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Question about sleep study results
#1
Question 
Question about sleep study results
Hello to all,

New member here and recently (finally) diagnosed with sever sleep apnea.  After looking over the results of both my split and my titration studies it looks as if I possibly have a positional issue where my non-supine AHI is way higher than my supine AHI.  I wanted to see what y'all thought about that and if there is any advice for remaining supine while sleeping?  Also they recommended 14cmH2O as my pressure but not only did they not test anything higher than that, it only resulted in an AHI of 6.3.  Shouldn't I aim to get lower than that with treatment?  I have yet to get an appointment with my DME and thanks to this site I have had my Dr. write a Rx for an Auto CPAP and I know what to ask for when I finally get that appointment.
this is a copy of my split night summary 
   
this is a copy of my titration summary
   

thanks in advance to anyone who looks at this and gives advice.
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#2
RE: Question about sleep study results
I would ask your doctor that question and state that since 14 didn't bring my ahi to below 5 isn't it logical to assume that I need more pressure? And since titration protocols call for a consideration of BiLevel at 15 and over shouldn't my machine be an auto BiLevel such as the ResMed VAuto? Especially since we do not know how much pressure is actually needed. And that would also allow for future pressure increases should my needs change over the next 5+years.

Or something like that.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Attaching Charts

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.
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#3
RE: Question about sleep study results
(09-08-2019, 01:08 AM)bonjour Wrote: I would ask your doctor that question and state that since 14 didn't bring my ahi to below 5 isn't it logical to assume that I need more pressure?  And since titration protocols call for a consideration of BiLevel at 15 and over shouldn't my machine be an auto BiLevel such as the ResMed VAuto? Especially since we do not know how much pressure is actually needed. And that would also allow for future pressure increases should my needs change over the next 5+years.

Or something like that.
Thanks for the advice. I just asked my doctor this via his portal. I’ll see what he says. He has been very good in working with what I ask for. Originally he wrote the Rx for a CPAP at a constant pressure of 14cmH2O I asked him to rewrite it after reading information here. So he rewrote it to and Auto CPAP with 10-18cmH2O. Hopefully he will rewrite it again to the VAuto. Any suggestions on where I should start with settings? I’m not familiar with the setting of a BiLevel machine.
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#4
RE: Question about sleep study results
The important number in a BiLevel is the EPAP (Exhale pressure) number. That is what splints open the airway, not the IPAP (inhale pressure) which is called pressure on a CPAP. Per your Sleep Study your titrated CPAP pressure is 14. This should also be your EPAP pressure on a BiLevel. By standard practice pressure support (PS) is initially 4, but I'm going to use 3 right now as an example.

So on a BiLevel you would set EPAP =14 and PS=3. PS is always added to EPAP so IPAP =EPAP + PS = 14 + 3 = 17.

To match this therapeutic treatment on a CPAP we would set Pressure =17 and EPR= 3

Auto mode on a VAuto I would do
Min EPAP = 12
PS = 4 (standard)
Max IPAP =20

For a start, expecting to adjust to what you need in your home setting. I mean as necessary and important as sleep studies are they are not exactly set up the same as your home are they. You don't sleep with all those wires and monitoring attached every night do you?
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Attaching Charts

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.
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#5
RE: Question about sleep study results
(09-08-2019, 08:42 AM)bonjour Wrote: The important number in a BiLevel is the EPAP (Exhale pressure) number.  That is what splints open the airway, not the IPAP (inhale pressure) which is called pressure on a CPAP.  Per your Sleep Study your titrated CPAP pressure is 14.  This should also be your EPAP pressure on a BiLevel.  By standard practice pressure support (PS) is initially 4, but I'm going to use 3 right now as an example.

So on a BiLevel you would set EPAP =14 and PS=3.   PS is always added to EPAP so IPAP =EPAP + PS = 14 + 3 = 17.

To match this therapeutic treatment on a CPAP we would set Pressure =17 and EPR= 3

Auto mode on a VAuto I would do
Min EPAP = 12
PS = 4 (standard)
Max IPAP =20

For a start, expecting to adjust to what you need in your home setting.  I mean as necessary and important as sleep studies are they are not exactly set up the same as your home are they.  You don't sleep with all those wires and monitoring attached every night do you?

I sent your suggested settings to my dr and hopefully he will provide the Rx. He has been amazing at working on this with me so hopefully he will keep that up. And you are right. The sleep study is definitely not the same as sleeping at home even though the best night of sleep I have had in a long time was the night of my titration study lol.
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#6
RE: Question about sleep study results
(09-08-2019, 08:42 AM)bonjour Wrote: The important number in a BiLevel is the EPAP (Exhale pressure) number.  That is what splints open the airway, not the IPAP (inhale pressure) which is called pressure on a CPAP.  Per your Sleep Study your titrated CPAP pressure is 14.  This should also be your EPAP pressure on a BiLevel.  By standard practice pressure support (PS) is initially 4, but I'm going to use 3 right now as an example.

So on a BiLevel you would set EPAP =14 and PS=3.   PS is always added to EPAP so IPAP =EPAP + PS = 14 + 3 = 17.

To match this therapeutic treatment on a CPAP we would set Pressure =17 and EPR= 3

Auto mode on a VAuto I would do
Min EPAP = 12
PS = 4 (standard)
Max IPAP =20

For a start, expecting to adjust to what you need in your home setting.  I mean as necessary and important as sleep studies are they are not exactly set up the same as your home are they.  You don't sleep with all those wires and monitoring attached every night do you?

That post should be in a sticky or Wiki.
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#7
RE: Question about sleep study results
(09-09-2019, 10:10 AM)ragtopcircus Wrote:
(09-08-2019, 08:42 AM)bonjour Wrote: The important number in a BiLevel is the EPAP (Exhale pressure) number.  That is what splints open the airway, not the IPAP (inhale pressure) which is called pressure on a CPAP.  Per your Sleep Study your titrated CPAP pressure is 14.  This should also be your EPAP pressure on a BiLevel.  By standard practice pressure support (PS) is initially 4, but I'm going to use 3 right now as an example.

So on a BiLevel you would set EPAP =14 and PS=3.   PS is always added to EPAP so IPAP =EPAP + PS = 14 + 3 = 17.

To match this therapeutic treatment on a CPAP we would set Pressure =17 and EPR= 3

Auto mode on a VAuto I would do
Min EPAP = 12
PS = 4 (standard)
Max IPAP =20

For a start, expecting to adjust to what you need in your home setting.  I mean as necessary and important as sleep studies are they are not exactly set up the same as your home are they.  You don't sleep with all those wires and monitoring attached every night do you?

That post should be in a sticky or Wiki.

Agreed. ???
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#8
RE: Question about sleep study results
Just got the Resmed Airsense 10 AutoSet today and this is my first night with it. Setting were 13-20 EPR 3 response standard. I have woken up with aerophagia now. Never had any issues with us during my split sleep study nor my titration study. I’m curious as to why this has come up now and possible solutions. Sadly my machine didn’t come with an SD card and I didn’t find out till I was getting ready for bed. I should have one tomorrow or the next day.  Any help with my limited info available would be appreciated.
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#9
RE: Question about sleep study results
I would go into the Clinician menu, select “Essentials”, and change it to plus. That will give you more control from the normal menu. It also enables a little more detail in the Sleep Report screen. I would then go into your Sleep Report and change the period to daily (instead of weekly of monthly). I look at that when I first wake up, while I still remember how I slept, etc. It will tell you the average pressure and what kind of events you had.
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#10
RE: Question about sleep study results
You should also read the sticky/Wiki articles about cervical collars. Chin tucking is a very common problem, and it will cause your pressure to go higher.

If you can avoid tucking your chin, and sleep on your side if possible, you may be able to keep your pressure from going as high, and that will help with aerophagia.

You may need to limit your maximum pressure for a little while to give your body a chance to adapt. This is what we are doing with my fiancée. I’m limiting the maximum to the bare minimum that gets her AHI down to somewhat reasonable levels. She really needs to go a little higher, but then she wakes up swallowing air. My plan is to just slowly nudge the maximum up by the smallest possible steps.

It’s hard to make a call on that without SD data though.

You didn’t mention the mask type, but a full face mask may help some with aerophagia. We switched Kim from nasal to an F20, and it definitely helped (by eliminating that big pressure difference between the mouth and throat).
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