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Titration Study Results
RE: Titration Study Results
(05-09-2021, 11:04 AM)Geer1 Wrote: I assume that claim by sleep Dr. was based on AHI reported by machine? There is more to apnea then AHI.

Do you have data from the nights you used 6-12 settings? If so post it, I just need to see some data to see if if higher pressures appear to have any effect on flow limitation.  

My gut feel is that you don't improve at higher pressure (might even get worse) hence why lower pressure seems more comfortable to you. If that is the case you are better at a lower pressure and using APAP at a lower pressure is useless because it pretty much maxes anyways so might as well use CPAP and avoid any pressure swings. If higher pressure does help then we just need to figure out how to make it more comfortable. Using CPAP mode might help if it is the pressure changes that are main issue that bother you rather than higher pressure, in which case the right ramp setting might also be helpful to make it easier to fall asleep if you find it difficult at a higher pressure.

As you can see there are options but we need data to drive the decisions.

This was last night at APAP 6.0-12.0 which was tolerated well overall.  I feel like I am still waking up way too many times and each time I did the pressure was over 11.0.  Should I stick with this pressure for awhile longer or increase?  I am completely exhausted today!


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RE: Titration Study Results
The chart for flow limits isn't shown, but on the left it shows a Max of .40. likely high enough to run your pressure up and where it needs addressed.
Dave

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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RE: Titration Study Results
Need to see your flow limitation chart. Your pressure didn't max as I thought it might but 95% flow limitation value stayed roughly the same. Your tidal volume (volume per breath) and minute ventilation (average ventilation) both increased which might be a sign that the higher pressure was helping overcome flow limited breathing.

You are going to wake up when pressure is around 11 because your pressure stays in 10-12 range. Waking up when the pressure is 11 doesn't mean that a pressure of 11 is the reason you woke up.

Some zoomed in images of the scraggly looking/high flow rate areas might help visualize what is happening there. When flow rates spike that is often a sign of arousal and a good spot to look closer at to try and understand what is happening (if flow was restricted prior to the spike or if it just happened for an unknown reason etc).

I would stick with these settings for a couple more nights.
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RE: Titration Study Results
We would rather see you comfortable and optimized than trying to prove something to your doctor. The doc ain't listening.
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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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RE: Titration Study Results
(05-10-2021, 06:21 PM)SarcasticDave94 Wrote: The chart for flow limits isn't shown, but on the left it shows a Max of .40. likely high enough to run your pressure up and where it needs addressed.

Sorry I created a new profile and forgot to put my charts in order.


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RE: Titration Study Results
(05-10-2021, 08:44 PM)Geer1 Wrote: Need to see your flow limitation chart. Your pressure didn't max as I thought it might but 95% flow limitation value stayed roughly the same. Your tidal volume (volume per breath) and minute ventilation (average ventilation) both increased which might be a sign that the higher pressure was helping overcome flow limited breathing.

You are going to wake up when pressure is around 11 because your pressure stays in 10-12 range. Waking up when the pressure is 11 doesn't mean that a pressure of 11 is the reason you woke up.

Some zoomed in images of the scraggly looking/high flow rate areas might help visualize what is happening there. When flow rates spike that is often a sign of arousal and a good spot to look closer at to try and understand what is happening (if flow was restricted prior to the spike or if it just happened for an unknown reason etc).  

I would stick with these settings for a couple more nights.

I circled 2 areas on my overall chart, for scraggly high flow rate am I looking at the right areas that I have circled? I will add some attachments of areas that look suspicious to my untrained eye.

What you say about the pressure makes sense, it's not a pressure of 11.0 that is waking me up, I am waking up for another reason because 95% of the night I spent at this pressure (is this right?).  I didn't feel overwhelmed with this pressure and actually did feel like I could breathe a bit easier.

I will keep my pressure the same for the next few nights and post my progress on here.  If there is a time that needs a closeup that I haven't included please let me know.

I've barely kept my eyes open all day and I am so exhausted I hope to get to sleep soon!


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RE: Titration Study Results
(05-10-2021, 09:02 PM)Sleeprider Wrote: We would rather see you comfortable and optimized than trying to prove something to your doctor. The doc ain't listening.

I quickly realized how stupid that statement wass  Too-funny  I can't continue like I am today, I have to chase this down.  The Dr. isn't going to care, it's up to me to help myself.

Thanks
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RE: Titration Study Results
It's OK, doc not listening is typical of almost all sleep pulmonary doctors. If there's a next time that I see mine, I'll give him a business card of a good ENT to get his hearing and eyes checked.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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RE: Titration Study Results
(05-10-2021, 09:17 PM)hookedonstitch Wrote:
(05-10-2021, 09:02 PM)Sleeprider Wrote: We would rather see you comfortable and optimized than trying to prove something to your doctor. The doc ain't listening.

I quickly realized how stupid that statement wass  Too-funny  I can't continue like I am today, I have to chase this down.  The Dr. isn't going to care, it's up to me to help myself.

Thanks


It is worthwhile noting your doctor has already done more than most as he has ordered both an in clinic sleep study and a titration study, lots don't even get an in clinic study and very few get a titration study although many should. Your doctor has already done everything clinically indicated which might make it harder for you to convince him to do more or it might mean that he is more willing to try things others wont. 

There will only be two more things we can try with your current machine. One is even higher pressure, the other is to set the machine at what we think is the best setting and give your body time (weeks/months) to adapt and improve. In your case I think there is possibility of this happening especially if you can improve your known vitamin/mineral deficiencies and if you can reduce weight (although this may seem insensitive it could be extremely helpful if this is a breathing issue which is why your sleep study included that comment).   

If those fail to create improvement the next step would require a different machine. To get that machine you either need to convince your doctor to try one or buy one on the used market out of pocket (this is what many on here end up doing). 

Anyways just wanted to make you aware of what future options will be and understanding potential role of doctor. For now I would collect more data to try and determine what the ideal settings are on your current machine then you can decide how long you want to try it for and if you want to try to work with doctor or give up on him.
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RE: Titration Study Results
(05-10-2021, 11:41 PM)Geer1 Wrote:
(05-10-2021, 09:17 PM)hookedonstitch Wrote:
(05-10-2021, 09:02 PM)Sleeprider Wrote: We would rather see you comfortable and optimized than trying to prove something to your doctor. The doc ain't listening.

I quickly realized how stupid that statement wass  Too-funny  I can't continue like I am today, I have to chase this down.  The Dr. isn't going to care, it's up to me to help myself.

Thanks


It is worthwhile noting your doctor has already done more than most as he has ordered both an in clinic sleep study and a titration study, lots don't even get an in clinic study and very few get a titration study although many should. Your doctor has already done everything clinically indicated which might make it harder for you to convince him to do more or it might mean that he is more willing to try things others wont. 

There will only be two more things we can try with your current machine. One is even higher pressure, the other is to set the machine at what we think is the best setting and give your body time (weeks/months) to adapt and improve. In your case I think there is possibility of this happening especially if you can improve your known vitamin/mineral deficiencies and if you can reduce weight (although this may seem insensitive it could be extremely helpful if this is a breathing issue which is why your sleep study included that comment).   

If those fail to create improvement the next step would require a different machine. To get that machine you either need to convince your doctor to try one or buy one on the used market out of pocket (this is what many on here end up doing). 

Anyways just wanted to make you aware of what future options will be and understanding potential role of doctor. For now I would collect more data to try and determine what the ideal settings are on your current machine then you can decide how long you want to try it for and if you want to try to work with doctor or give up on him.
The past 2 nights have been interesting.  I will post some charts.

On May 10 even though I was exhausted beyond belief, insomnia hit me hard and I finally gave up trying to fall asleep after an hour or so.  After reading for about an hour I was able to try again.  The rest of the night I kept waking up blowing air out of my mouth.  Very frustrating but I persevered through it.


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