Can't believe this

Good catch, ozij...about the titration lasting only half an hour and the pressure being bumped from 7 to 12 in that scant half hour's time. Raising the pressure that fast could very well have been the cause of temporary centrals showing up during the titration. If more time had been spent at each pressure, those centrals would probably have subsided...if they even happened, which they might not have if the pressure had been started lower in the first place and more time had been spent. Then no one would have been suggesting further titration with an S/T machine!

You're right to be upset, but count yourself lucky, Jeff, that you WEREN'T given an S/T titration or an S/T machine!! Not the most comfortable kind of thing to use if a person doesn't really need a timed backup rate. And that rushed half-hour titration sure isn't anything to go by to determine that.

I would not be worrying about having "centrals" at all, Jeff. I sure wouldn't worry about it based on the kind of fast titration you went through. It probably caused transient centrals that you would not have at all under normal circumstances (normal titration and normal cpap treatment.)

Back in 1998... perhaps.... hmmmm... nah... even back then surely a titration like that would have been considered wayyyy too fast and too short to be meaningful.

gasp wrote:It's my policy to never let an inept medical organization have the opportunity to mess up twice. I give my business elsewhere after adequate research.

I was thinking the very same thing. How could you close your eyes even if they offered a complementary PSG? Really?

Also be sure to check, the doctor may have doctored the notes of your visit that day to say he told you. I have seen this CYA with my own records. Just simple things like BP's, etc. that were not taken or things that were not said documented as being told to me.

ozij wrote:

JeffH wrote:
At the cpap pressure of 12 cm h20, all obstructive apneas were abolished, however, the patient began experiencing central apneas at 7 cm h20, numbers of which increased with increased cpap pressure. While a significant number of apneaic events remained at the cpap number of 12, no clinically significant oxygen desaturations were noted at this pressure. No clinically significant amount of central apnea was documented at the cpap pressure of 12. A retitration is recommended with Bi-level positive airway pressure (Bipap ST) to better manage both the central as well as the obstructive component of the patient's apneic events.

Jeff,
The things I colored just don't jell - I wonder if it was actually a proper supervisory intervention that kept you from getting this baseless interpretation. From 7 to 12 in half an hour? I mean, how absurd can they get? That ENT resident must have been a true idiot, assuming he could interpret anything based on 30 minutes of sleep with cpap (were those 30 consecutive minutes?). Do you know who signed your Rx, as opposed to who signed the interpretation? A repeat sleep study may have been necessary - but its also possible that someone decided you couldn't sleep in the lab, and they'd give you a cpap to see how it helps you.

O.

Good catch Ozij. That paragraph had been bothering me in more ways than one, though. Why would they recommend a Bipap ST to better manage central's if there were no clinincally significant central's at 12. ?? Sounds to me like they completely fudged your titration.

I think the crux of your argument should be that they gave you a prescription based on only 30 minutes of titration time. Do you remember what was going on the rest of the time?? (sorry maybe that was in your earlier posts).

[quote="JeffH I'm supposed to hear from them on Wednesday of next week. I really think I should get a free sleep study from this.
JeffH[/quote]

darn,Jeff; don't let them get away with this!
It's quite pitifull to see how something as important as this can slip between the cracks so easily.
You have all my support!
I think you should get more that a free study!
D.

sleepydoll wrote:[quote="JeffH I'm supposed to hear from them on Wednesday of next week. I really think I should get a free sleep study from this.
JeffH

darn,Jeff; don't let them get away with this!
It's quite pitifull to see how something as important as this can slip between the cracks so easily.
You have all my support!
I think you should get more that a free study!
D.[/quote]

I've talked to a lawyer and he told me medical malpractice cases are almost impossible to win. In 2006 there were 7 cases that went to trial in Oklahoma and the Doc's won 6 of them. Of course, that hasn't stopped the right wing nut cases we have for representatives in the State house and senate to stop hollering for "tort reform" every thirty seconds or so.

The report has seemed fishy to me too. BTW, the resident Doc wasn't in the sleep lab, just the one doing the original appointment and follow up.

Thanks for everyone's input. I waited a couple of days before I posted this...it seemed so bizarre that I kinda had to let it sink in first.

I saw that 30 mins of sleep as well and thought - how could they decided anything with that amount of sleep - let alone raising it from 7 to 12 in that period of time!!! I was waiting for more experienced forum members to reply.

A 2nd titration should have been ordered immediately, since that one was useless. To even suggest bipap titration with that situation is,to me, ridiculous.

You should certainly get a free titration as soon as possible. I hope you go to a different sleep centre for another titration. I would want to know who the tech was that came up with that, to be sure I didn't get him/her again, if that person is still doing sleep studies. On the other hand, maybe that person has learned something in 10 years time! I would wonder about the doctor as well.