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ozij wrote:Two possible benign reasons for having a low recommended pressure during PSG:

Sleeping there is so strange that you simply don't sleep deeply enough. Your airway doesn't collapse as badly as when you're asleep, and nobody in the lab knows how bad things can get.

Another possible explanation (this is based on birdshell's recent post): Snoring swells your airways. After a while on the right pressure, you no longer snore, the tissues are floppier, and more pressure is now needed to maintain patency.

O.

Thanks ozij,

I would go along with the sleeping in a VERY strange place with wires, mask, people, etc. I did sleep 6 hours with 76% Stage 2 and 21% REM (70 events/hours without CPAP) and got zero Apneas on 7.0 psi. Must have been just the lucky hour they chose to titrate me!

I noticed the change in cpap pressure required the first night, so I don't think it was attributed to not snoring, unless it changes that fast.

[quote="Slinky"]Welcome to the world of sleep apnea therapy. The sleep docs rely on the local DME suppliers to provide the education, support and advice. And too many local DME suppliers don't have the personnel or interest to provide the education, support and advice needed. Too many sleep docs don't take any interest or even bother to see the patients they script therapy for. Then "they" wonder WHY there is such a dismal compliance rate??? Duh.

Our sleep is really never the same every night. There can be subtle changes due to diet, exercise, stress, aches and pains, the sniffles, etc. Seven nights gives you a good averaging of your data to work with.

Gads, my sleep doc started me out on therapy and said, see you in 30 days. Yet once I got an auto he cautioned me to make changes based on a one week average. I suppose that 30 days was to give me time to adjust to wearing a mask, finding a comfortable mask, etc. When he started me on the bi-level, he said see you in 3 months. Go figure.

Slinky wrote:Our sleep is really never the same every night. There can be subtle changes due to diet, exercise, stress, aches and pains, the sniffles, etc. Seven nights gives you a good averaging of your data to work with.

Gads, my sleep doc started me out on therapy and said, see you in 30 days. Yet once I got an auto he cautioned me to make changes based on a one week average. I suppose that 30 days was to give me time to adjust to wearing a mask, finding a comfortable mask, etc. When he started me on the bi-level, he said see you in 3 months. Go figure.

Nah! Probably coincides with his Mercedes and house payment schedules.


Den

Giggle. Actually, Den, due to the COPD I did need the appts and the assistance. Now, this one coming up in two months (been on the bi-level a month now) you may be right and I may not need it. Cancellations only take a phone call.

oceanpearl wrote:Tell him that he don't know crap and that you will get all the information and diagnosis you need on CPAPTALK,COM!!

Since this was the most concrete advise I was given, I had to approach it a little more diplomatic. I certainly appreciate all the help given to me on this forum from the start and I felt that I was getting good therapy in the first six weeks. The doc went over the sleep study and explained it in detail and answered quite a few questions that I had written down for the visit. He put me a copy of the scored portion of the sleep study with graphs, each of the summaries, and Rx on a CD for me at my request and didn't seem to mind. I got a mini physical exam as to why I had sleep apnea and talked to me quite a bit about masks and their fitting to my face and even called the DME and asked them to get me another mask. He asked about compliance in detail but never asked for the card to read.

I told him that I couldn't duplicate the sleep study results at 7 cm and that I had to set the machine to 10.5 cm to get an acceptable AHI. He didn't seem to mind and explained that a sleep study is just slice in time and said you may get a little more mask leaks at 10.5 cm. He also explained that the machines sometimes get fooled for snores and some scoring is not as accurate as in the sleep studies. He said he was glad I could do that as he sometimes has a hard time trying to explain to patients over the phone how to set their machine to a different pressure. Thats one for oceanpearl!!!!!

He didn't think a bipap would help over a cpap for me, but didn't close the door if it would help in the future.

He set the next visit to fit our schedule to be back in the city in about 3 months.

Again, thanks for all the advice and questions answered by forum members in the past six weeks leading up to this visit with the sleep doc.

That sounds like a great sleep doc! Congratulations.

O.

You got a good doc WW. In hindsight I will say the diplomatic approach is the best way to start. For 9 out of 10 sleep docs OceanPearl's advice may be a good second step.

ww wrote:I had to approach it a little more diplomatic.
... doc went over the sleep study ... in detail ...
... answered questions ...
... put ... sleep study ... summaries, and Rx on a CD ...
... and didn't seem to mind.
... talked to me quite a bit
... didn't seem to mind
... explained that a sleep study is just slice in time ...
... He said he was glad ...

A great example of how things can work, if both the patient and physician approach the process sincerely.