" is "more pressure"....

WarpedTrekker wrote: ↑

Mon Oct 15, 2018 5:22 pm

If I start sleeping bad again tonight, or my oxygen level dips low, I'm not sure what to do.

Here is a sample of a BAD night I have occassionally. See how my machine pegs out? And now they want to lower settings.

Well, ..... viewtopic.php?f=1&t=173246&p=1271677#p1271625

Well they wanted me to use this machine on their settings for 2 weeks and get back to them. It's not even one week, and last night I had those same weird obstructions again. I called and left a message to the head supervisor about this, and hope to hear from them monday. On another forum, someone told me that my breathing pattern seemed very weird. I'm not sure what to make of it myself. But during every sleep study I've had, they never saw any weird breathing or struggling to breathe, like what is shown here....

Just raise your min. pressure by 2-3 cms and try that for a few days... then come back and let us know how things went.

WarpedTrekker wrote: ↑

Sat Oct 20, 2018 2:28 pm

Well they wanted me to use this machine on their settings for 2 weeks and get back to them. It's not even one week, and last night I had those same weird obstructions again. I called and left a message to the head supervisor about this, and hope to hear from them monday.

They'll probably tell you "Your(sic) under 5! you're doing GRATE(sic)!"

WarpedTrekker wrote: ↑

Sat Oct 20, 2018 2:28 pm

On another forum, someone told me that my breathing pattern seemed very weird. I'm not sure what to make of it myself.

Which is what you get from "another forum"... nothing weird about the pattern at all.

WarpedTrekker wrote: ↑

Sat Oct 20, 2018 2:28 pm

But during every sleep study I've had, they never saw any weird breathing or struggling to breathe, like what is shown here....

Well, as I said in your other thread...

You could try using regular bi-level spontaneous therapy mode, until you figure out the EPAP that clears your obstructive apneas. Then flip over to VAuto mode and set an EPAP min, with the min being close, or set at the needed pressure to keep the airway open. But you can also do this in VAuto mode as well more or less.

I would ignore the sleep study recommendations - they all sound like morons, sad to say.

raisedfist wrote: ↑

Sat Oct 20, 2018 10:00 pm

You could try using regular bi-level spontaneous therapy mode, until you figure out the EPAP that clears your obstructive apneas. Then flip over to VAuto mode and set an EPAP min, with the min being close, or set at the needed pressure to keep the airway open. But you can also do this in VAuto mode as well more or less.

I would ignore the sleep study recommendations - they all sound like morons, sad to say.

What is bi-level spontaneous mode? Is that just a fixed pressure all night long?

Yes S mode is fixed pressure with BiLevel pressure support

WarpedTrekker wrote: ↑

Sun Oct 21, 2018 11:54 am

raisedfist wrote: ↑

Sat Oct 20, 2018 10:00 pm

You could try using regular bi-level spontaneous therapy mode, until you figure out the EPAP that clears your obstructive apneas. Then flip over to VAuto mode and set an EPAP min, with the min being close, or set at the needed pressure to keep the airway open. But you can also do this in VAuto mode as well more or less.

I would ignore the sleep study recommendations - they all sound like morons, sad to say.

What is bi-level spontaneous mode? Is that just a fixed pressure all night long?

You got it. There is no real requirement to maintain a pressure support (difference between IPAP and EPAP) of (at least) 4 cm h2o if you are only using bi-level to treat obstructive sleep apnea. Comfort and treatment efficacy are both important.

Since you have known obstructive apneas that are not being treated, you could start at 8 IPAP / 6 EPAP and go from there. I think it's pretty evident that an EPAP of 4 or 5 is probably a wasted night and won't effectively treat you. If you still have obstructive apneas, you can then raise EPAP by 1, and then IPAP by 1 to maintain the current pressure support level (PS of 2).

I would argue that the most important part of any sleep study titration, or at-home tinkering, is finding the EPAP that works. Without an open airway, it's likely that nothing else is going to work very well.

raisedfist wrote: ↑

Sun Oct 21, 2018 1:28 pm

you could start at 8 IPAP / 6 EPAP and go from there. I think it's pretty evident that an EPAP of 4 or 5 is probably a wasted night and won't effectively treat you. If you still have obstructive apneas, you can then raise EPAP by 1, and then IPAP by 1 to maintain the current pressure support level (PS of 2).

I would argue that the most important part of any sleep study titration, or at-home tinkering, is finding the EPAP that works. Without an open airway, it's likely that nothing else is going to work very well.

Given that an epap of 10 isn't enough for him on bad days... I would argue that an epap of 6 will be woefully inadequate.

Also, it's shown that he's got wildly varying needs, so S mode isn't a good idea either.

palerider wrote: ↑

Sun Oct 21, 2018 1:46 pm

raisedfist wrote: ↑

Sun Oct 21, 2018 1:28 pm

you could start at 8 IPAP / 6 EPAP and go from there. I think it's pretty evident that an EPAP of 4 or 5 is probably a wasted night and won't effectively treat you. If you still have obstructive apneas, you can then raise EPAP by 1, and then IPAP by 1 to maintain the current pressure support level (PS of 2).

I would argue that the most important part of any sleep study titration, or at-home tinkering, is finding the EPAP that works. Without an open airway, it's likely that nothing else is going to work very well.

Given that an epap of 10 isn't enough for him on bad days... I would argue that an epap of 6 will be woefully inadequate.

Also, it's shown that he's got wildly varying needs, so S mode isn't a good idea either.

Good points. Time to crank up that EPAP min .

palerider wrote: ↑

Sun Oct 21, 2018 1:46 pm

raisedfist wrote: ↑

Sun Oct 21, 2018 1:28 pm

you could start at 8 IPAP / 6 EPAP and go from there. I think it's pretty evident that an EPAP of 4 or 5 is probably a wasted night and won't effectively treat you. If you still have obstructive apneas, you can then raise EPAP by 1, and then IPAP by 1 to maintain the current pressure support level (PS of 2).

I would argue that the most important part of any sleep study titration, or at-home tinkering, is finding the EPAP that works. Without an open airway, it's likely that nothing else is going to work very well.

Given that an epap of 10 isn't enough for him on bad days... I would argue that an epap of 6 will be woefully inadequate.

Also, it's shown that he's got wildly varying needs, so S mode isn't a good idea either.

The question is why am I having wildly varying nights? I sleep in the exact same position every night. I wake up in the exact same position. Maybe my head is slightly turned to one side, but that is it. Sleep Studies are a crap shoot for me, since every time I've had one, I had a "good" night.

In Feburary, that sleep study started me on CPAP from 6 to final pressure of 12, which failed to eliminate events. Then BiPAP/Bi-level titration was started at 14/10, and titrated to 16/12. My report says the "most appropriate setting" is 14/10. The study showed I had ZERO REM sleep. Total sleep time 399min, with poor sleep efficiency 73.2%. Arousals were 19.5 an hour. SpO2 nadir 84%, with one minute below 89%.

This last sleep study in October, it says total sleep time 382min, with poor sleep efficiency of 78.3%. Arousals 6.6 an hour. BiPAP started at 8/4 and titrated to 9/5. "Most appropriate" setting 8/4. At that pressure there were AHI 0, RDI 0, Arousal index 2.7/hr. Sleep efficiency 91% and SpO2 nadir 91%. I wore my dental appliance at this sleep study, so that may be why i was titrated at lower pressure?

WarpedTrekker wrote: ↑

Sun Oct 21, 2018 9:03 pm

The question is why am I having wildly varying nights?

because you're a squidgy meatbag, full of variables, not a precision machine.

The sooner you accept that, and just work with what you have, the sooner you'll be able to improve.

Pugsy's pressure needs range from 7 to 18 *in a single night*... so much for that "we only need two hours to get a good number" BS.