Titration Issues

[hart1026]

    So, called the Sleep Center and they stated that the summary is all they can provide. I had for all the graphics and readings, but to no avail.  I have attached the 2-3 minute screen shots around some of the hypoapneas as requested. Please let me know what else I can do. Thanks.

[Gideon]

Play hippa on them. You have a right to your medical records

[hart1026]

Well I can check on that. Hopefully everything I provided can give some insight while I wait for that. Any thoughts on the graphs and prior reports? Thanks.

[Sleeprider]

Fred, the first 3 pages of 8-pages of attachments are a titration study and do not include the detailed event-at-pressure charts we prefer, but the 5 pages of diagnostic study shows obstructive sleep apnea. The titration study narrative indicates that at the titrated pressure of 7.0 there was 1-central and 2-"partial apnea" and they concluded 1.0 AHI. At 8-cm there were two centrals and 2 partial apnea for an AHI of 5. The diagonstic study shows OA events mainly in REM and clusters of hypopnea in all sleep stages, and abundant snoring. The CAI is very low. While the titration study was poorly presented, and the conclusion was that a good titration on CPAP happened.

We are not going to bleed anything more useful out of this poor titration study. This is therapy onset centrals and they missed it. I have to run (41st anniversary dinner), but let's carry on with what we have.

[Gideon]

I must have jumped too early, there were only 3 pages.

[hart1026]

Thanks Sleeprider and Bonjour! I hope both y'all can figure out how to help. It seems like I'm damned if I do (up in pressure) and damned if I don't (decrease in pressure). When I look at my daily readings from the ScanDisk, I'm high in CA or HypoApneas. The actual Obstructive events are always none or 1-2...lol.  Im not sure whether to use Flex, no flex....well you know.  Any and all suggestions are so welcome.

Happy Anniversary Sleeprider.

Thanks

[hart1026]

        Hi Guys...Just checking to see if we have any more thoughts on my issues.  I have attached two more readings from this week. I went ahead and upped the pressure to  9.0 Flex 2 and got these results. Looks like central and hypo's now lower, but whether that is by design or what, I don't know.  Better AHI though. Hope you can help

[Sleeprider]

These are pretty good results considering what your titration left you with. The obstructive components are the flow limitations, RERA and maybe the hypopnea. You almost have to look closely at the individual events to assess whether it is obstructive or central. Your higher pressure seems to have been beneficial, but keep in mind central apnea can be consistently inconsistent, so what works one night, may not be repeatable. if it is, this is pretty good. Something that can reduce centrals and is considerably less expensive than ASV therapy is Enhanced Expiratory Rebreathing Space (EERS). http://www.apneaboard.com/wiki/index.php...ace_(EERS) In your pre-CPAP days, you might have covered your nose or mouth with a pillow or breathed into your blanket. This is the same idea as EERS. You rebreathe a small volume of expired air, and the increased CO2 stimulates respiration. Read the wiki, and if you're interested we can pursue that further.