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Starting My Therapy
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tedburnsIII Offline

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Post: #41
RE: Starting My Therapy
(06-29-2015 02:58 PM)AlanE Wrote:  I don't have the full report from the titration. Just the interpretation from the initial sleep study.

My pre-sleep study (overnight oximetry) showed my O2 dropping below 89% for 25% of the time.

For the PSG the O2 was not that terrible at all:
The average SaO2 was 97%. Average desaturation was 4%
Lowest desaturation was 88%
Length of time below 89% 0.6 minutes.

I am a little bit confused.

Have you or anyone else done overnight oximetry studies since going back on CPAP recently?

Without the titration report in your possession, do you perhaps know what it reported as your recommended pressure?

There should also be a separate report written by a board-certified sleep physician interpreting the sleep study and titration performed as well as said doctor's recommended pressure.
(This post was last modified: 06-29-2015 04:30 PM by tedburnsIII.)
06-29-2015 03:30 PM
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AlanE Online

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Post: #42
RE: Starting My Therapy
Huhsign

Going back on CPAP? First started therapy 3 months ago and have been on it since.
Why assume there is one recommended pressure?
Why assume no report exists?
What reason would anyone order another overnight oximetry?

Dont-know

I was told, after my titration, that I responded favorably to all pressure adjustments. I would assume, it is why my doctor prescribed an APAP with a range instead of a CPAP with a fixed pressure.

I don't get the meaning behind your questioning?



Using FlashAir W-03 SD card in machine. Access through wifi with FlashPAP or Sleep Master utilities.

I wanted to learn Binary so I enrolled in Binary 101. I seemed to have missed the first four courses. Big Grinnie
06-29-2015 06:30 PM
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tedburnsIII Offline

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Posts: 196
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Machine: 3B RESmart APAP
Mask Type: Nasal mask
Mask Make & Model: Wisp nasal; ResMed FX nasal
Humidifier: came with unit-I vary it, currently set at '3', '5' is max
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Other Comments: Dx moderately severe OSA. Overnight pulse oximeter-CMS50D Plus

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Post: #43
RE: Starting My Therapy
(06-29-2015 06:30 PM)AlanE Wrote:  Huhsign

Going back on CPAP? First started therapy 3 months ago and have been on it since.
Why assume there is one recommended pressure?
Why assume no report exists?
What reason would anyone order another overnight oximetry?

Dont-know

I was told, after my titration, that I responded favorably to all pressure adjustments. I would assume, it is why my doctor prescribed an APAP with a range instead of a CPAP with a fixed pressure.

I don't get the meaning behind your questioning?

Whenever one is titrated at the lab, they have to come up with either an 'optimal', 'good' or 'adequate' fixed pressure. This is required by the Clinical Guidelines

It is always a fixed pressure, though physician can choose to prescribe an Auto range of pressures.
(This post was last modified: 06-29-2015 07:46 PM by tedburnsIII.)
06-29-2015 07:38 PM
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quiescence at last Offline

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Post: #44
RE: Starting My Therapy
some sort of guidelines that were submitted for publication in 2008?

Alan, have a nice time. You are getting prescribed treatment, and you are being smart and involved with your own therapy. You are checking things with health professionals.

And, learning what you can from an educational source online.

QAL

Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. 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.
06-29-2015 10:59 PM
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tedburnsIII Offline

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Machine: 3B RESmart APAP
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Mask Make & Model: Wisp nasal; ResMed FX nasal
Humidifier: came with unit-I vary it, currently set at '3', '5' is max
CPAP Pressure: 10 cm CPAP
CPAP Software: Other Software

Other Comments: Dx moderately severe OSA. Overnight pulse oximeter-CMS50D Plus

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Location: San Diego

Post: #45
RE: Starting My Therapy
Huhsign Oh, pardon me! Did I say something wrong? Unsure
06-29-2015 11:49 PM
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AlanE Online

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Post: #46
RE: Starting My Therapy
Not at all, just you seem like you are trying to make a point?



Using FlashAir W-03 SD card in machine. Access through wifi with FlashPAP or Sleep Master utilities.

I wanted to learn Binary so I enrolled in Binary 101. I seemed to have missed the first four courses. Big Grinnie
06-30-2015 04:27 AM
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tedburnsIII Offline

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Posts: 196
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Machine: 3B RESmart APAP
Mask Type: Nasal mask
Mask Make & Model: Wisp nasal; ResMed FX nasal
Humidifier: came with unit-I vary it, currently set at '3', '5' is max
CPAP Pressure: 10 cm CPAP
CPAP Software: Other Software

Other Comments: Dx moderately severe OSA. Overnight pulse oximeter-CMS50D Plus

Sex: Male
Location: San Diego

Post: #47
RE: Starting My Therapy
I do not understand the cynical comments I have received in this thread.

The point is that if one undergoes a titration study one is given the benefit of a recommended fixed pressure under laboratory conditions to cover worst case scenarios (supine and in REM). It assures that AHI is <5 (if optimal pressure) along with adequate sats and no desats <90%.

That optimal pressure defines the best overall starting recommended pressure for YOU! Why the hostility?

The thread has omitted to discuss what the optimal recommended pressure was and I don't believe one should take it lightly- it should be given considerable weight. It seems that relying on SH does not tell the entire story without knowledge of the optimal pressure.
(This post was last modified: 06-30-2015 02:49 PM by tedburnsIII.)
06-30-2015 02:47 PM
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Post: #48
RE: Starting My Therapy
(06-30-2015 02:47 PM)tedburnsIII Wrote:  That optimal pressure defines the best overall starting recommended pressure for YOU! Why the hostility?

The thread has omitted to discuss what the optimal recommended pressure was and I don't believe one should take it lightly- it should be given considerable weight. It seems that relying on SH does not tell the entire story without knowledge of the optimal pressure.

Some of the people on this forum have found that the one night titration was just not sufficient to arrive at pressures that achieved optimal results. So some tend to look at the titration with a jaundiced eye. Sleep labs, it seems, like DMEs vary a lot when it comes to the results they deliver. Some are great and some not so much.

Sleepyhead with a full data reporting machine can lead one to the optimal pressure. I have come to believe that should be backed up by recorded oximetry to insure that the optimal settings for apnea events is not allowing desats that might be undesirable.

Best Regards,

PaytonA
06-30-2015 04:38 PM
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DariaVader Offline
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Post: #49
RE: Starting My Therapy
I feel deprived... my doc did not find a titration study to be necessary. A home study determined, that yes I have apnea, and an auto pap decides my pressure. The doc likes the ranges wide, especially on the upper end, and I don't wake at all with pressure changes so that is where it is.

هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه
Tongue Suck Technique for prevention of mouth breathing:
  • Place your tongue behind your front teeth on the roof of your mouth
  • let your tongue fill the space between the upper molars
  • gently suck to form a light vacuum
Practising during the day can help you to keep it at night

هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه
06-30-2015 05:02 PM
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tedburnsIII Offline

Members

Posts: 196
Joined: Mar 2015

Machine: 3B RESmart APAP
Mask Type: Nasal mask
Mask Make & Model: Wisp nasal; ResMed FX nasal
Humidifier: came with unit-I vary it, currently set at '3', '5' is max
CPAP Pressure: 10 cm CPAP
CPAP Software: Other Software

Other Comments: Dx moderately severe OSA. Overnight pulse oximeter-CMS50D Plus

Sex: Male
Location: San Diego

Post: #50
RE: Starting My Therapy
(06-30-2015 04:38 PM)PaytonA Wrote:  
(06-30-2015 02:47 PM)tedburnsIII Wrote:  That optimal pressure defines the best overall starting recommended pressure for YOU! Why the hostility?

The thread has omitted to discuss what the optimal recommended pressure was and I don't believe one should take it lightly- it should be given considerable weight. It seems that relying on SH does not tell the entire story without knowledge of the optimal pressure.

...
Sleepyhead with a full data reporting machine can lead one to the optimal pressure. I have come to believe that should be backed up by recorded oximetry to insure that the optimal settings for apnea events is not allowing desats that might be undesirable.

Best Regards,

PaytonA

I for the most part agree with the above statement because reliance on SleepyHead alone will never, according to the Clincial Guidelines, be able to lead one to the CLINICALLY optimal pressure.

See the below titration chart.

If I had had no titration study and auto-titrated CPAP and then used SleepyHead there is little doubt that my average pressure may have been as low as 7cm, because my RDI was 3.3 at that pressure.

The titration study took into account all-important minimum sats resulting in an optimal pressure of 12cm.

In fact, one can glean from the Guideliness that min sats must be at least 90% even in an 'adequate' titration where RDI can be as high as 15, or a 75% reduction of baseline RDI.

So, minimum sats of 90% is to a degree arguably MORE IMPORTANT than RDI . Gotta have those Sa02 min sats at or above 90%! SleepHead doesn't report that information.

[Image: 8932ffad-1373-4835-8e9e-005ab489b133_zpscula7hy8.jpg]
(This post was last modified: 06-30-2015 06:02 PM by tedburnsIII.)
06-30-2015 05:21 PM
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