Doctor ordered a CPAP sleep study

[melody]

I finally saw the doctor, 9 months after starting CPAP. As expected, he didn't intend to look at any data other than my AHI.  I showed him my Oscar data - disturbed breathing patterns, palatal prolapse. Interestingly, he doesn't trust the data coming from the machine and said that even though it looks like palatal prolapse, we don't know that for sure. He made it clear that anything under 5 AHI is not a concern for my health but ordered a sleep study where he said I will wear a CPAP and  a human will manually monitor and adjust my pressure throughout the night.

Anyone else have this type of sleep study? Was it helpful? If my doctor is only concerned about AHI over 5, and I already achieve that every night with CPAP, am I wasting my time and money? My flow rate chart and flow limit show what I feel - my sleep quality is not good. But I don't know if I'm wasting my time with this doctor.

Would love to hear about other's experiences. Thanks!

[Nightynite]

Melody, did you do a home sleep study before. Or did you just go out and buy a cpap machine?

[melody]

I did a home sleep study.

[Nightynite]

Melody, I’m in the same boat as you. My solution and many others on this site is just to buy a Resmed Aircurve Vauto out of pocket. Buy used on CL or from Supplier #2.

[Sleeprider]

Melody, you posted a chart in your Palatal Prolapse thread last month. https://www.apneaboard.com/forums/Thread...l-prolapse I mentioned at that time you appear to have significant flow limitation and what may be palatal prolapse, or at least a fast termination of expiratory flow. Your AHI was just over 1 per hour. The solution to your inspiratory flow limit problem is probably a bilevel machine like the Aircurve 10 Vauto. Your doctor is correct that diagnosis of palatal prolapse using Oscar data is at best tenuous. We can recognize the expiratory flow patter associated with PP in your results, but I can also find the same pattern in my own results. I don't suspect I have PP, so have concluded this pattern may reflect other causes. As described in this article, the diagnosis of PP generally required sedated endoscopy by an ENT specialist. https://sites.google.com/view/palatal-prolapse/ I do think your inspiratory flow limitation with a 95% value of 0.16 is potentially disruptive to sleep and would improve with bilevel. Your chart also showed a RERA index of 0.82, which is probably and under-count as the machine is not very good at detecting RERA.

Your doctor has ordered an attended clinical titration study for CPAP and I don't think that will be beneficial. Standard protocol for a titration study is to identify a CPAP pressure that minimizes apnea, hypopnea and sometimes arousals and sometimes that enables REM sleep. The study would be more valuable if the order included evaluation of bilevel pressure to minimize respiratory event related arousal. If that can be added to the order, it would be worth doing. As you have described it, your doctor expects a routine finding that CPAP pressure is effective, and will find the best available pressure that meets the test criteria for an hour. I know that you have focused on the PP aspect in your Oscar charts, but I am more concerned with the persistent inspiratory flow limitation, and think that it would be more productive to focus on that first and ask if your doctor can amend his request so that the test objective is to minimize arousals, maximize sleep integrity and include evaluation of bilevel pressure. If the doctor is unwilling to do that, then I would not take a test that would likely find your current therapy effective. Alternatively, if you believe PP is your problem, you need a study specific to that diagnosis. Instead of a CPAP titration, you would need referral to an otolaryngologist for evaluation of palatal prolapse.

[melody]

Sleeprider, thank you so much for the thoughtful reply and taking the time to review my previous post. I wish my doctor was so thoughtful. I think you are right not to focus on the PP. I've actually been seeing less of this pattern lately. Wish I had not done that so much at the visit. I will message the doctor and see if he will adjust the order. If he won't, I will look for another doctor instead.

[melody]

Sleeprider, I got a new mask and pillow and even though I have a much higher leak rate, my flow limit numbers have come down quite a bit. Over the last few nights the 95/99 values have been .1/.29, .06/.15, .07/.21, .08/.20.  Are these numbers anything to be concerned about or is this considered normal? I still am having trouble getting enough sleep (due mostly to waking up early and not being able to stay asleep) but my numbers have improved and my AHI has been between .4 and 1 most nights.

I called the sleep lab, since I do not have a copy of the actual order, and they said the doctor wrote on there "may need bipap" so they said the technician will likely do both a cpap and bipap titration. I messaged my doctor but he did not respond. 

I've attached the last couple of night's data for feedback.

         

[Sleeprider]

Those flow limits are a significant improvement over what we saw before. I think you can improve it a bit more by changing EPR from 2 to 3. We are getting closer to a solution and I feel a CPAP titration would be a waste of time and money at this point.

[melody]

Thanks for the quick reply. I did try EPR 3 for a couple of nights recently and didn't like it. The numbers don't look very different. But I didn't take any notes so I don't remember why exactly. I can try it for a few more nights and see how it goes.

[Sleeprider]

No problem. Noted.