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AASM Guidelines for Titration
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zonk Offline

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Post: #11
RE: AASM Guidelines for Titration
(11-12-2013 02:22 AM)me50 Wrote:  I also noticed on some of the centrals that my pressure did not go up so that bothers me. Any thoughts or suggestions that I can tell the new doctor?


I just changed my EPR to 2 but not sure that will help at all.
I've noticed too, the autoset does not respond to central apnea (only detect)
as you,re experimenting with EPR, if you don't need it, turn it off and see if any changes ... you can always turn it back on
11-12-2013 02:53 AM
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archangle Offline
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Post: #12
RE: AASM Guidelines for Titration
Zoom in on those centrals. The numbers seem to indicate they're short duration. If you look at them, you may find they aren't even complete apneas, just reduction in airflow rates. They may not be worth worrying about.

Get the free SleepyHead software here.
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Click here for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
11-12-2013 03:12 AM
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archangle Offline
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Post: #13
RE: AASM Guidelines for Titration
What's your AHI? From those graphs you look like you're cured.

What happens if you turn your minimum and maximum pressure down a bit?

Looks like you had 3.5 minutes of sleep at 15 cmH2O and they made a judgment based on that?

And you had 55 minutes of sleep with 1 hypopnea at 13? Why the heck didn't they stay at 13? Unless it's a REM problem.

Why haven't they tried lower fixed pressures? You've got a fully data capable machine.

Get the free SleepyHead software here.
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Click here for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
11-12-2013 03:29 AM
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me50 Offline

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Post: #14
RE: AASM Guidelines for Titration
(11-12-2013 03:29 AM)archangle Wrote:  What's your AHI? From those graphs you look like you're cured.

What happens if you turn your minimum and maximum pressure down a bit?

Looks like you had 3.5 minutes of sleep at 15 cmH2O and they made a judgment based on that?

And you had 55 minutes of sleep with 1 hypopnea at 13? Why the heck didn't they stay at 13? Unless it's a REM problem.

Why haven't they tried lower fixed pressures? You've got a fully data capable machine.

I tried to get answers from the sleep doctor but he did not give me answers. I tried to talk with the technicians and they did not give me answers. As a matter of fact, they refused to give me the times that the technician changed my pressure settings and told me that I had their best technician that didn't even bother to put the belts on me during the sleep study. I am not sure what the belts record but I didn't have them on me.

why they didn't stay at 13 I don't know. Maybe it was because if my apnea was at 1 the insurance company wouldn't pay for a machine because? I do know that on the 10th, I had 3 centrals that my machine does not treat and that is scary. During the sleep study, the higher the pressure, the lower my O2. At 15 and 16 O2 was 85 and at 14 O2 was 88. When I was at the lower pressures (12 to 20) I was at the max capability of the machine. I think I would do better on BIPAP but what do I know? I watch the detailed data and I showed the detailed reports to the doctor and he said "Well, we don't know how they get that data" and I said but the data is all we have to go on and it is better than no data.

Feeling frustrated and mad b/c I don't have answers and I don't think my apnea is being treated properly.
11-12-2013 04:01 AM
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DeepBreathing Offline
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Post: #15
RE: AASM Guidelines for Titration
me50, I've been following this and some other threads of yours and really feel your frustration. I've never had a titration study, and I am a CPAP newby, but I do wonder how useful they really are. Your sleep changes from night to night and from time to time during the night. Just trying different pressures for 5 or 10 minutes hardly seems to be a sensible way to go.

My experience (in Australia) is that a machine is provided with pressures set up on a "best guess" basis based on the polysomnogram. You use it for a full week then go back and discuss with the therapist. Pressures are adjusted again. The clinic I went to offers four weekly consultations and hire of the machine for $360, half of which is refunded by Medibank. In my case it took about 7 weeks (and a change from APAP to VPAP) to get it right, but there was no additional charge. I have a lot more confidence in this mode of delivery.

In answer to your question about the belts - they are used to detect / confirm centrals. If you're having an OA there will be no airflow but your chest and diaphragm will be working hard to get you breathing again. With a central, the chest and diaphragm are relaxed and not trying to breathe. Your machine can detect centrals indirectly by sending little puffs of pressure down the tube and measuring the back-pressure (like an echo). From what my doctor told me that's reasonably effective but not as accurate as using the belts. So it may be that they were relying on the machine used for your titration to discriminate between the OA and CA events.

Looking at the charts you posted (10 & 11 November) I only see a few centrals. I don't think there's enough there to worry unduly. It's a bit hard to see what's happening at 12:00 as they are right on the edge of the chart, but then there's no activity. Did you get up just after noon? The event at 0400 seems to be treated correctly, and then there are a couple at 0700. My guess is that all these events (except 0400) are happening during transition from sleep to wakefulness. My understanding is that centrals do occur during these periods, but they are nothing to worry about.

If I'm off-beam here I hope somebody will jump in to correct me. But it looks like your therapy is working well. I think the real problem is that your doctors aren't communicating with you. Health care is a partnership and you need to be an informed partner.

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11-12-2013 05:21 AM
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me50 Offline

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Post: #16
RE: AASM Guidelines for Titration
[quote='DeepBreathing' pid='49086' dateline='1384251699']
me50, I've been following this and some other threads of yours and really feel your frustration. I've never had a titration study, and I am a CPAP newby, but I do wonder how useful they really are. Your sleep changes from night to night and from time to time during the night. Just trying different pressures for 5 or 10 minutes hardly seems to be a sensible way to go.

[font=Arial][size=x-large]
I think they are beneficial in confirming apnea so people can get help but I don't think they are always able to get the right pressure in 8 hours. In the states, a person cannot be diagnosed with apnea without a sleep study to see that they meet the guidelines of bad enough apnea to be put on therapy and to determine what type of machine they need.

Looking at the charts you posted (10 & 11 November) I only see a few centrals. I don't think there's enough there to worry unduly. It's a bit hard to see what's happening at 12:00 as they are right on the edge of the chart, but then there's no activity. Did you get up just after noon? The event at 0400 seems to be treated correctly, and then there are a couple at 0700. My guess is that all these events (except 0400) are happening during transition from sleep to wakefulness. My understanding is that centrals do occur during these periods, but they are nothing to worry about.


Here is the info from the 9th as I think I took a nap that day and slept a little past noon.

[attachment=549]

Yes, the doctors don't listen to me. I have had this machine for 2 months and it is at its maximum capability. As we all know, it is not just the AHI under control, it is how we feel, how we sleep, are we sleepy and tired the next day, etc. etc. Because my pressure is high, I was supposed to be tested on a BILEVEL to see if it helped because currently, I don't feel as I should after being on CPAP for 3 years. Actually, I have never had quality sleep and continue to wake up quite often every night.

It wasn't like I was trying to tell the doctor what to do but, these machines are not cheap and generally cannot be replaced without documenting the need for that. If you look on the 10th I had at least one central around noon.
[attachment=550]

Thanks for looking at all of this. If my AHI's were low and I felt good some of the time and wasn't at the max capability of my machine, I wouldn't be as concerned. we all know that it is up to us to watch things (my sleep doc, as I posted before, told me that we don't know how the data is gathered from the machine....well, we don't know how it is gathered from a sleep study either and at least the machine shows data over a period of days and weeks and not just over a 3 hour sleep period!) lol he didn't like that even though I was diplomatic in saying that we can only rely on what we have and it has to be close to accurate!
(This post was last modified: 11-12-2013 08:01 AM by me50.)
11-12-2013 07:59 AM
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me50 Offline

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Post: #17
RE: AASM Guidelines for Titration
I went to another doctor today. Amazing that they got me in as this doctor only comes to my city once per month and he was there today.

He listened to what I had to say. He said that he didn't know if a BIPAP would be the answer BUT he said we won't know unless we do a sleep study with a BIPAP and he said he would start me at 12 and 6 and see what happens. He said that if nothing else, it would give us a information and where to look next if BIPAP wasn't the answer.

He also gave me 4 options and 3 of them required a sleep study as I am positive that an insurance company would not agree to either of them without a documented sleep study to show if it was needed. The 4th option which he and I both said no way jose and that was to medicate me at night so I would sleep all night.

So a light at the end of the tunnel!
11-12-2013 07:45 PM
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DeepBreathing Offline
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Post: #18
RE: AASM Guidelines for Titration
Congratulations! Let's hope this is a turning point for you.

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
11-13-2013 05:01 AM
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