BPAP Titration Sleep Study

[ajack]

as to sleep stages, it may take a bit of reading to get your head around it
https://www.ncbi.nlm.nih.gov/books/NBK19956/
Sleep architecture refers to the basic structural organization of normal sleep. There are two types of sleep, non-rapid eye-movement (NREM) sleep and rapid eye-movement (REM) sleep. NREM sleep is divided into stages 1, 2, 3, and 4, representing a continuum of relative depth.

[Sleeprider]

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....

Exactly!
And when you properly use words like "foci", it's time to use the word "epiphany" in place of "light bulb moment". 

[HalfAsleep]

I am known to overuse the word epiphany when it comes to my singular brainwaves....  



And is that Bengali in your sidebar, SleepRider?

[HalfAsleep]

Thanks for that article, Ajack. I still can't wrap my head around having 114 stage shifts in 5 hours. The sleep study said I had 2 full cycles, so the stage shifts must be arousals to a different level of sleep and then settling down again?

[MitchS]

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....

Exactly!
And when you properly use words like "foci", it's time to use the word "epiphany" in place of "light bulb moment". 

I am known to overuse the word epiphany when it comes to my singular brainwaves....  



And is that Bengali in your sidebar, SleepRider?

Oh, Jeez! Not only is he teaching her to sound like him, she's getting his twisted sense of humor! I'll bet she didn't even have to look up "foci".  

I've been following this thread with great interest and admire your determination to get the right treatment for your apnea. Good luck in your endeavor.

[SarcasticDave94]

we're doomed...

[Walla Walla]

A 4 letter word that starts with F. Nope I'll never use it. I know my spelling and luck. I'd be booted off for good.

[HalfAsleep]

No. I did not have to look up foci.   Even though my brain is addled from a dearth of slumber.  

I brought verbal baggage with me to the forum. Just not the deep throat kind. Alas.   

I've always wanted to use those graphic emotive icons...



Update soon...

[Sleeprider]

It's been fascinating to work with HalfAsleep. Her medical team is so blinded by the procedures that work on most people, that they think it is working for her.  A titration is an experiment that compares the results of different pressures against each other, and in this case against the diagnostic study which is the "control".  If a change does not occur from the control, then that fulfills the null hypothesis.  In this case the doctors are so fixated on finding the "best" pressure, they completely miss the failure of CPAP or BPAP to exert a positive change from the control.  Not only do they miss it, but they acknowledge the titration failed to find a "completely" effective pressure and go on to recommend a higher pressure that was not tried in titration.  

A doctor has enough science and laboratory study to fully understand the scientific method, and this is a fundamental violation of those principles.  The diagnosis and titration studies are almost as pure an example of the scientific method as you can find in medicine, and it is incredibly simple.  The titration protocol is a logical series of experiments, observations an decisions.  Where the doctor goes wrong is rather than making objective observations of the events, she dismisses them as transient sleep disturbances.  If that error does not occur, then in the presence of central events, the titration protocol requires evaluation of BPAP with backup rate.  What is really phenomenal is that the titration result is identical to the diagnostic control, and this team concludes they have found a solution!

What should have happened in this BPAP titration:


 
Centrals persisted but were dismissed as insignificant, and the study was terminated with the decision to use an ineffective pressure. The patient has demonstrated a failure to achieve efficacy with CPAP, and this test demonstrated no treatment with BPAP. With central apnea present and no effective correction using bilevel, the correct next two steps must follow:

[SarcasticDave94]

It is intriguing to have a doctor either proclaim treated or failed when the very numbers on the report they "should" be basing that decision on must have been ignored or dismissed. Examples of this as in HalfAsleep's numbers or like my own where the highest AHI numbers were deemed treated successfully.

Truly frustrating for each patient that deals with Ducks.

Um charts are hard to read so I'll guess (spins wheel or throws dart)...