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Dr says I have to have new sleep study to change titration
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clrapstad Offline

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Machine: Resmed AirSense 10 AutoSet for Her
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Post: #1
Dr says I have to have new sleep study to change titration
This is horse pucky. I had an overnight pulse ox with my cpap and I had 10 events where my oxygen dropped 3% or more. and I was dropping to 79%. Spent 33% of the night below 90% oxygen.

The doctors office says in order to change the pressures I have to have another titration study done in the lab. I know I can change the pressures myself and in fact had jumped it one prior to the overnight pulse ox.

Oh-jeez

I am not sure how to proceed.

Cindy lots-o-coffee
03-09-2015 01:14 PM
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JWR Offline

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Post: #2
RE: Dr says I have to have new sleep study to change titration
(03-09-2015 01:14 PM)clrapstad Wrote:  This is horse pucky. I had an overnight pulse ox with my cpap and I had 10 events where my oxygen dropped 3% or more. and I was dropping to 79%. Spent 33% of the night below 90% oxygen.

The doctors office says in order to change the pressures I have to have another titration study done in the lab. I know I can change the pressures myself and in fact had jumped it one prior to the overnight pulse ox.

Oh-jeez

I am not sure how to proceed.









According to your profile you are running a auto machine, why not set the max pressure up and let it find you. Your setting is 6 - 8 cm why not set it at 6 - 10 and check your numbers with sleepy head in a week and go from there.

03-09-2015 01:27 PM
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justMongo Offline

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Post: #3
RE: Dr says I have to have new sleep study to change titration
Sort of defeats the purpose of having an Auto machine to need a sleep study to change pressure range.
My opinion is that some docs are just doing CYA when they say that.
OTOH -- the doc may be considering adding supplemental O2 tot he CPAP flow.
When was you last study? recent?

6-8 is not a wide range, nor very high pressure.

For me -- I would find another, more enlightened, doctor.
You have to make a decision you are comfortable with.
You are your best advocate for your healthcare.

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.
03-09-2015 01:34 PM
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AshSF Offline

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Post: #4
RE: Dr says I have to have new sleep study to change titration
(03-09-2015 01:14 PM)clrapstad Wrote:  This is horse pucky. I had an overnight pulse ox with my cpap and I had 10 events where my oxygen dropped 3% or more. and I was dropping to 79%. Spent 33% of the night below 90% oxygen.

The doctors office says in order to change the pressures I have to have another titration study done in the lab. I know I can change the pressures myself and in fact had jumped it one prior to the overnight pulse ox.

Oh-jeez

I am not sure how to proceed.

Why don't you post your sleepyhead chart from this night. This may provide some clues on what should be the next step. Since you have a pulse ox, you can titrate your pressure at home and evaluate the result on pulse ox. You can also integrate the pulse ox reading in your sleepyhead charts and watch both cpap and pulse ox data concurrently.

This will also help to answer if you do need an in-lab titrations (to evaluate if you need supplemental o2 or BiPap).

Started APAP 4-20, Closed range to 7.5-14, then straight 8.0 w/ Aflex 3
RDI always below 1. But sleep much much better at straight pressure.
Started on F10, Tried Quattro Air successfully. Finally settled on P10.
03-09-2015 01:42 PM
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eseedhouse Offline

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Post: #5
RE: Dr says I have to have new sleep study to change titration
If you can present some Sleepyhead graphs to your doctor showing how a new pressure level improves things he might be more supportive. Perhaps the principal to apply here is that it is easier to get forgiveness than permission.

Ed Seedhouse
VA7SDH

I am neither a Doctor, nor any other kind of medical professional.

Actually you know, it is what it isn't.
03-09-2015 01:48 PM
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retired_guy Offline

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Post: #6
RE: Dr says I have to have new sleep study to change titration
It would be nice to see your actual results. But with such a tight range I'm not sure they would be all that meaningful. If it was my cute little body I would set the range to 6 min, 12 max and see what happens. Download/install the Sleepyhead software so you can check the results after you make the changes. It does sound like your doc is one click above the docs that prescribe an Auto machine, then insist on dummy'ing it down to a regular cpap without any particular consideration as to how well that might work for the patient.
03-09-2015 02:09 PM
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clrapstad Offline

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Post: #7
RE: Dr says I have to have new sleep study to change titration
(03-09-2015 01:42 PM)AshSF Wrote:  
(03-09-2015 01:14 PM)clrapstad Wrote:  This is horse pucky. I had an overnight pulse ox with my cpap and I had 10 events where my oxygen dropped 3% or more. and I was dropping to 79%. Spent 33% of the night below 90% oxygen.

The doctors office says in order to change the pressures I have to have another titration study done in the lab. I know I can change the pressures myself and in fact had jumped it one prior to the overnight pulse ox.

Oh-jeez

I am not sure how to proceed.

Why don't you post your sleepyhead chart from this night. This may provide some clues on what should be the next step. Since you have a pulse ox, you can titrate your pressure at home and evaluate the result on pulse ox. You can also integrate the pulse ox reading in your sleepyhead charts and watch both cpap and pulse ox data concurrently.

This will also help to answer if you do need an in-lab titrations (to evaluate if you need supplemental o2 or BiPap).


The pulse ox meter was the clinics. I think I am going to purchase one. Anyone have one that works with their Resmed Air Sense 10 for her machine to sync results?

Cindy lots-o-coffee
(This post was last modified: 03-09-2015 02:43 PM by clrapstad.)
03-09-2015 02:42 PM
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OMyMyOHellYes Offline

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Post: #8
RE: Dr says I have to have new sleep study to change titration
(03-09-2015 01:27 PM)JWR Wrote:  According to your profile you are running a auto machine, why not set the max pressure up and let it find you. Your setting is 6 - 8 cm why not set it at 6 - 10 and check your numbers with sleepy head in a week and go from there.

Heck, set it at 6-20 and let it do its thang!

OMM
03-09-2015 03:44 PM
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clrapstad Offline

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Machine: Resmed AirSense 10 AutoSet for Her
Mask Type: Full face mask
Mask Make & Model: AirFit F10 AirFit P10
Humidifier: attached with ClimateLine Hose
CPAP Pressure: 7-12 (Dr thinks 6-8)
CPAP Software: ResScan SleepyHead Other Software

Other Comments: Cough Variant Asthma - using CMS-50F Recording Wrist Oximeter

Sex: Female
Location:

Post: #9
RE: Dr says I have to have new sleep study to change titration
Wasn't brave enough to open is all the way up but I bumped it to 6-12 and found it was wanting to run at 12. My AHI were higher than the night before but I tend to ping all over the place anyway.
Didn't have time to look at the data in sleepyhead and am still figuring that all out.
I am really thinking with my funky asthma issues I should have it opened up more so it can respond if it needs to.
I wonder if it is picking up my asthma breaths as snores as my husband says he doesn't hear me snoring and the machine is picking up I am.

My lung function while awake is not the best so laying down is making it worse.

Cindy lots-o-coffee
03-10-2015 09:38 AM
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surferdude2 Online

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Post: #10
RE: Dr says I have to have new sleep study to change titration
What you did sounds good. It may even be wanting to run higher than 12! Leave it alone for a week and see if you can spot a trend developing. That is to say, see if it points you to a higher pressure or lower one. If no trend, give it another week. Eventually you will clearly see what the pressure needs to be by how the machine is responding to breathing limitations. Then you can accurately adjust for effect. Any sudden increase in pressure can take time to be tolerated. This process may take you several weeks. Jumping from a max of 8 cm to 12 cm in itself can cause temporary sleep disturbance so you may need to back off and come up more gradually.

FYI, I have the Contec pulse oximeter model CMS 50D+ and it works well with the Sleepyhead software.

After doing all that, if you still have issues, then it's time to go back to the doctor armed with the data you have accumulated by your efforts and let him prescribe a course of action.

Best regards, Dude
03-10-2015 10:05 AM
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