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BPAP Titration Sleep Study
#1
I'm scheduled for a BPAP titration study. Is there any reason I can't titrate a BPAP myself, just the way I titrated the APAP? Or would I have to have an official sleep center sleep study? I'm on Medicare....

I may ultimately need an ASV, but don't want to waste any time in the BPAP phase. I meet with the sleep center this week, but don't have my sleep study for another 5 weeks. I want to know what to ask for.

I have written to the doc spelling out my more salient issues. I asked if they could titrate the ASV and the BPAP at the same sleep study.


1. This was an, ahem, "good night". My mask tossed itself, ahem, off, though I did sleep more hours without. Evidently, I had trouble breathing altogether, even though there were few "events." I evidently tried to catch my breath before the mask took itself off: there are a few big spikes. My pressure rarely goes all the way to 15 like that.

The one quick big leak is a deliberate mask off.

My AHI has never otherwise been this low.

[Image: wmQzKK9l.png]


2. This was a "bad night" (usually my AHI is 7-9 or so), including one event at 68 seconds. Not atypical.

[Image: 6g62Kj0l.png]

I breathe shallow (around 11, -11 most of the night; this is usual for me).

I'm not sure the distinction between OA's and CA's is entirely accurate in my case. I think the OA's are over-diagnosed and the CA's under.

The longer I sleep, the higher the AHI. This is typical.
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#2
Just stopped by to say, "Hiya!" and to wish you luck on your journey.

...also, Holy Cow! on the 2nd chart. Bug-eyed
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#3
Likewise, wishing you best of luck in your deliberations.

Will be thinking of you..........and keeping my fingers crossed.

Only thing I can add is (despite not understanding how the Medicare system works) is there a way of persisting politely with querying whether you can do the BIPAP and ASV study when at the study.

From my own experience here in the UK (of course it is different system) if the study is long (like mine was as I had to sleep at 9pm being exhausted from poor sleep of yonks before) they have more than enough time to titrate for both I would have thought. Is there a chance of bringing some sleepyhead history with you to persuade for a double titration?

Unless they are hard hearted cows, I have found that people in the health industry are generally kind, understanding individuals who will try to help as much as they can.

Anyway, bestest to you.......
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#4
Your chart would be a pretty rainbow if it wasn't your health involved. Hope you can talk them into doing the ASV also.
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#5
Even when you're not having many events, like around 2:30-3:30 in that first chart, your respiratory flow rate fluctuates wildly. There may not be scored events there, but that is not good breathing or good rest. We pretty much called ASV from early-on with you, and I hope you can get it sooner than later. We have talked in some detail about what we see in your respiratory flow, particularly a persistent flow limitation that is unresponsive to CPAP pressure, and very very long apneas. The AHI does not do the time in apena justice with you. Keep pushing for a multi-mode titration that evaluates BPAP and ASV. Something needs to be done to stabilize the breathing, and simply resolving AHI does not cut it when an apnea can last over a minute with you. A successful titration must address flow limit!

Have you ever done SpO2 monitoring?
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#6
The "Contec CMS50F Wrist-worn Pulse Oximeter with Software and Download Cable" is available through Amazon from the manufacturer, with fulfillment by Amazon for <$90 and free 2-day shipping if you have prime (I signed up for a trial just to get this item).

It is compatible with SleepyHead.
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#7
As far as I recall, APAP and BPAP should be easy enough to self-titrate if you're given the opportunity to do so. And as for splitting a PSG (sleep study) into 2 levels of machine, why not. It was done for me, although splitting from CPAP to BPAP instead in my case. So again, why not? Never hurts to ask, unless when you ask they throw stuff at you.

Dave
lots-o-coffee 
Dave

Even a 1,000 mile trip requires a first step. My recommended first steps are getting good shoes and 2 cups o coffee

Wiki Info for Beginners
Sleepyhead Chart Organization
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#8
Josephdfco was titrated on BPAP and ST, and I know ASV can be done as a duel titration. The main criteria is to have a qualified technician available for the test, and an appropriate order for the test from the doctor. For someone sensitive to pressure support, BPAP is often failed due to centrals, at which point ASV is tried.
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#9
If you want Medicare to pay for your machine, then yes, you have to have a lab titration. You would have to check with your doc to find out if Medicare allows titration of the 2 machines the same night (I doubt it, but no harm in asking).
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#10
Thanks

You all are reinforcing my concept of trying to get BPAP and ASV titrated at the same time.... I'm going to focus my next sleep center meeting on this. I've already written to the doc requesting it a couple of weeks ago.

They want to do split APAP and BPAP. But I don't think there's any possibility that the APAP will work. They're not going to be able to raise the pressure and still have me exhale (I mostly hover under the current pressure max anyway), and lowering it makes no sense. It seems like a APAP titration will be a total waste of time. Even if they could raise the pressure (by having me use a BPAP), there's no sign that my events disappear with more pressure: as it is, I don't max out the settings.

Weehee! I seem to be understanding how this all works (no worries, though, I could get another steep learning curve any moment).


------------

I can't figure out how I can have extremely high flow limit, very shallow breathing ≤10, and no events (e.g. Chart #1 above, at the end of the night). I can't imagine that I have any significant  O2/CO2 coming and going.

Duh, you are probably right, Kiwii et al.: I should get an oxygen meter.

The thing is: every time I do a puff test (for lung efficiency/capacity), I score A+, and the pulmonology tech chews out my doctor for sending me for a puff test. And, every time they measure my 02 sat with the finger thingy at the hospital, I score 99-100%.  So, there's no sign that I have an oxygen issue. Does anyone have any idea if I could have a significant oxygen issue that might not show up on these 2 tests? My sleeping brain is not signaling correctly? A heart problem? Other?

My (non sleep) doc is even having me use an asthma inhaler for 30 days to see if that reduces the flow limit (creative, huh?), but it doesn't.

Explanatory aside: the puff test is not because I show signs of having a lung issue, illness, asthma or much of anything: I have another condition that could destroy my lungs (but so far, I rarely even get RTI's), and baseline info has to be on file.

------------

Yes, Sleeprider, this seems to have been taking forever. It's only actually been 2 1/2 months since I started (seriously!), and I've had major family issues to attend to as well. There's certainly nothing that the sleep center could parry me with at this point, though, so maybe the time has been well spent, versus "more haste, less speed": no leaks to speak of (yippee, after what I went through in Month #1), great compliance, lovely capable informed patient....And those several weeks have made me much more confident in my understanding of how this all works. Thanks for reinforcing the presentation points: I will look up my screenshots of your earlier input so I can refresh my memory.
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