Self Titration

Hi, I’ve been diagnosed with OSH but can not afford a tiltration. I was wondering the safe way to start as I was recommended to get a ResMed 10 autoset. My sleep report is below.

[img][https://imgur.com/a/d4969BK/img]

Dread wrote: ↑

Wed Jul 12, 2023 5:45 am

Hi, I’ve been diagnosed with OSH but can not afford a tiltration. I was wondering the safe way to start as I was recommended to get a ResMed 10 autoset. My sleep report is below.

[img][https://imgur.com/a/d4969BK/img]

The safest way is don't bother. There's nothing to tiltrate.

Who diagnosed the OSA? Has your doctor reviewed this report with you? Did your doctor recommend the CPAP therapy?

I think the reason Rubicon and LSAT are raising these questions is that your sleep study doesn't show any significant sleep-respiration problems. You have fragmented sleep, but the study doesn't suggest that the fragmentation is related to your breathing.

So it's extra important for you to discuss the significance of the report with your doctor. I see that bradycardia and tachycardia were noted; both of those conditions deserve further discussion too, if you haven't already had that conversation with your doctor.

It would be especially valuable if you have a doctor, or team of doctors, who can interpret your sleep-study findings in light of your history of scoliosis, low blood pressure and depression. In theory, that kind of coordination should be the job of your primary-care physician, but PCPs don't always actually function that way.

Oops

palerider wrote: ↑

Wed Jul 12, 2023 2:02 pm

Dread wrote: ↑

Wed Jul 12, 2023 5:45 am

Hi, I’ve been diagnosed with OSH but can not afford a tiltration. I was wondering the safe way to start as I was recommended to get a ResMed 10 autoset. My sleep report is below.

[img][https://imgur.com/a/d4969BK/img]

"OSH" afaik is Obesity Hypoventilation Syndrome.

In this case it's "obstructive sleep hypopnea." I had an inkling and checked on the AB forum, where I found that the OP has posted additional information:

I was recently diagnosed with Obstructive Sleep Hyponea and was wondering what type of machine would they likely prescribe? I have a doctors appointment tomorrow and they said once sleep studies results were shown, I could get a machine. Here is my report, and was curious if APAP or CPAP would be likely. I suspect UARS but need to wait for the ENT on August 30th. I wake up unrested, excessively sleepy, thirsty, craving, often hear whistling in my nose, and did notice a very low hanging palate. I never had any trouble sleeping until a dose of 300mg Gabapentin combined with 5mg Norco. If you are wondering why, I used to take the gabapentin for scoliosis nerve pain, and Norco for severe scoliosis bone pain. Yeah I’m never taking meds again lol.

His sleep study notes that he weighs 117 lbs. He also noted today at the AB forum that he now has a ResMed Airsense 10 Auto machine and will soon have some data from his SD card. He suspects he has UARS.

Dread, did your sleep doctor actually tell you that you have "obstructive sleep hypopnea"? Did the doctor recommend treatment with a PAP machine?

Miss Emerita wrote: ↑

Wed Jul 12, 2023 2:59 pm

palerider wrote: ↑

Wed Jul 12, 2023 2:02 pm

Dread wrote: ↑

Wed Jul 12, 2023 5:45 am

Hi, I’ve been diagnosed with OSH but can not afford a tiltration. I was wondering the safe way to start as I was recommended to get a ResMed 10 autoset. My sleep report is below.

[img][https://imgur.com/a/d4969BK/img]

"OSH" afaik is Obesity Hypoventilation Syndrome.

In this case it's "obstructive sleep hypopnea." I had an inkling and checked on the AB forum, where I found that the OP has posted additional information

Ooops, my bad.

Miss Emerita wrote: ↑

Wed Jul 12, 2023 2:59 pm

Dread, did your sleep doctor actually tell you that you have "obstructive sleep hypopnea"? Did the doctor recommend treatment with a PAP machine?

on TOF Dread wrote:Welp PA said cpap was not needed.

But that's OK, the Magic Machine option is already on the table:

on TOF Dread wrote:I read encouraging posts like people had cpap not work, and jump to asv and a few months it helped.

Miss Emerita wrote: ↑

Wed Jul 12, 2023 2:59 pm

He suspects he has UARS.

With an Arousal Index of 5.4, he ain't got that either since they're all spontaneous (note that G3 Sleepware does report RERAs, and it's 0.0).

Dread, about UARS and Rubicon's observation, here is a snippet from the NIH's National Library of Medicine:

While OSA and CSA are defined by the number of apnea and hypopnea episodes per hour of sleep (apnea-hypopnea index, AHI), UARS is defined in general as airflow limitation due to increased respiratory effort leading to arousals from sleep without significant desaturation (i.e., RERAs) associated with daytime symptoms.[4] UARS has also been more specifically defined as apnea-hypopnea index < 5 events/h, oxygen saturation ≥ 92%, and respiratory effort–related arousal index ≥ 5/hour.[5] Another study used a slightly different definition when AHI <5/hour, minimum SpO ≥ 92%, the presence of airflow limitation during sleep for ≥5% of total sleep time, and daytime sleepiness and/or fatigue.[6]

Your sleep study doesn't seem compatible with a diagnosis of UARS, though of course you should discuss this with your doctor.

BUT, you've already bought a machine, and you are welcome to post an Oscar chart here for review. Please provide the image of the chart via a hosting service like Imgur.

Hi all. The clinic told me if my hyponeas were a tad longer they would of heavily recommended cpap. My report mentioned “Rare respiratory disturbances, including OSH”. I’m awaiting a cardiologist referral but have pulmonogist July 31st with Ent on August 27th and Neurologist on August 8th. A PA at my neurologist office recommended getting the airway checked for UARS or similar obstructions. Every night my pulse ox measures low usually. My doctor thought I was anemic because poor circulation but the blood work came fine for iron :/
https://imgur.com/a/fSwrBVu
It was concerning enough for my doctor, but since my insurance is picky he could not write a script for cpap.

Miss Emerita wrote: ↑

Thu Jul 13, 2023 11:31 am

Dread, about UARS and Rubicon's observation, here is a snippet from the NIH's National Library of Medicine:

While OSA and CSA are defined by the number of apnea and hypopnea episodes per hour of sleep (apnea-hypopnea index, AHI), UARS is defined in general as airflow limitation due to increased respiratory effort leading to arousals from sleep without significant desaturation (i.e., RERAs) associated with daytime symptoms.[4] UARS has also been more specifically defined as apnea-hypopnea index < 5 events/h, oxygen saturation ≥ 92%, and respiratory effort–related arousal index ≥ 5/hour.[5] Another study used a slightly different definition when AHI <5/hour, minimum SpO ≥ 92%, the presence of airflow limitation during sleep for ≥5% of total sleep time, and daytime sleepiness and/or fatigue.[6]

Your sleep study doesn't seem compatible with a diagnosis of UARS, though of course you should discuss this with your doctor.

BUT, you've already bought a machine, and you are welcome to post an Oscar chart here for review. Please provide the image of the chart via a hosting service like Imgur.

I asked and oddly they don’t measure RERA so so I do not know. They only measured Respiratory Events by body position a]but no RERA or RDI apparently. I called and asked. I’m thinking about a second study to see for RERA.
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Dread wrote: ↑

Thu Jul 13, 2023 11:48 pm

The clinic told me if my hyponeas were a tad longer they would of heavily recommended cpap.

That makes absolutely no sense whatsover.

I asked and oddly they don’t measure RERA so so I do not know. They only measured Respiratory Events by body position a]but no RERA or RDI apparently. I called and asked. I’m thinking about a second study to see for RERA.

You don't need a second study. That software can register RERA so tell them to rescore that one, it's easy enough.

That said, ALL your arousals would have to be RERAs to barely hit minimum criteria of index 5.0, being 5.4.

And arousals are normally part of sleep.

On a side note, Effexor Sleep is usually bad sleep.

Just sayin'.

What’s odd is I’ve been off venlafaxine for 7 weeks and still have shitty sleep. Circulation feels extremely bad. I’m hoping the CPAP will atleast let me so,what rest.

Would a good pressure to start be 6-12, EPR 2, and then slowly go up 0.5 1-2 days.