New sleep study required???

My AHI has been increasing with my current mask and we finally found one that doesn't leak, is a Liberty so it's for mouth breathing (I have LOTS of sinus and allergy problems despite being on medicine for it and doing nightly sinus rinses) and fits perfectly well...the only problem is that my AHI has been increasing. Well let me rephrase that, it's actually been increasing a little bit before this mask now that I think about it. I've only been on CPAP for about 2 months, had my sleep study mid-May (5/11 to be exact) so I just can't imagine that all of the sudden my pressure would need to be increased. Did the lab tech make a mistake during my sleep study and put me on too low of a pressure??? Will a new sleep study be required to determine what pressure to put me at with my current mask (I certainly hope not because my insurance will not cover another one and I can't afford it on my own)? Or do you think they'll prescribe me an APAP or something like that? Everything is so up in the air. I'm supposed to take my smart card in tomorrow to my pulmonologist for them to download the data and then we'll go from there. I just thought I'd get the input of members who have been there done that. Thanks!!

~Heather

Frustrating to want to help, but not knowing what pressure you're supposedly at or what you were prescribed makes it hard to do so.

Your M Series Pro is fully data capable. If the doctor is worth his salt at all he will look over the ENTIRE downloaded data and will have a pretty good idea of what changes if any need to be made.

Julie wrote:Frustrating to want to help, but not knowing what pressure you're supposedly at or what you were prescribed makes it hard to do so.

I'm sorry, I probably should have mentioned that. I didn't even think about it. I'm prescribed a relatively low pressure at only 7 and I have moderate to severe apnea but the lab tech said that as soon as he went up to 8 I started mouth breathing so he kept it at 7. He seemed to be pretty knowledgeable but now I'm beginning to wonder! Thanks for the help!!

Slinky wrote:Your M Series Pro is fully data capable. If the doctor is worth his salt at all he will look over the ENTIRE downloaded data and will have a pretty good idea of what changes if any need to be made.

Good to here that! My doctor seems, so far, to be very good at what she does so here's to hoping she'll look over my info and know what changes to make based on that.

hjjsnell wrote: ........... I didn't even think about it. I'm prescribed a relatively low pressure at only 7 and I have moderate to severe apnea but the lab tech said that as soon as he went up to 8 I started mouth breathing so he kept it at 7. .......

Try this logic. Think about when you were being titrated and the tech had the pressure at 7. If you were having no events, a decent tech would have left it at 7 and continued to monitor you. Since this tech raised it to 8, I assume you were having events at a pressure of 7.

So now the tech raises it to 8 and you start mouthbreathing. What does the tech do next? The sorryass lowers it to 7 and lets you have events. The rest of the night is easy for the tech. He doesn't have to mess with fitting a full face mask on you. He can surf the internet and draw a good wage!

But all of that doesn't really matter. Even excellent technicians working in sleep labs have trouble titrating the correct pressure. You don't sleep in the strange sleep lab environment the same way you sleep at home and you are only there one night.

The thing to do now is to get the monitoring software and a card reader and self-titrate at home over several weeks.

Rooster wrote:... The thing to do now is to get the monitoring software and a card reader and self-titrate at home over several nights. ...

I tend to not disagree w/you, Rooster, EXCEPT - the self-titrating should be done GRADUALLY over several weeks rather than over several nights. One night's data does NOT the entire story tell. ONE CHANGE for ONE WEEK, then if needed ONE more change for ONE weeK, etc.

I've been wanting to get the software and reader just haven't had the money to do so and it's not covered by my insurance. I think it's definitely something I'm going to have to invest in now because I really do believe I wasn't set at a high enough pressure. Thanks for all the advice!!

Slinky wrote:

Rooster wrote:... The thing to do now is to get the monitoring software and a card reader and self-titrate at home over several nights. ...

I tend to not disagree w/you, Rooster, EXCEPT - the self-titrating should be done GRADUALLY over several weeks rather than over several nights. One night's data does NOT the entire story tell. ONE CHANGE for ONE WEEK, then if needed ONE more change for ONE weeK, etc.

So noted and my post corrected Dear Slinky.

It's an art. Every case is different and every individual has varying knowledge of what is going on with their therapy. Some will take weeks to find the sweet spot and some may do it in days.

hjjsnell wrote:I'm prescribed a relatively low pressure at only 7 and I have moderate to severe apnea

Actually, the amount of pressure it takes to keep the airway open doesn't correlate with the mildness or severity of a person's Obstructive Sleep Apnea. In other words, one person could have very mild sleep apnea and need a very high pressure like 18 or 19. Another could have very severe sleep apnea and need only 6 or 7 cm H2O pressure to keep the soft tissue inside the throat pushed aside. The pressure needed has to do with anatomy, not severity.

However, that said... the titration was a fiasco, imho. But I'm not a doctor or anything in the health care field. Just my opinion, based on this:

hjjsnell wrote:but the lab tech said that as soon as he went up to 8 I started mouth breathing so he kept it at 7. He seemed to be pretty knowledgeable but now I'm beginning to wonder!

You're right to "wonder", hjj !!

I agree with the good rooster that it was ridiculous for the tech to go backwards in the titration without trying to do something to stop the mouth breathing instead! Something as simple as a chin strap might have taken care of that. Or, as rooster said, a full face mask could have been brought in at that point.

I think it's inexcusable that the tech would simply go back to less pressure for the reason the tech cited -- mouth breathing! There were other things the tech could have tried instead of just giving up and ending up with an incomplete titration. Geeze.

Slinky wrote:One night's data does NOT the entire story tell.

True.

Slinky wrote:ONE CHANGE for ONE WEEK, then if needed ONE more change for ONE weeK, etc.

There are a lot of ways to go about self-titrating, with or without software or data from the machine. I have all the patience in the world when it comes to training animals. I don't have that much patience when it comes to home titrating.

Seriously, I do think that for most people it's not necessary to go quiiiite that slowly, especially when starting at a low pressure like 7 from a titration it sounds like the tech botched. Well, botched, imho, but that's all that is -- just my opinion. I'd go up one cm at a time, every couple or three days -- to as much as 10 or 11 cm.

Perhaps you could get your doctor to prescribe an autopap trial at home, hjj. If so, I'd want the minimum pressure set at 7. A range of 7 - 20.

In the meantime, I'd be asking the doctor to order a download of your current machine's data right away, with special instructions to the DME to send both you AND the doctor the "Full Report" from the download -- not just the "Summary" or "Trend" report. I'd want to look especially at the leak rate for several of the most recent individual nights.

Just thought I'd let y'all know that the nurse at the pulmonologist office said that she is going to request the dr put me on an autopap to try out to see what pressure I really need and then we'll go from there. No new study required thankfully!! I do think he botched it the more I think about it, the more I learn, and the more you all tell me about things. So I thank you all for my new found knowledge! Now let's see what the good ole' doc has to say when the nurse calls me back tomorrow to tell me. We shall see!!

~Heather

Good luck!!!

hjjsnell wrote:Just thought I'd let y'all know that the nurse at the pulmonologist office said that she is going to request the dr put me on an autopap to try out to see what pressure I really need and then we'll go from there...

Heather, ask if they'll also loan you a recording oximeter. That will allow them to correlate your oxygen levels and pulse rates with the events from the APAP.

hjjsnell wrote: Just thought I'd let y'all know that the nurse at the pulmonologist office said that she is going to request the dr put me on an autopap to try out to see what pressure I really need and then we'll go from there. No new study required thankfully!! .........~Heather

Heather,

Very good!

I think that is total confirmation of what is often preached here. These particular medical professionals are smart enough to know they can't get the pressure right in one night in the sleep lab and will have you self-titrate at home with a data-capable machine!

Make a post about how that goes. I am concerned that they will set your machine to a pressure range of 4 - 20 cm and this may be too wide to give good results.

Will that autopap be your own or just a loaner?

Regards,

The autopap will be a loaner from what she says and I think they'll go from the data in that to set my CPAP to the adjusted pressure. But I should be talking to her today though, so I'll check with her on whether it's a loaner or not.