BPAP Titration Sleep Study

[kiwii]

The thing is: every time I do a puff test (for lung efficiency/capacity), I score A+, and the pulmonology tech chews out my doctor for sending me for a puff test. And, every time they measure my 02 sat with the finger thingy at the hospital, I score 99-100%.  So, there's no sign that I have an oxygen issue.

Erm... there's no sign that you have an oxygen issue while you are awake.

[Walla Walla]

To answer the O2 question. Yes you could have your O2 dropping down while you sleep due to apnea. Daytime testing won't show that. You have to be recorded during the night. Your Doctor can request an over night O2 test through your DME. Unlike a home oximeter they provide a portable recording oximeter that is accepted by insurance.

[HalfAsleep]

There wasn’t a significant O2 problem on my sleep study, but I think that sleep study was all kinds of messed up.

[trish6hundred]

Hi HalfAsleep,
I wish you good luck with getting your titrations for BPAP and ASV set up for one night.

[Spy Car]

I'd try to push for a split study (Bi-level/ASV) if it is possible.

My hunch is that the Bi-level is a waste of time (and $) and that you are going to need ASV.

Good luck jumping the hoops.

Bill

[HalfAsleep]

I'm really tired of hoops.....

However, much as my normal temptation is to rush this kind of thing along and get impatient, it's really helped me to go slower.

-I didn't have an easy start because of mask issues (for a whole month of hell). I did get my compliance obligation done, though.

-I tried maybe 5 masks and picked the least leaky one. It had to stay on and be comfortable when I slept. This took about 2 weeks, and I was still having big leaks.

-Then I realized I needed more confidence (now that I was an anxious sleepless wreck from the mask stuff) to deal with those leaks. I did an experiment using low pressure, getting the leaks under control for 2-3 days, and then moving up one pressure increment. I used SleepyHead to evaluate the leaks. It took about 2 weeks to get to my current (as prescribed) upper pressure. Those two weeks of being a tortoise and not a hare helped enormously, and I felt like a genius (a major goal of mine in the next life if not this one).

-In getting the leaks under excellent control, I was able to focus more exactly on my sleep breathing and understand it better. I had a lot more confidence.

-I do in fact feel more rested many days, but clearly my sleep breathing is a mess, and that's what I need to address now.

I am only at the 2 months and 3 weeks mark. Seriously. Seems like forever, though.

I am in a very strong position to argue my case at the sleep center, now that I've been through all of that.

Onward, HalfAsleep, to BPAP/ASV titration persuasion. Easy now, easy now....This isn't a race.....

[HalfAsleep]

Erm... there's no sign that you have an oxygen issue while you are awake.

   Duh..... 


I suppose it's possible I might actually have an oxygen/breathing problem when I'm awake, since the conditions of those kinds of vitals tests are hyper-alert-ful. Either I'm getting forced and coached to breathe and expel large volumes of air (the puff test; painful as heck, by the way), or I've raced into the doctor's office and my blood/heart/lungs are thumping right along (oximeter).

Those tests do tell me I have full oxygen capacity, but it's very possible I don't use it if I'm not focused on the breathing.

Guess it's sounding like I need an oximeter...

[kiwii]

Guess it's sounding like I need an oximeter...

Yup. Best of luck! I hope that you're able to get the go-ahead for the combo titration. You're doing really well advocating for yourself. I'm betting you'll succeed.

About leaks.. wasn't it you that recently mentioned that you'd had leaks with the P10? I meant to tell you, and forgot, that in trialing both the regular P10 and the For Her version, one of the small cushions turned out to be defective. I could not get that one cushion to stop leaking, no matter what I did. Since I had 2 Small cushions, I was able to say with certainty that it was only the defective one that was problematic.

You may want to take a look at your P10 cushion and see if the two stems are of equal length, and that the pillow parts are both pointing upwards.

The defective one had one stem slightly shorter than the other, and that pillow was pointing inward just a bit. I wouldn't have even noticed it, or anticipated such a small difference to be a problem, except that I was experimenting with all of the cushions and both sizes of headgear (and it probably wouldn't be a problem for some nostril shapes/orientation).

[HalfAsleep]

That's a thought, Kiwii.....2 minutes later: I checked my P10 current cushion with a brand new one in package. All seems to be well. My P10 only works one nostril at a time. Evidently, I have a kink in my nose, so one of the nozzles just shoots air into a sidewall. I've tried all 3 sizes of cushions. Same problem.

I also had a problem with it sliding all around.

I should have given up on the P10 way sooner. Since I had no idea what to expect, I hung in there thinking I could get it right. What a waste of 30 nights' sleep.

I now only use the P10 for naps or getting a breath of fresh air.

[HalfAsleep]

Why me? I tell ya, I get sleep appointments from hell.

Yeppers, the Sleep Center "doesn't do sleep quality". They go by AHI. For sleep quality, I would be referred for cognitive behavioral therapy.

Do you see me pulling out my hair?

 The loco is them not me.

Plus, they took my AHI record via download from my machine. I pointed out that the AHI was under-presented since I used a mask (actually a different one) while napping, reading, trying to fall asleep, hitting the snooze button, making tea....and all the time spent in those activities is getting averaged in. Undeterred, she put the machine AHI in my chart.

She chided me for using SleepyHead. "Too much detail.We don't use that here."

She proceeded to tell me that EPR is not exhale relief but it does make exhale easier.

 The loco is them not me.

Then, she decided to make the APAP work. She called the DME to change the settings (never mind that I could do it myself) to 10-16.  If that doesn't work, she's going to do a single pressure at 13. I already told her I couldn't exhale at 15 (EPR 3) or 8 (at sleep onset with EPR 3).

So, forget trying to get a split study that's BPAP/ASV. I couldn't even begin with this person.

I did, however, get the wretched APAP/BPAP sleep study scheduled for tomorrow.

Then, I guess I have to look for a new sleep center. But there's probably not another one for 100 miles.

Sympathy needed.....