[Diagnosis] New Here - sleep study and titration done

[8TheGreat]

Hi everyone!  So glad I found this community, it looks like there is a TON of great information and some very helpful people. 

I have been having sleep issues for the past 5ish years and finally decided to see a sleep doctor.  I had a sleep study with them on December 20th and then I had a titration on January 31st.

After my sleep study I had an appointment with my doctor who went in depth on how I was a great candidate for CPAP based on my 78.9 AHI and other metrics.  He also mentioned it may be helpful to use a BiPAP based on the severity of my apnea.

I received a copy of the sleep study and titration reports - was hoping that I could get some assistance in interpreting it.  I've got another appointment to discuss the titration report and I'm assuming the product of this will be his Rx, so I want to go into this with some knowledge on what would be best especially given how expensive these machines are. Both reports are attached.

I will say that coming out of the titration, I felt very fatigued in my lungs like I was really working hard to breath that night. I felt like I was suffocating at the lower pressures (specifically exhaling) but felt fine at the uppers.

Thank you for your time - it's greatly appreciated!

[Gideon]

Welcome to the forum,

Your Results:
First, your Apnea is about 75% obstructive and 25% central present, the Centrals disappeared with higher pressures, that's good.  

Which machine? IMHO if the doctor is willing to provide a BiLevel, go for it, it is more flexible than the AutoSet (which is an excellent machine) most doctors would give you.
ResMed AirCurve 10 VAuto, a BiLevel, would be my first choice.  There are a few settings beyond what you get that we may or may not recommend depending on how your treatment goes, but the main benefit is the increased pressure support (the difference between inhale pressure and exhale pressure) that is greater than the 3 cm you can get with ResMed's EPR which is available on the AutoSet's.

With regard to pressures, I feel terrible at anything under 10cm and also do better at higher pressures.

Also, your diagnostic showed 17 minutes below 90% O2.  Note that the low value means only to look harder, it is the cumulative duration of time at low Oxygen levels that is an issue.  Without CPAP, of which any flavor will improve your sats, you are in this category.  I suggest that you get a recording oximeter so you can check your O2 levels overnight, or daytime for that matter.  While I don't believe this will be an issue once you are on CPAP/APAP/BiLevel it never hurts to be sure.  Thus I suggest you purchase a recording Pulse-oximeter that is compatible with OSCAR, just to be sure.

[pholynyk]

I can give you some reasons for the bi-level recommendation that Gideon gave. It may help convince your doctor. When I look at your first study, I see many hypopneas - they are two thirds of your AHI. And when I look at the titration results, I see that increasing pressure with IPAP equal to EPAP doesn't reduce them.
In my experience with a Resmed AutoSense, if I have the same pressure on inhale and exhale, my hypopneas spike, so I apply the maximum Exhale Pressure Relief -which is 3 - to reduce my exhale pressure, or to put it another way, increase my inhale pressure. My hypopneas go down remarkably. The bi-level Resmed VAuto does the same thing, but with a greater differential range and finer control.
I don't know what a bi-level titration would cost, but a VAuto is probably cheaper - depending on insurance, of course.

[8TheGreat]

Thanks for the replies guys. I had my appointment and the doctor said from what he saw in the sleep study and titration that he didn't think a bipap was necessary. That being said, I was able to get an AirSense 10 Autoset in pretty short order (should be here tomorrow evening). Given that the doctor recommended a pressure of 12cm, what would be the best starting place for the autoset settings along with EPR?

[Gideon]

Mode: Auto
Min=8
Max=15 (shouldn't matter)
EPR=1,fulltime, gently get into it because of your centrals

[8TheGreat]

Mode: Auto
Min=8
Max=15 (shouldn't matter)
EPR=1,fulltime, gently get into it because of your centrals

Okay, so I just got done with my 3rd night using the AS10.  The first night was pretty good, but last night and the night before were kinda brutal.  I ended up taking off my mask in the middle of the night (for what reason I honestly dont remember, I'm going to make a concerted effort to NOT do this).  The second night I did up my min pressure from 8 to 9, but then put it back to 8 last ngiht. My AHI is going up each night.  Any thoughts on some modifications to the settings or anything else?

[Geer1]

Your centrals on titration study were present until EPAP of 10 cm. On autoset machine EPAP = Pressure - EPR.

I would try min pressure of 11 cm with 1 EPR to see if you can replicate titration study findings.