Nervy: retitration tonight! Am I missing sleep study pages?

First issue:

As some of you might remember, my sleep doc's only been willing to Rx cpap; my insurance company's only willing to pay for apap if cpap fails; I don't have the $$ to get one on my own; they got zero on-my-back numbers during my titration study; and my sleep doc scheduled me for a retitration, saying he'll only Rx apap if they're able to get supine-sleeping numbers from me and if those numbers are widely different than my side-sleeping numbers.

Tonight's the night!!

Sleeping on my back's a challenge, because I have benign positional vertigo, and my particular brand kicks in the vertigo when I put my head back or lay on my back. Sometimes if I stick it out and stay in that position, it'll go away. I am determined to do that tonight. Keep a good thought. (BTW, yes, I am familiar with the Epley Maneuver, as well as the home version/exercises. This is the fourth occurrence, and there isn't time to get it taken care of soon enough. Thanks for the thought, though. )

I'm nervy about it, NOT nervous, because of the need-to-sleep-on-my-back-in-spite-of-the-vertigo thing and especially because the possibility of my getting an insurance company-funded apap is riding on it. Listen! Can you hear that? It's silent movie organ music and a deep-voiced Gary Owens kind of teaser.....
"Will she be able to sleep on her back long enough for her retitration?"
"Will her supine-sleeping and side-sleeping numbers vary enough for her sleep doc to Rx apap?"
"Tune in next week to find out...."

Second issue:

I was about to call my sleep doc's office to request my original titration report and noticed that I have a total of four pages from my original sleep study. (It was a full-night sleep study, not a split study.) When I request my titration report, I also want to request whatever else I should have from the first night. I vaguely remember reading there should be at least five pages. These are the pages that I have (all have the title "Sleep Analysis Report" at the top):

-- tables showing apnea events, hypopopnea events, respiratory events and body position, and respiratory events with arousals.
-- tables showing PLMs and sleep stages, PLM events with arousals, PLM events without arousals, and spontaneous arousals.
-- a table showing oxygen saturation; also one for pressure level analysis, but there's no info in it.
-- a page with charts for: Staging, respiratory, legs, oximetry, and body position; also charts for CPAP and bi-level, but there's no info in them.

What pages am I missing from the sleep study?
Should I have the same kinds of pages for the titration study?

Thanks!!
Marsha

I think it depends on the software used to collect the data and generate the report how many pages result in the print out. Mine was 5 pagesbut I've heard of up to, if I remember right, 20 pages reported. What they hey, take the printout w/you, show it to your sleep tech and ask if that's all or if there should be more. Nothing ventured, nothing gained, right? Good luck tonight!!!!!!

marshaeb wrote:First issue:

As some of you might remember, my sleep doc's only been willing to Rx cpap; my insurance company's only willing to pay for apap if cpap fails; I don't have the $$ to get one on my own; they got zero on-my-back numbers during my titration study; and my sleep doc scheduled me for a retitration, saying he'll only Rx apap if they're able to get supine-sleeping numbers from me and if those numbers are widely different than my side-sleeping numbers.

Tonight's the night!!

Well, what you do is take the trial CPAP, then wait a few days and start calling the Dr. office complaining about the pressure (caution: you might look silly doing this if your pressure is only 7 or . If your pressure is higher you keep complaining and become a thorn in the DME's back. Then before 30 days are up you take the cpap back to the DME and leave it on the counter (be careful of what you sign, be sure to read it).

Basically, at that point you have failed CPAP. Now they can offer you a Autopap and insurance will pay for it since you failed CPAP.

marshaeb wrote: Sleeping on my back's a challenge, because I have benign positional vertigo, and my particular brand kicks in the vertigo when I put my head back or lay on my back. Sometimes if I stick it out and stay in that position, it'll go away. I am determined to do that tonight. Keep a good thought. (BTW, yes, I am familiar with the Epley Maneuver, as well as the home version/exercises. This is the fourth occurrence, and there isn't time to get it taken care of soon enough. Thanks for the thought, though. )

Have you ever seen a Neurologist and had a cervical MRI? The reason would be to rule out a Chiari malformation, more specifically a Type III Chiari malformation which could show up by putting your head on the pillow.

If you have medical insurance, you should insist your doctor refer you to a Neurologist for a workup and MRI.

marshaeb wrote:
Second issue:

I was about to call my sleep doc's office to request my original titration report and noticed that I have a total of four pages from my original sleep study. (It was a full-night sleep study, not a split study.) When I request my titration report, I also want to request whatever else I should have from the first night. I vaguely remember reading there should be at least five pages. These are the pages that I have (all have the title "Sleep Analysis Report" at the top):

-- tables showing apnea events, hypopopnea events, respiratory events and body position, and respiratory events with arousals.
-- tables showing PLMs and sleep stages, PLM events with arousals, PLM events without arousals, and spontaneous arousals.
-- a table showing oxygen saturation; also one for pressure level analysis, but there's no info in it.
-- a page with charts for: Staging, respiratory, legs, oximetry, and body position; also charts for CPAP and bi-level, but there's no info in them.

What pages am I missing from the sleep study?
Should I have the same kinds of pages for the titration study?

Thanks!!
Marsha

The titration report should be the same as the diagnostic report but with the additional page including the titration table. It should also include a page with the hypnogram showing how you did in positional sleep if that was tested. They want you on your back because that will demonstrate the worst possible condition for apnea (even though you may not sleep there at home). You should make it a point to mention to them how you sleep as they should titrate you the way you sleep.

However, if you have muscle-skeletal pains you should NOT avoid or ignore that pain. Be assured if you have it during the day, you can have it during the night during sleep. Those pains can also impact your sleep just as the discomfort gets your attention during the day. If they give you medication for it, you have to know if the medication for the pain doesn't also disturb or impact your quality of sleep.

just like a sore back can keep you awake. I would ask the doctor about the Neuro visit, that part of the brain can impact your vision, your breathing, your sleep, your blood pressure etc. Let the neuro know you get vertigo when you place your head on the pillow, is it the angle? or is it the pressure on the back of the neck? the MRI will rule any malformation out.

Snoredog wrote:Basically, at that point you have failed CPAP. Now they can offer you a Autopap and insurance will pay for it since you failed CPAP.

This is a great plan, Snoredog. I've had my machine since 8/11, but it's still in the insurance-required rent-to-own phase. Would that override/delay the 30-day requirement? I don't actually own it yet.

Snoredog wrote: Have you ever seen a Neurologist and had a cervical MRI? The reason would be to rule out a Chiari malformation, more specifically a Type III Chiari malformation which could show up by putting your head on the pillow.

No, I haven't. The doc that has been following the BPV is an ENT @ the Hershey Medical Center. My sleep doc is a neurologist with sleep studies as his specialty area. I can tell from seeing other pts in the waiting room that he doesn't limit his practice to sleep studies, though. Would you recommend discussing it first with him? I have a follow-up for tonight's retitration scheduled with him on 10/22.

Snoredog wrote:The titration report should be the same as the diagnostic report but with the additional page including the titration table. It should also include a page with the hypnogram showing how you did in positional sleep if that was tested. They want you on your back because that will demonstrate the worst possible condition for apnea (even though you may not sleep there at home). You should make it a point to mention to them how you sleep as they should titrate you the way you sleep.

However, if you have muscle-skeletal pains you should NOT avoid or ignore that pain. Be assured if you have it during the day, you can have it during the night during sleep. Those pains can also impact your sleep just as the discomfort gets your attention during the day. If they give you medication for it, you have to know if the medication for the pain doesn't also disturb or impact your quality of sleep.

just like a sore back can keep you awake. I would ask the doctor about the Neuro visit, that part of the brain can impact your vision, your breathing, your sleep, your blood pressure etc. Let the neuro know you get vertigo when you place your head on the pillow, is it the angle? or is it the pressure on the back of the neck? the MRI will rule any malformation out.

I just got the titration report, and all of those things are there. There are a number of things in it I'll want to ask about and probably more about what you've written here, but I'm on a project that's needed here ASAP (for some silly reason, they expect me to work when I'm here ), so I'll post them another time. Here's the sleep tech's summary (I don't have a scannner):

CPAP initiated @ 4 cm using an Optilife nasal mask, C-Flex of 2 and heated humidity. Leak @ 16 tolerating well. Gradually increased to 9 cm, where pt had a period of uninterrupted State 3 sleep but no REM. Pt awoke and stated she felt like her nose was obstructed and was stuffy. Changed her to a comfortable nasal mask and discontinued heated humidity. Pt had a difficult time from this point on with frequent spontaneous arousals and what appeared to be small hypopneas which would cause arousals. Many different pressures were tried but nothing appeared to eliminate arousals or small hypopneas. No REM was recorded. Final pressure was CPAP of 16. Pt appeared to tolerate and do best at CPAP 9 cm.

Any final thoughts before my retitration?

Marsha

marshaeb wrote:Pt had a difficult time from this point on with frequent spontaneous arousals and what appeared to be small hypopneas which would cause arousals. Many different pressures were tried but nothing appeared to eliminate arousals or small hypopneas.

I would try to get clarification of the sequencing here. Is the typical sequence one of arousal/hypop/arousal or is it a sequence of just hypop/arousal. It happens both ways, and stimulus/response sequencing can literally be reversed from one scenario to the next.

Good luck!!!

-SWS wrote:I would try to get clarification of the sequencing here. ... Good luck!!!

I'll do that. Thanks much. More later.

Marsha

I don't see that you've mentioned at any time how long or much yuo slept at your titration? Homany hours? minutes?