[CPAP] Newbie ready for guru input

[Sleeprider]

Not the detailed report yet. I'm working on getting my report. Similar story as others post, pulmonary doc doesn't think I need the report on me. I'm trying the primary care request method and asking same primary care to supply a copy of their copy, assuming it is a full detailed report. Otherwise, pulmonary doc will have to get me one. I will show it here when I do.

Dave, the reason to have a full report is for your permanent records, or if you need a second opinion.  I can't tell you how many members have needed these files 10 years or more after the test, and they are no longer available.  This sometimes means new tests, costs etc.  It's not really your doctor's decision whether you "need" the results, it is a matter of legal obligation under HIPAA.  See section 3. https://www.privacyrights.org/consumer-g...nts-rights

Don't you just hate being patronized by a doctor? It's a prevailing attitude some of them have, and I prefer to avoid that in favor of those that can engage in a meaningful dialogue and information exchange.

[SarcasticDave94]

I agree with you. I'll be getting my report ASAP. Since this is my report, I'm entitled to have a full copy, which I will get. Second opinion doctor may be sooner rather than later for me. I've not heard one peep yet on the results about this test except I'm on BiPAP & get the machine from the DME. They did ask if I had a preferred DME.

Dave's on the warpath now! Take cover and be aware of fallout debris. No damage to apnea board folks ever intended nor implied. Later.

[Marillion]

[SarcasticDave94]

 Alrighty then. I've got my sleep study report! The big "we have to get the Dr. to authorize..." from them, Me: "Well, no offense, but legally it's my report, I'm requesting a copy. So, when can I stop in to pick that up? ... Tomorrow before 4 PM is fine by me." Ironically, then they don't need an ID to get the report. 

So disappointed, it's not in color. What is needed from this report then? Standard protocol is...?

[Sleeprider]

Let's start with the summary of results...hours of sleep, latency, events, AHI, recommendations. Copies in jpg or png format with names and personal details redacted. Post results from both diagnostic and titration study if available, especially results at alternate pressures.

[SarcasticDave94]

OK copy. Will have info available later this eve. Got church service in a few. Later & thanks in advance.

BTW mine are hard paper copies FWIW.

[SarcasticDave94]

OK here we are with the info:








That's all there was on the study.

[Sleeprider]

That explains a lot. Thanks for posting the study. Although the conclusion of your study is severe obstructive apnea, your diagnostic study before PAP shows predominately central apnea, but enough OA that this would lead to a likely diagnosis of complex or mixed apnea in the severe range. Central events were more numerous and longer in duration than obstructive, with an event actually going more than 1-1/2 minutes. Bet you couldn't hold your breath that long if your were awake! Your BiPAP titration did reduce OA and helped significantly with your sleep architecture and some of the effects of apnea such as snoring; however, the report concedes you continue to have CA. The CA "improved" with final pressure but was not resolved.

A glance at the charts on page 4 shows that at the beginning of the night you had predominately OA events. You seemed to do pretty good at CPAP pressure of 11/11 for about 15 minutes during N2 sleep. They moved you to 16/12 bipap during a wake period that transitioned to N2 sleep. They then dropped pressure to 10/6 and you immediately had abundant CA, which transitioned to OA and back to CA as bipap pressure increased. A 15 minute period at 14/9 just after 1:00 had no apnea, but you were recorded as awake. Pressure increased to 15/10 then 19/14 with a brief drop-out of events. It appears that this period may be the basis of your titrated BiPAP pressure.

My impression is that you are headed for ASV (hopefully soon). This titration shows you were not successfully treated at any of the pressures attempted, and no trial lasted longer than 15 minutes. Your BiPAP titration is the best compromise found, with none being in a range that would be considered effective. Your results since the titration demonstrate that you will not succeed at bilevel without a backup to treat centrals, and your treated complex apnea remains in the high moderate to severe range. The titration study tells me, that there is not an effective pressure range any of us can recommend to you that will result in an acceptable AHI for any long-term.

I'm sorry to say, there is nothing I can suggest to improve your results other than you need to be sure your doctor is aware that you continue to have severe mixed sleep apnea, with many central and obstructive events, and for you to push to obtain ASV at the earliest possible time.

Tom

[SarcasticDave94]

Thank you on that. Maybe this shows my lack of understanding, but if my results were yours, how would you describe to the doc what the issue is and that ASV is required? I am following you in what you posted regardless of the question above, just asking for clarity. BTW great timing on your analysis: I'm seeing primary care doc this afternoon. I may be pushing for 2nd opinion pulmonary doc.

Is this right? I have many CA events along with some OA. I fall into a mixed apnea diagnosis. This requires an ASV to remedy. BiPAP won't work to remedy.

I'll be suggesting ResMed 10 Aircurve in ASV by the way.

Side note: not to complicate matters, will my early COPD diagnosis have any impact on machine choice? When I say early COPD, I'm having stage 1 and beginning of stage 2 complications. I can elaborate later as required. Mainly, it shows up as difficulty breathing always as of now.

[SarcasticDave94]

Another question, this may be for others that had to get an ASV also, would this explain why I actually feel worse on BiPAP than without it?