pressure plateau

[milboltnut]

I just posted a screenshot with a posted green line with the time line..... next to the purple CA flag. Trying to time it, but the time line is a bit to read. I only had one OA.... I should keep the pressure where it is.

Forum user-tip: You don't need to quote a whole post, just what's needed, or if what you are replying to is obvious nothing. You can even just say which member you are replying to. We do this because some members are visually impaired and use readers. The complex and long quotes make their life difficult.

Will do. copy and pasting into the quote box takes awhile. i used to color code my answers in reply in prior post quote.

Now that I can read the flow chart correctly, do you fellas think i still need to have titration study?

I don't know what happen last night.... but, I hope it stays this way !

First one is last night the second is my first night in APAP

[Sleeprider]

All of the above CA events look to be actual CA with diminishing resp volume before and gradually increasing after. .Your results on 5/21 look like what we're after. As far as a titration study, it is unlikely to reveal very much you can't figure out for yourself. Your CA events seem to be diminishing and are not at a level where insurance is likely to approve ASV. Most of the hypopnea, RERA and FL being flagged is related to flow limitation that would improve with some pressure support your machine does not provide.

You have to look at a titration study from the technician's point of view and with perspectives you probably have since reading the Resmed Titration Study Protocol. All titration studies will observe your sleep, events and oxygen saturation while testing CPAP pressure, and if needed bilevel pressure. The technician titrates CPAP pressure upward only when events are observed, and only moves to bilevel when CPAP is failed. The decision tree i the protocols are simple to follow and you can apply it to your CPAP therapy. In your last chart there is less than one event per hour and you probably would have titrated to a fixed pressure of 10.0. If you had a night like that March 23 mess, then the tech would be busy and might have trouble finding an effective pressure. Comparing those charts shows the benefits of increasing miimum pressure and other adjustments you have made, as well as simply becomig more adapted to the therapy. A titration test is nothing more than a trial of pressure and responding (or not) to the result. There is no problem solving and very little analysis.

[milboltnut]

In your last chart there is less than one event per hour and you probably would have titrated to a fixed pressure of 10.0. 

So there is a good possibility I haven't tirated yet at 8.5. I was at 8 minimum pressure for quite awhile. Last night I bumped up to 8.5. If I only had one CA, that would effect titration?

As far as a titration study, it is unlikely to reveal very much you can't figure out for yourself. Your CA events seem to be diminishing and are not at a level where insurance is likely to approve ASV.

you won't approve ASV titration study..... I want to call my Dr... and ask if I might hold off or cancel study. I still have to the 1st of June until they call me to schedule.

In your last chart there is less than one event per hour and you probably would have titrated to a fixed pressure of 10.0. 

I see that.. although my pressure spike more like 12 for a period.... it pretty much flattened, other than the occasional spike. I attached the full cart here.

Was wondering if I could talk my Dr, into possibly upgrading to a Res med APAP with EPR.. or maybe your suggestion?

[SarcasticDave94]

A ResMed APAP may serve better. Justifying the change may need to be the inconsistently good charts and you'd need to include complaints that sleep is not good.

Just for clarification, as I understand it, titration is simply adjusting pressure settings after events call for an adjustment, viewing the results and via trial and error, doing said adjusting and review several times to get events to a minimum. Nothing extra. No chemical analysis or any anything.

Titration: See OSCAR (data) events, adjust pressure, repeat these see and adjust actions until events are at best ratio of lowest event to comfort. Then stop titration. This does not need a lab unless the events you are dealing with cannot show in OSCAR for you to titrate it yourself.

One problem is that your good nights are random, mixed in with lots of bad nights with various event flags. A second is do no overcomplicate things. The Bible mentions straining at gnats and swallowing camels. Do not make little things too big or too complicated. Finally, fix what you can and leave the rest.

I'd suggest 2 things. Practice on how to focus on: 1) the complaints needed to 2) change to ResMed APAP.
To clarify: complaints on all things wrong with sleep that any CPAP should help reduce. Second is change to ResMed.

[Gideon]

I'll add that we do recommend a lab study to justify a machine, IF, and only if, that machine will treat you better. Example, we OFTEN stress to get a lab titration for an ASV because we KNOW that the titration will demonstrate successful treatment for Central Apnea (and Obstructive events) thus justifying getting the ASV Prescription and machine.

[milboltnut]

got a call this morning from the sleep center to schedule an appointment.... I'll go with the Dr. knowing he is monitoring my progress. And as you guys said, the inconsistency, Dave is the issue and how I feel most days, and Fred for a different machine the study is necessary for prescription.

Good stuff thank You again.

P.S. Appointment is June 10th..

[SarcasticDave94]

On my birthday, how nice. Have a good appointment and some free cake.

[milboltnut]

IF I don't need ASV after the study what machine would be a good choice Res Med wise? I'm sold on EPR.

[SarcasticDave94]

If single pressure is good then I'd go with ResMed APAP with EPR, limited to 3 cmH2O, equal to PS drop. If a BPAP is needed, go with the VAuto that has PS.

We will deal with pressure settings when you get the script on a new device. Ramp is only for comfort, and in most needs to be a short duration as the machine cannot respond to events on the ramp. You may get a pressure setting of 5-20 or something like that. We'd need to see results, but depending on machine, 6 is a good minimum for most. On the high end, it depends a lot on what the machine tells us your 95% is during use.

[milboltnut]

Now that I have a more fuller understanding of CA's... what about OA's.