BPAP Titration Sleep Study

[Sleeprider]

Ajack, it might be the case, but most titrations show the time at trial and breakdown the events. I really have no idea what is going on here, but if HalfAsleep can get a bilevel or auto bilevel, at least we would have more to work with for the flow limits. The problem is, none of this squares with earlier titration findings of predominantly central events.

[HalfAsleep]

The conclusions written on the sleep study (the above assessment was actually the whole contents of a note from the doc in the sleep center portal) were even more rudimentary:



Incidentally, there was no evidentiary basis for the recommended pressure. It wasn't tested.

[ajack]

Ajack, it might be the case, but most titrations show the time at trial and breakdown the events. I really have no ideal what is going on here, but if  HalfAsleep can get a bilevel or auto bilevel, at lease we would have more to work with for the flow limits.  The problem is, non of this squares with earlier titration findings of predominately central events.

Agreed that it's not that detailed a report, when they go on the pressure, they normally have the times and sleep state separate, this seems to be all lumped together. They didn't even have the o2 levels, just that they were all between 90-99%. As you know, The doctor is only going to go from the study. Going by the study, it doesn't need a back up rate. So an ASV or ST is off the table.

The vauto would be better than S. The doctor should be able to justify this to the insurance. 

If I was HalfAsleep I would set the autoset using min12 epr3 max15 The results could be used to show the doctor, if they aren't good. HalfAsleep want's to press the issue, if the sleepyhead charts are still poor. Perhaps if he orders a resmed o2 sensor for a week, to get detailed data?

All of these CA must be without an o2 drop of >3% That could be another reason the autoset is flagging clear airway, but the study didn't count them as central apnea.
https://i.imgur.com/6g62Kj0l.png

[Sleeprider]

Good analysis ajack, and yet this study offers no insight on the incredible flow limitation shown in that chart. At least with bilevel there is some chance that can be dealt with, but we still have the centrals. I just think it's a terrible study with very little information from which to draw conclusions.

At least the skiing nearby is very good. Waterville, Loon, Bretton, Wildcat. Ragged.

[HalfAsleep]

Am I missing something? as far as I can see the apnea resolved when they went from 10/6 to 12/6 and then they reduced the PS back to 4 and finished on 12/8

Before you get carried away.....the truth is more incompetent IMO.... but you can check my logic

The titration sleep study AHI was around 18 correct? I spent the night at that number, correct? Events averagely distributed? That must mean the titration was leveled at 18? I couldn't have spent half the night at 0......

And......

The starting titration was 12/8. Ending titration per the Doc's evaluation was 11/7.

See how there's no REM or non-REM for the first two trials?

The reason there's an AHI of 0 there is because I couldn't exhale and had to immediately ask to lower the bottom number. I did this twice. While I was awake.

So she evidently did the 3rd pressure during the first non-REM cycle, switched to the 4th for the rest of that cycle and into REM, and then went for a smoke for 3 1/2 hours.

Yes, the AHI result was 18.

[HalfAsleep]

If I was HalfAsleep I would set the autoset using min12 epr3 max15 The results could be used to show the doctor, if they aren't good. HalfAsleep want's to press the issue, if the sleepyhead charts are still poor. Perhaps if he orders a resmed o2 sensor for a week, to get detailed data?

Ajack..... although my settings are 8/15 with EPR of 3, most of the night, per SleepyHead, I'm settled in to same as your recommended 12/15 epr3. That's just the way it works out. I float around between 13 and 15 ipap quite steadily most of the night.

I can't exhale at 9 when I first go to sleep. And ramp climbs relentlessly; I need the auto.

Will it make a difference if I go 12/15 epr 3 instead of easing up to it the way I do now?

[ajack]

They count nothing while you are awake. The awake brain wave cancels everything, you could hold your breath for 2 minutes and it wouldn't be counted. The awake desaturation could be explained by the trouble you are describing. You body is more compliant to the pressure, when you are asleep.

The way I read the study and final assessment is your AHI on "12/8 was 0.0" There were "scattered transitional central apnea. There was no significant central apnea."
You are getting a bit of CA falling asleep, with a bit of awake desat. The rest is OK. When you are asleep, all your "asleep O2 levels are 90-99%".

why don't you put your autoset on min12 epr3 max15 to nearly duplicate the recommended pressure and see what happens? At least you will have something to show the doctor if you want to dispute the study.

[HalfAsleep]

I found another piece of chart. (There are a few additional pieces). I'm thinking this might be what SleepRider has on his wishlist:



Exactly as I thought. Zero AHI for first 2 pressure settings: I was awake and requested them. 20 minutes at Pressure #3. The rest of the night at Pressure #4. Yep. She got more sleep than I did.

[HalfAsleep]

The way I read the study and final assessment is your AHI on "12/8 was 0.0" There were "scattered transitional central apnea. There was no significant central apnea."
You are getting a bit of CA falling asleep, with a bit of awake desat. The rest is OK. When you are asleep, all your "asleep O2 levels are 90-99%".

I was awake for the first two settings and requested the 3rd. I was NOT asleep. 12/8 was the starting pressure, not the ending pressure.

Nothing was counted during the first two settings because I was awake. =0 AHI.

I added another chart, just above. It's easier to tell.

[ajack]

Ok, normally they start low and work up, but now it's making more sense. You did have the times after all. Do you have any other bits? it's probably better to post the lot of it.

I don't see the point of having you on 11/7 for 4:47 hours without a change and then say "reasonably good control of obstructive". Then suggest 12/8 without testing it. I think you are right, she didn't do a thing with you while you were asleep. There may be grounds to ask for a retest.
Your AHI during that time was H:14, CA:2.9 OA:0.8 total AHI 17.7
does everyone else get that? I wouldn't call that under 5