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My Sleep Study Results
#11
(05-30-2015, 08:51 AM)iSnore Wrote:
(05-30-2015, 08:24 AM)Sleeprider Wrote: Since you don't tolerate the clinical sleep setting very well as evidenced by your sleep onset latency, why not skip titration and just ask for an Auto-titrating Rx? You could save some money and time, and with an auto and sleepyhead, DIY your titration. You will eventually do that anyway. The only value a titration study has now is to approximate your therapeutic pressure and eliminate the slight possibility of complex apnea from CPAP therapy. You will know right away with an auto the answers to both those questions.

Thanks for that input!

My sleep doctor gave the that option--he only prescribes autos because he believes patients' needs vary. He also gave me the choice of home or lab initial sleep study, and although he prefers Respironics, he'll get me a ResMed if that's what I want. He's really flexible--tells me what he prefers but is very positive about making alternatives work.

I actually enjoyed the sleep study and I think I'll do better on the second visit. My insurance approved a second visit for titration on the initial authorization. If it's called for, the lab titration will justify bi-level to the insurance. Perhaps I'd get used to it, but I feel like I potentially may have a problem with expiratory pressure--I was pretty surprised how hard it was to exhale into 4 cm during the mask fittings. I'm down to a DS560 or DS760 and want to make the right choice the first time, rather than have to be non-compliant without a BiPAP.

All this being said, I've had Sleephead on all my computers for two months now, LOL. I've gotten Encore Basic at least launching on my Macs using a version of Wine. I'm ready to do some self-monitoring and titration!

Sounds like you're set to go. Unlikely you will pass the "medically necessary" hurtle for a BiPAP unless your pressures are over 14 cmH2O. Either machine is great, but the minimum EPAP pressure is 4.0 on both of those. What will be ironic is if they titrate you at something like 9 or 10, then issue you a APAP set for 4-20. Don't be too surprised.
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#12
(05-30-2015, 09:16 AM)Sleeprider Wrote: ...What will be ironic is if they titrate you at something like 9 or 10, then issue you a APAP set for 4-20. Don't be too surprised.

I won't, but I've had nothing but great experiences with the doctor and sleep lab. I'm hoping that extends to my DME. We have local offices for Crapria, Lincareless, and American HomePatient. I'm hoping the latter will be staffed with good folks too.

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#13
(05-30-2015, 09:16 AM)Sleeprider Wrote:
(05-30-2015, 08:51 AM)iSnore Wrote:
(05-30-2015, 08:24 AM)Sleeprider Wrote: Since you don't tolerate the clinical sleep setting very well as evidenced by your sleep onset latency, why not skip titration and just ask for an Auto-titrating Rx? You could save some money and time, and with an auto and sleepyhead, DIY your titration. You will eventually do that anyway. The only value a titration study has now is to approximate your therapeutic pressure and eliminate the slight possibility of complex apnea from CPAP therapy. You will know right away with an auto the answers to both those questions.

Thanks for that input!

My sleep doctor gave the that option--he only prescribes autos because he believes patients' needs vary. He also gave me the choice of home or lab initial sleep study, and although he prefers Respironics, he'll get me a ResMed if that's what I want. He's really flexible--tells me what he prefers but is very positive about making alternatives work.

I actually enjoyed the sleep study and I think I'll do better on the second visit. My insurance approved a second visit for titration on the initial authorization. If it's called for, the lab titration will justify bi-level to the insurance. Perhaps I'd get used to it, but I feel like I potentially may have a problem with expiratory pressure--I was pretty surprised how hard it was to exhale into 4 cm during the mask fittings. I'm down to a DS560 or DS760 and want to make the right choice the first time, rather than have to be non-compliant without a BiPAP.

All this being said, I've had Sleephead on all my computers for two months now, LOL. I've gotten Encore Basic at least launching on my Macs using a version of Wine. I'm ready to do some self-monitoring and titration!

Sounds like you're set to go. Unlikely you will pass the "medically necessary" hurtle for a BiPAP unless your pressures are over 14 cmH2O. Either machine is great, but the minimum EPAP pressure is 4.0 on both of those. What will be ironic is if they titrate you at something like 9 or 10, then issue you a APAP set for 4-20. Don't be too surprised.

Agree. Be sure to get a copy of the SLEEP DOCTOR'S interpretation and recommendation re the lab titration findings.

If SLEEP DOCTOR'S recommendation is fixed pressure for example of 10cm, my advise would be to set straight CPAP for 10 with ramp. If you go Auto, insist upon starting setting of, perhaps, 8-12cm, with shorter ramp. See how it goes for a couple of weeks.

In my case, SLEEP DOCTOR'S REPORT recommended a trial of straight CPAP 12cm with 15 minute ramp.

Cardio prescribed Auto 6-15cm. More likely to assure Compliance, but my aps were clearing at only 7 or 8, and that was inadequate pressure for oxygen saturation. YMMV.
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#14
(05-30-2015, 09:16 AM)Sleeprider Wrote:
(05-30-2015, 08:51 AM)iSnore Wrote: I'm down to a DS560 or DS760 and want to make the right choice the first time, rather than have to be non-compliant without a BiPAP.

Sounds like you're set to go. Unlikely you will pass the "medically necessary" hurtle for a BiPAP unless your pressures are over 14 cmH2O.

Hi iSnore,

A bi-level machine like the DS760 can make therapy much more comfortable when exhaling against pressure and can make for more restful sleep.

A few patients are unable to tolerate much pressure at all during exhalation. If you find yourself in that category, I suggest you should ask for bi-level right away, during the titration, so you will be able to sleep.

Take care,
--- Vaughn
Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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#15
(05-29-2015, 10:44 AM)iSnore Wrote: Apnea plus Hypopnea index (AHI) 48.3

Wow - that's about my level pre CPAP testing in May this year...my first one done in 2010 was 72.

With my CPAP test, it was 1.3, and with my first week of CPAP trialling, it's been 0.0 the last few nights !!! Now I just have to find the best mask.
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#16

Hi AussieMediaGuy, welcome to Apnea Board.



Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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#17
Thank you Wink
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#18
Thank you all for the replies. I should have updated earlier--they had a cancellation and I was able to get my titration done last Thursday night.

I used the Swift FX I tried last time and the tech fitted it pretty loosely. I really wasn't aware of it or the hose throughout the night--except for feeling that jet of air exhaust. I sleep with a fan blowing on me (and had that during both the sleep study and titration), so it doesn't bother me, but it might my wife. I'm going to see if the P10 will fit my huge head at the DME and if not, stick with the FX. My wife starts her journey into CPAP with the first consult this week.

The tech hinted at my pressure, saying she had to go above 8 cm to resolve my snoring and only went up to 10 to give the sleep doctor a little more data. The first couple of times at 10, the pillows blew off my nostrils and woke me up, so the second time, I tightened the straps a bit and went back to sleep. The tech said I had low leak rates except for those events. I apparently had no problems exhaling at any pressure. Nor do I inhaling when conscious, even at only 4 cm.

So it looks like the DS560 is going to be plenty for me, probably around 9, maybe 8-10 on auto. We'll see what the doc says this week. I may play with A-Flex and Ramp. I've already got SleepyHead installed and a FlashAir 2 card on hand.

Thanks for all the help and suggestions!
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#19
Got the titration results this morning. I had pretty bad leg pain that night, having to sit up once before sleep to massage my calves, so total sleep time was only 181.0 minutes for the night and limb movement was high. At home, I would get up, wire up to my TENS unit in Russian mode and be relieved in a half-hour or so.

Pressure varied from 4 to 10 cm throughout the study. There were no obstructive, 2 centrals, and 39 hypopneas. At 10 cm, AHI was 9.1. This is worse than I thought and is obviously not good enough for me.

Titration Report Conclusion:
CPAP at 10 cm of water reduced the patient's apnea plus hypopnea index. Recommend starting an auto-CPAP at 9-13 cm H20 with follow up in 6 weeks to determine compliance and any pressure adjustments needed.

So my sleep doctor's preferred DME named "DASCO" has my prescription for a DS560TS and mask of patients choice.

Edit to add: My wife had her first sleep consult this morning and is heading for a split sleep study.
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#20
(06-25-2015, 09:01 AM)iSnore Wrote: Got the titration results this morning. I had pretty bad leg pain that night, having to sit up once before sleep to massage my calves, so total sleep time was only 181.0 minutes for the night and limb movement was high. At home, I would get up, wire up to my TENS unit in Russian mode and be relieved in a half-hour or so.

Pressure varied from 4 to 10 cm throughout the study. There were no obstructive, 2 centrals, and 39 hypopneas. At 10 cm, AHI was 9.1. This is worse than I thought and is obviously not good enough for me.

Titration Report Conclusion:
CPAP at 10 cm of water reduced the patient's apnea plus hypopnea index. Recommend starting an auto-CPAP at 9-13 cm H20 with follow up in 6 weeks to determine compliance and any pressure adjustments needed.

So my sleep doctor's preferred DME named "DASCO" has my prescription for a DS560TS and mask of patients choice.

Edit to add: My wife had her first sleep consult this morning and is heading for a split sleep study.

According to the Clinical Guidelines, it seems that you were titrated to a 'good' pressure, not the clinically 'optimal' pressure.

http://www.aasmnet.org/Resources/clinica...040210.pdf

Is there is a titration table/chart?

Is there a sleep doctor's report on the titration?

Perhaps there's a reason you were only titrated to the low end of the 'good' level.

[Image: TITRATION%20OPTIMAL%20STANDARD_zps5jlxvyxj.png]



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