Bad Sleep study experience

[Ron AKA]

My understanding is that a sleep study and a titration of a PAP device are two separate undertakings. The first is done with instruments to detect breathing and apnea incidents, but as well when they happen, on your back or side, and at the same time what your oxygen levels are. It should result in a detailed report of these readings including a breakdown of the ratios of the various apnea events in an UNTREATED STATE. In other words when you are getting no assistance from a PAP device. A titration study on the other hand is to determine what pressure levels you need to treat the apena you are having. I have never had one, and for basic apnea issues treated with an AutoPAP they may be unnecessary.

You probably know all of this, but there is one key subtle issue. That is the ratio of apnea events in the untreated condition. Your own APAP cannot really do that, as it is treating you as it is recording events. My understanding is that consideration of using a Adaptive Servo Ventilator (ASV) is when the UNTREATED (sleep study) central apnea events exceed 50% of the total apnea events. So I am thinking that the doctor has sent you back for a sleep study to determine what your untreated apnea looks like to determine if you are a candidate for ASV. If there is titration it would be to see how well it can be treated. In other words this technician really can't mess up the sleep study with her bias views. It will be what it is and the doctor should be able to make a good decision about treatment. 

I have a bit of a concern about this issue as the ResMed S9 that I tried for a night reports an incidence of 1.5 CA events compared to a total AHI of 2.87. The ratio of CA events is 52%. At first blush one could think I may be a candidate for ASV. However, I do not think so. When I look back at my home sleep study results I had total of 3 CA events out of a total of 268 events. This is a CA frequency of 1.1%. This would suggest I am not remotely close to justifying the use of a ASV device.

[SarcasticDave94]

FWIW: my BPAP sleep study or titration, whichever is to be appropriately applied, showed a central count if 124 (IIRC) to 24 obstructive. The very nice Sleeprider pointed out that I may have a need of an ASV instead of BPAP. Eventually he was proven right. Optimizing the DreamStation BiPAP failed in under one month. No optimizing was going to help me. All a FWIW...

[KCFLY]

Ron,

You are  correct in all of that.

My insurance wanted a BiPAP titration study to see about going to BiPAP to solve the centrals as that is their normal progression (CPAP --> BiPAP --> ASV).  They were satisfied with the original split study I had and did not request an additional sleep study.

My doc requested they titrate the BiPAP and the ASV the same night to capture that data while I was there as he suspected the ASV is where I needed to be and did not think the bipap would be adequate to control my apnea.

[SarcasticDave94]

Makes sense. I had to have 1 sleep study and 3 titration nights to go from CPAP to BPAP to ASV. Insurance required me to have 3 distinct steps.

[KCFLY]

I may still get stuck having to try BiPap and then doing anther study for ASV, this was just my docs attempt to try and get the data for that next study now if possible.

Insurance is never as easy as it should be.

[Hojo]

I may still get stuck having to try BiPap and then doing anther study for ASV, this was just my docs attempt to try and get the data for that next study now if possible.  

Insurance is never as easy as it should be.

I hate to say it but, welcome to the club; Sleep Study, then CPAP Study, then BiPAP Study, then ASV Study, now on ASV.

[ardenum]

I've went from over 60 OA's to 30 CA's when on cpap. But my CA's resolved when i switched to bipap. Cpap was 18 with EPR 3, Bipap now is 17/12. Had trouble exhaling and aerophagia.

 I do feel somewhat like im on a Ventilator. What I noticed though is that when I feel a difference between exchaling and inhaling I sleep like a baby. But my problem lies in the fact that I have a larynx dysfunction and i get laryngospasms. Those obstructive that I had at the very beginning were 50% laryngospasms. After I had UPPP and Septum/turbinate surgery 30 OA's went away. I do have a tongue relaxing/jaw falling onto the chin issue but fortunately a different kind of a mouthpiece solves that(tongue retaining device). Can't really remove the tongue now, can you.

So much trouble, so many years. I wish there was an easy way out of this, but the idea of constant pneumonia risk, just doesnt make it any better. Otherwise I'd want a tracheotomy and have it over with.