Question on sleep titration study -- arousal index, uars

[dcg494]

Hi everybody, 

Here's a picture from my last sleep titration study. It seems they titrated using a fixed pressure cpap (i.e. no pressure relief). 

The doc said 8cm controls the events, but I'm not so sure, looking at the arousal index.

Also, does have an idea why the arousal index jumps from a low at 8cm to a high at 9cm pressure ? 

Thanks !!

   

[Gideon]

There are 2 things that make apneas significant, O2 Desats and arousals. Yours are bouncing around. To better interpret these please post your entire (redacted) sleep study. What I see as odd are desats increasing both ways from the 8 cmw that was chosen as EPAP for you. The last 3 readings you were in REM sleep for a good percentage of the time.

[DeepBreathing]

Hi dcg494. I personally don't believe titration studies for ordinary CPAP/APAP achieve anything except line the pockets of the doctor and clinics. Looking at your numbers the best AHI results were achieved at 5 cmH2O and the arousal index was reasonably good also at that pressure. The fact is that apneas, hypopneas and other arousals are not evenly distributed through the night - they come and go, sometimes in clusters, sometimes not. Your position in bed, stage of sleep and other factors can all affect your sleep quality. So can things like coughs and colds, sinus infections, external factors (noise etc) and a whole range of others.

A titration study is basically telling you "Just lie here in this strange bed in a strange room with 19 wires and tubes attached to your body and sleep 'normally'. Then we'll pump air into you for a couple of hours and on the basis of some sketchy results we'll give you the one magic pressure which will control your apnea forever". I don't buy it.

I assume from the appearance of this study that you have ordinary obstructive apnea. The absolute best way to treat this is to use an auto-tirating machine (eg Resmed AutoSet), start with a wide range then narrow down over a few weeks to get your optimum range. (Note I said 'range' and not a single fixed pressure). This is almost guaranteed to fix your apnea - a single pressure from a titration study is not.

<rant over>

[Sleeprider]

I actually suspect the opposite of what Deepbreathing does, your oxygen desaturations may qualify for supplemental oxygen at all pressures tested. It only takes five minutes through the night at less than 88 to qualify for oxygen supplement. This titration chart is very incomplete as we can't see tidal volume, minute vent, breaths per minute or other data critical to seeing why O2 is persistently low. As far as accepting an arousal index of nearly 17, that is an arousal every 3.5 minutes! This looks a lot like central apnea or hypoventilation, and my suspicion is that you need a bilevel, probably with backup to augment your breathing.

I'm onboard with Bonjour's suggestion you post more complete sleep study results. Your doctor has "cherry-picked" a result that may be acceptable during the test, but the 8-cm pressure is surrounded by very poor results. If this titration is implemented, you should obtain a recording oximeter to monitor your SpO2. They are very inexpensive and can quickly document if your treatment is falling short of expectations.

[Michaely6]

Any good recommendations for an oximeter that is compatible with sleepyhead and a Macbook pro?

[Sleeprider]

Any good recommendations for an oximeter that is compatible with sleepyhead and a Macbook pro?

Supplier #19 is very fair in pricing and offers full support. The CMS oximeters are compatible with Sleepyhead and will work with your Mac.  You can call the store for any questions or guidance, they are very good.  There are a lot of threads in the Software Support forum about troubleshooting the data import on the CMS oximeters.

[Michaely6]

Thank you sleeprider!

[Michaely6]

How accurate do you think the cms50F is or even oximeters in general? Also is low tidal volume of say below 400 for a 6ft 1" a good indication of oxygen desaturation?

[heropass]

Any good recommendations for an oximeter that is compatible with sleepyhead and a Macbook pro?

I have the CMS50I and am very happy with it.  The accuracy is very good and its data lines up well with my CPAP data easily in SleepyHead.

[Michaely6]

Any good recommendations for an oximeter that is compatible with sleepyhead and a Macbook pro?

I have the CMS50I and am very happy with it.  The accuracy is very good and its data lines up well with my CPAP data easily in SleepyHead.

Thanks I will look into that one!