Hopefully soon...

Krelvin · Post by **Krelvin** » Fri Jun 09, 2006 5:52 pm

Now I'm a bit peeved.... (you can remove the "bit" part)...

Called the Dr. again today to find out why they have not sent me the study results yet... They said they got it today (I know they got it a week ago).

Now they wanted me to fax over a release.... So I wait for the relase to be faxed over.... nothing. Call at 4pm (they are open until 5pm) and there answering system says they are now closed.

Grrrrrrrrr... You'd think this was a national security report.

So, I try something new... I called the sleep study lab.... I'm surprised to hear they can send me a copy of the report. They just need a simple release which I faxed to them 3 min's later.

I'm waiting for that now. Funny all of a sudden, the original Dr's office release shows up. I sent them both in.

Hopfully I will get something today.

Krelvin · Post by **Krelvin** » Fri Jun 09, 2006 7:04 pm

Got the report.... From the Dr's office. 12 pages. came with DME order with a suprise (to me anyway) and a referal to another Dr. (I think for possible surgery options).

The Suprise... a order for a Bi-Pap. Wasn't expecting that.

I've had no one go over the report with me yet so I'm not sure about some of the stuff. Some of it I understand.

Below is the Pre-Cpap test. The real suprise... No REM sleep at all or stage 3-4 either.

Code: Select all

Pre-CPAP Diagnostic Analysis

Start Time (lights off)     11:06:15
Stop Time (lights on)       03:01:14  (Funny I thought it was 2am)
Time in Bed                 234 mins
Total Sleep Time            129 mins
Sleep Effiecency            54.9%     Normal > 88%
Latency to sleep onset      3 mins    Normal < 20 mins
Latency to REM              None      Normal 90-120 mins
Wake Time (after sleep onset)
                            102 min   
Number of Stage Shifts      169
Number of Awakenings        56

Sleep stages
Stage 1                     85.0     65.9%
Stage 2                     44.0     34.1%
Stage 3 & 4                  0.0      0.0%
REM                          0.0      0.0%

Arousal:

Apnea + Hypopnea arousals:  197       91.6 /hr
Resiratory Effort-Related    43       20.0 /hr
Limb movement                 0        0.0 /hr
Spontaneous EEG arousals      1        0.5 /hr
Total                       241      112.1 /hr

Apnea Hypopnea Index (AHI) was 92.1/per hour and Resporiatory Distrubance
(RDI) was 112.1

Respiration
						 #    Min    Longest
Hypopneas:               55   16.6   24.3       25.6 /hr
Obstructed Apneas:      143   15.4   24.5       66.5 /hr
Central Apneas            0
Respiratory EffortRelated
Arousals (RERA's)        43                     20.0 /hr

Position

                     Min         AHI       REM min     Min. SaO2%
Supine               29          113.7     0.0         86.1
Lateral              85           87.7     0.0         85.6
Prone                15           64       0.0         85.1

REM                  0.0          0.0
Non-REM            129.0          92.1      ---        85.6

I had to "type" this in... so there might be typo here and there, but I think it is correct. Will do the After Cpap next.

Would really like to know what it means.

I think it is worse than I thought it would be.

Krelvin · Post by **Krelvin** » Fri Jun 09, 2006 7:19 pm

Here is the results after CPAP

Code: Select all

With-Cpap Diagnostic Analysis

Start Time (lights off)     03:01:14
Stop Time (lights on)       05:47:34 
Time in Bed                 166 mins
Total Sleep Time            126 mins
Sleep Effiecency            76.1%     Normal > 88%
Latency to sleep onset      4 mins    Normal < 20 mins
Latency to REM              77 mins   Normal 90-120 mins
Wake Time (after sleep onset)
                            35 min
Number of Stage Shifts      57
Number of Awakenings        15

Sleep stages
Stage 1                     26.0     20.3%
Stage 2                     64.0     50.6%
Stage 3 & 4                  2.5      2.0%
REM                         34.0      26.9%

Arousal:

Apnea + Hypopnea arousals:   60       28.5 /hr
Resiratory Effort-Related    14        6.6 /hr
Limb movement                 0        0.0 /hr
Spontaneous EEG arousals      1        0.5 /hr
Total                        75       35.6 /hr

PAP ANALYSIS

PAP MASK/SIZE:	    Respironics Comfort Full-Face /Medium
Accessories:        None
Humidification      Heated

CPAP was gratually increased from 7 cmH2O to 20 cmH2O in an attempt to
elminitate repiratory disturbances.  Therapy was tolerated well.

Large Chart of Treatment levels (can include later)

Cardiac Events

Pusle was 46.6 b.p.m to 76 b.p.m

Due to his sleep-disordered breathing, CPAP was applied and
titrated incrementally from 7cm to 20cm of H2O pressure.  BiPAP was
applied and titrated from 22/20cm to 28/20cm.  The best pressure
appeared to be in the BiPAP range of 27/20 to 28/20cm.

The patient avgeraged a decreased number of limb movements following CPAP.

The sleep architecuture revealed a severe decrese in sleep effieceny with 
increase in lighter stages of sleep and absense of both slow-wave and REM
sleep during the diagnosic portion of the study.  Following application
of CPAP, his sleep efficency improved and he experienced a significant recovery
of REM sleep.  This suggests exellent response to CPAP.

Krelvin · Post by **Krelvin** » Fri Jun 09, 2006 8:02 pm

Dr. ordered from a DME the following

Code: Select all

Type of Therapy:   Bi-Level
Pressure Level:    27 cm (IPAP) 20 (EPAP) Bi-Level
                   N/A LPM Oxygen
Mask:              Per Patient Comfort
Accessories:       None
Humifier:          Heated Required

No CPAP vs APAP issues for me apparently.

snoozie_suzy · Post by **snoozie_suzy** » Fri Jun 09, 2006 8:31 pm

Maybe you could ask for the Auto BiPap though? It works the same way the auto pap does but with the higher pressures that you need, plus exhalation relief. I don't own a Bi Pap but there are others here who have the Auto Bipap, and maybe you'd be able to track your data too with software.

Suzy

NightHawkeye · Post by **NightHawkeye** » Fri Jun 09, 2006 8:39 pm

While the BiPAP-auto is a good machine it's highest pressure is only 25 cm, not the 27 cm prescribed. It might not be a good match - kinda depends on the details of the titration. There aren't many machines that go that high, so the selection of machines will be limited.

Regards,
Bill

ozij · Post by **ozij** » Fri Jun 09, 2006 11:20 pm

I'm no sleep tech, doctor or anything like that.
I suggest you send all your results to "sleepydave" at http://www.apneasupport.org". Dave is a sleep tech, head of a lab, and knows what's what. Make sure you send him the chart of treatment levels too.

The reason I say this is that a pressure of 27 is very very high, and if it were me, I wouldn't want to consider this as a the final word based on a 2 3/4 titration, part of which was apparently done on CPAP and part on Bi-PAP.

Start Time (lights off) 03:01:14
Stop Time (lights on) 05:47:34

Again, I'm not a professional in this. It's the sampling time which doesn't make sense to me.

If it were me I'ld ask to try a home titration with either an automatic machine or an Automatic Bi-Pap. Now - this might be medically wrong, the doctor might think your apnea is so bad he doesn't want you doing any experiments - and I don't know you nor your condition. However, if I coud do it I would then record and monitor:
1. How I slept
2. How I felt
3. What the pressures were.

If it was bad after 2 nights, I'ld call the doc. Otherwise, I'ld give it two weeks.

That's me, a patient - do contact sleepydave

Good luck, and keep us posted.

O.

rested gal · Post by **rested gal** » Fri Jun 09, 2006 11:56 pm

Guest wrote:I am an RT that works for a DME and I am well aware of how you all feel about DME companies. I just have to let you know ....<snipped>

Thank you for your two posts back on page 1 of this thread, Guest. You're doing it right. Would that every DME employee felt the way you do and went about their job the way you do.

There have been several DME employees who have shown empathy for those of us on the "other side of the fence", and who really try to do their very best for their clients. If you decide to register, I think you'll receive a warm welcome. Hot sometimes; but warm, too.

I'm kinda' fond of the autopap ozij uses - the PB 420E. It's the one I use, too..by choice. Autopaps of the three major mfgr's are sitting right here in my house. (Crazy hobby, I know!) I could use whichever I choose. But if I were going to recommend an autopap to a new user, I'd say Respironics or ResMed, rather than my own little favorite.

rested gal · Post by **rested gal** » Sat Jun 10, 2006 2:15 am

Krelvin, ozij has given you excellent advice. Do go to the "Sleep Studies" forum of apneasupport.org. The following link will take you straight to that particular forum:

http://www.apneasupport.org/forum-4.html

Look for the topics that "sleepydave" participated in.

That's the man who can interpret your sleep study results and offer insight into whether it might be questionable as to whether you really, REALLY need a whopping IPAP pressure like 27.

I agree with snoozie_suzy that the Respironics BiPAP Auto with Bi-Flex would be the way I'd want to go if any doctor was planning on prescribing such an astronomical pressure for me.

I realize the BiPAP Auto doesn't go up to 27, as NightHawkeye pointed out, but that's still the machine I'd want to try FIRST. It may very well be that you do not actually need 27 at all, or 25 for that matter. Even if you do, it might be that the extremely high pressure is not needed except for very brief times during the night...so seldom that you could get more than adequate treatment even letting a few events go untreated "up there".

But mainly, I'd have the same concerns that ozij expressed, about how your titration was handled. May have been done perfectly, but.... I'd want sleepydave to take a look at it before I accepted that kind of pressure (27/20) as necessary.

Check out this thread in the sleep studies forum, and you'll see a very interesting discussion where a person was titrated to very high pressures:

Miss Rumphius's study:

http://www.apneasupport.org/viewtopic.php?t=2408

http://www.apneasupport.org/viewtopic.php?t=2739

http://www.apneasupport.org/viewtopic.php?t=2981

http://www.apneasupport.org/viewtopic.php?t=3701

Krelvin · Post by **Krelvin** » Sat Jun 10, 2006 6:42 am

I've have taken your advise and posted on the other forum.

Thanks.

ozij · Post by **ozij** » Sat Jun 10, 2006 11:14 pm

Krelvin wrote:I've have taken your advise and posted on the other forum.

Thanks.

Just remember to come back and tell us!

O.

Krelvin · Post by **Krelvin** » Sun Jun 11, 2006 1:17 pm

I posted the info on the other forum and sleepdave looked at it.

Basically, he says the study shows that I have a pretty severe OAS and that using a bi-pap most likely is the proper determination.

So we will see how it goes. I should have something this coming week.

rested gal · Post by **rested gal** » Sun Jun 11, 2006 2:29 pm

http://www.apneasupport.org/viewtopic.php?t=4772
"Sleep Study results a bit scary... "

Krelvin, I'd still push for the Respironics BiPAP Auto with Bi-Flex. It is first and foremost a bipap machine. Its maximum of 25 is close enough to the 27 they've prescribed for you to do the job, imho...especially since you prefer to lie on your side...apneas being less on your side than on your back.

If there are significant differences in the amount of pressure needed to let you breathe well, depending on what position you're in -- side (lateral), back (supine), tummy (prone) -- the auto-titrating feature in that particular bipap machine could make treatment much more comfortable for you.

There is no reason to try to lie on your back at home. You should sleep in whatever position you're most comfortable in at home. Of course, having a mask on your face can make it tougher to get comfortable on your side or tummy, but if you can get the mask situated off the pillow in a way that lets you side or tummy sleep, that's perfectly ok. You don't have to sleep on your back (unless you want to) to get good cpap treatment.

The only reason sleep techs encourage you to lie on your back (and rightly so) during a sleep study and during a titration, is to get data from the worse case position scenario...patient on his/her back. That's when apneas are most apt to happen, and especially so if on your back AND in REM. So they want to titrate to take care of that kind of situation. Whether they achieved that kind of titration for you in the short time they worked on it that night...well.

I'd ask for at least a trial at home on the Respironics BiPAP Auto with Bi-Flex.

Krelvin · Post by **Krelvin** » Sun Jun 11, 2006 9:25 pm

rested gal wrote:http://www.apneasupport.org/viewtopic.php?t=4772
"Sleep Study results a bit scary... "
I'd ask for at least a trial at home on the Respironics BiPAP Auto with Bi-Flex.

I have no Idea what options if any that I have. I guess when I get contacted by the DME I will be able to ask some questions.

If it is a matter of the Insurance only covering so much, and I'd have to cover the rest, that would not be an issue. I can afford to pay, if needed.

I will keep that model handy when they call. Hopefully tomorrow....

Krelvin · Post by **Krelvin** » Mon Jun 12, 2006 4:33 pm

I was able to confirm that the DME order was placed. I contacted them, and was told I would have something within a week. The person I chatted with didn't know if they had anything in stock (nor what they stocked), or how much of an issue the Insurance company would be etc.... I.e. No opportunity to see what type of machine is being offerred or any way to modify what that might be.

I did notice on the forms I got that the order was actually set by the sleep clinic, not the Dr. The Dr. only approved what they had already written down.

The DME is Apria.
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