BPAP Titration Sleep Study

[SarcasticDave94]

Uh wow. OK class can you repeat after me? Duck.

Not really sure what else to say, except hope you get good results somewhere in some way ASAP. But, I'm afraid the good results or help will not be coming from this current doctor. And I thought my prior duck was bad. Just don't do anything resembling a felony charge, OK?

[HalfAsleep]

Sometimes I just need the second, third, and fourth opinions from other posters. They add to my stock of empathy and keep my exasperation at a manageable level.

Who’d have thought I’d be taking issue with a well-regarded medical specialist about not being sufficiently evidence-based?

I bet the doc didn’t even look at my diagnostic study. That was the one where I slept on 2 beds.

[HalfAsleep]

While I ‘m asking questions of fellow posters....

What kind of numbers are normal on the number of awakenings on a sleep study? Arousals? How about stage shifts? What’s a stage shift anyway?

[Walla Walla]

Stage shifts are the different levels of sleep you go through. They have different names depending on who you talk to. REM is one level you probably know.

Every time you shift from one to another they count it as a stage shift. Think of it like shifting gears in a car. It's something they can track only in a sleep lab.

As far as a normal number I don't think there is any.

[HalfAsleep]

I guessed that’s what stage shifts meant, but how could a person have 114 in 6 hours? All you’d be doing is shifting.

By the time you throw on awakenings, arousals, apneas, RERA’s....

[HalfAsleep]

I guessed that’s what stage shifts meant, so you’re confirming my guess, but how could a person have 114 in 6 hours? All you’d be doing is shifting.

By the time you throw on awakenings, arousals, apneas, RERA’s....

[Sleeprider]

To your doctor, all apnea is obstructive and must be treated with pressure. Your central events are a figment of your imagination and do not count.

If your diagnostic and sleep test results were read objectively without regard to the fact one is untreated, while the other is treated, then the conclusion would be that there is no difference (or treatment). The AHI and event types are not impacted by CPAP/BPAP pressure alone. This will be true regardless of using fixed or auto pressure. If the event rate is high enough to require a therapy, and the proposed CPAP/BPAP is demonstrated to be ineffective, then logic dictates a different solution must be tried; e.g. BPAP with backup. Where is the disconnect here?

[Gideon]

Did I just hear the sound that ducks make here?

[SarcasticDave94]

Super NES Duck Hunt...OK and seriously HalfAsleep, wishing for success that you get other medical person via second opinion.

[HalfAsleep]

Oh, okay, SleepRider. I'm having a lightbulb moment.

Like this? Since I started with an AHI of 18, and after BiPAP titration I have an AHI of 18, that must mean my entire set of AHI is centrals. Because BiPAP (and CPAP) are treatments for obstructive apneas. No treatment effect=the wrong treatment is being used. Ergo, my events are likely all central, not obstructive.


My focus was more on how "they must have botched the titration procedure". Yours shifts to "the titration experiment failed because the wrong tool was selected [for the apneas you have]".

No doubt, both of those foci were true, but I can also now see that the failed titration actually provides important information....