Thank you for that information. I do have a copy of the report, but it seems like there are a lot more blank fields on it than filled-filled out ones...
(04-12-2015 11:27 PM)vsheline Wrote: CPAP "was titrated" up to 13cm, right?
Correct. Typo, oops!
(04-12-2015 11:27 PM)vsheline Wrote: Does the data portion of the report indicate what was meant by "25/10cm"? (Please note: For your husband's own personal medical records, he has a right to receive copies of the complete reports, including the data, of both the diagnostic sleep study report and the titration report.)
Does the titration record show that IPAP (or Max IPAP) was set to 25 cmH2O, and Pressure Support (or Max Pressure Support) was set to 10 cmH2O?
What was the breakdown of central apnea versus obstructive apnea, at the final titrated pressures?
Here's what I have in the report--
Cover sheet: In addition to the quotes I provided originally from the cover sheet, there is a section on the cover page that says (and forgive any mis-spellings -- I'm looking a copy of a faxed report):
"Procedure: Polysomnography was conducted. The following were monitored, Central and occipital EEG, Electrooculogram, submentals, EMG, nasal and oral airflow, thoratic wall motion, anterior tibialis, EMG and electrocardiogram. Arterial oxygen saturation was monitored with the pulse oximeter. The tracing was scored using 30 second epochs. Whenever indicated CPAP or BIPAP was titrated. Oxygen was used when desaturation existed despite CPAP or PIPAP use."
Sleep Staging Data
Sleep Onset Latency (min): 0.0
REM Latency (min): 45.5
Latency to Stage N1: 6.0
Latency to Stage N2: 0.0
Latency to Stage N3: 14.0
Latency Wake: 349.0
# Cycle N1: 23
# Cycles N2: 35
# Cycles N3: 11
# Cycles REM: 7
# Cycles NREM: 69
# Cycles W: 4 or *... can't read it
Then there's a table with Time/Normal Values TST, TIB over Stage N1, Stage N2, Stage N3, REM, Wake.
Then there's a tracing.
Next page has 4 charts with TST, Bruxlamo, Crisis, CAP, RBD, RMD, but all have all zeros.
Next page has Cardiac Data (let me know if this would be relevant to post)
Next: Periodic Limb Movement & Snoring Data
Next: "Body Position Data" -- and I take this all with a grain of salt because there are rows for data for Supine, Left, Prone, Right and Standing, and all have zeros in all columns except for Standing which lists 395.5 minutes of Standing data... broken down as follows:
REM Duration (min): 83.0
NREM Duration (min): 292.5
# Apnea C/O/M: 0/12/0
Index Apnea C/O/M: 0/0/0
Index total Apnea: 1.9
# Hypo: 29
Index Hypo: 4.5
Index RERA: 0
# Snore: 0
Lastly there's a page with tracings for DSAT, Position, Arousal, Apneas, PAP and REM. The tracing for PAP show:
starting lines at 20 and 8 (maybe 7?). Top line increases to 25 after a few hours, bottom line increases to 8 after an hour or so and then to 9 when the top line switches to 20 and then a little notch higher for the last hour or so.
(04-12-2015 11:27 PM)vsheline Wrote: If the pressure is too high, or if the Pressure Support is too high, these can cause central apneas to increase. But on the other hand, the pressures were presumably needed to control the obstructive apneas and hypopneas, and, usually, central apneas which are created by CPAP therapy gradually settle down and go away during the first few weeks of therapy, as the nervous system gradually becomes accustomed to CPAP therapy.
Good to know.
(04-12-2015 11:27 PM)vsheline Wrote: 1. I suggest confirming with your doctor (or whoever provided your husband's prescription) that appropriate ranges for EPAP and IPAP would be:
Max IPAP: 25 cm H2O. (This seems to be what the sleep report is recommending, but actually this is very high, the highest possible value supported by the PRS1 BiPAP Auto. Although it is not unusual to set the Max IPAP this high, if your husband experiences a painful amount of air swallowing "aerophagia" you may need to lower the Max IPAP, at least temporarily.)
Min EPAP: 8 cm H2O. (This seems to be what the sleep report is recommending.)
Max EPAP: 15 cm H2O. The sleep report does not seem to be recommending a value for this. Some machines do not have this setting and the EPAP simply ranges as high as it needs to go, as long as EPAP + PS does not exceed Max IPAP. For machines which have a Max EPAP setting, Max EPAP is set somewhere between (Max IPAP minus Max PS) = (25-10) = 15 as an example lowest possible value, to (Max IPAP minus Min PS) = (25-4) = 21 as an example highest possible value.
2. The ResMed bi-level Auto machine can only use a fixed (manually-adjusted) value for Pressure Support, but a very nice feature of the PRS1 BiPAP Auto is that we can give PS a range, and the machine will automatically adjust itself to use only as much PS as your husband needs to avoid Flow Limitation.
I suggest confirming with your doctor (or whoever provided your husband's prescription) that an appropriate range for Pressure Support would be:
Min PS: 4
Max PS: 10
That is excellent information. The sleep study doctor didn't actually provide a "prescription", just the report. Our Primary Care Physician wrote the prescription based on the report. However, our PCP seemed to think from the report that the settings would be IPAP 25, EPAP 8. If we need a range, I'm not sure who would be better to get the info from -- the sleep doctor with the semi-flakey report (and who moved right at the time of the study, and took 3 weeks to produce the report in the first place) or the PCP who isn't an expert on these things.
At this point, I am unsure which machine would be better for us: the ResMed or the PRS1 BiPAP Auto... Based on our exeriences with the sleep study Dr (and report) and the DME's I'd like a machine that is the most DIY or self-adjusting because I don't trust the local providers to be of much support. Any advise to help us decide?
Thank you for all the info. It is very helpful.