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Titration Study Results
#11
RE: Titration Study Results
Flow Limits are not tracked on any sleep study. Some studies do track RERAs and we use that as a flag to say you have a lot of Flow Limits. According to Dr. Krakow, for all practical purposes, the following three terms are interchangeable:

UARS (upper airway resistance)
Flow limitation
RERAs (respiratory effort-related arousal)


Most doctors assume that an auto machine will automatically dial in the optimal pressure. That is absolutely not the case. without question every once in a while they find someone whom is perfect for those settings but that is very rare.

on min pressure, there are two goals
1. eliminate/minimize obstructive apnea, (and other obstructive events) this is the only thing the sleep lab is looking for
1a. on a bilevel, increase PS (on a ResMed we use EPR for this, the lab never looks at this) to decrease flow limits, RERAS, hypopneas

2. increase min pressure as needed for comfort. Note, the sleep lab NEVER does this.

so there is typically no problem adjusting pressure up. Go ahead and find what is comfortable.
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#12
RE: Titration Study Results
(04-13-2021, 12:30 PM)SarcasticDave94 Wrote: Turning dials during titration is hard work. The tech didn't try but a few pressure combos I'd guess. And they start at the bottom and work upward. Tommy tech probably got to something with little events and quit looking for better. The report is presented you did just fine on this pressure and viola this is your magic combo. Just turn the dial yourself and forget about Dr. Ducky. Alternate is you turn the dials and report in doing much better here, mark these as better. And thanks for your hard work Dr. Ducky.

I had a bad feeling when I was told in the morning as I was leaving that I stayed on the same pressure all night.  This tech was completely useless.  He started and left me on 6.0, it was a complete waste of my time.
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#13
RE: Titration Study Results
(04-13-2021, 12:39 PM)staceyburke Wrote: Just a note to clarify - all Cpap machines can go to 4 at the lowest. So your Dr set this to the min pressure they could set. 

EPR is exhale pressure relief. Your exhale is the min number. You subtract the EPR from the min to get a new exhale pressure. But yours is set to 4 so it can NOT do anything. That is why you want the min at 7 or greater. So for example if your min was 8 and you subtract the EPR of 3 your exhale pressure is 5.   8-3

EPR makes it easier to exhale because it allows you to exhale against higher pressure. BUT more important to you it is how you decrease flow limitations.

Dr look at larger apnea 
And don’t worry about the small flow limits. And they consider you I compliance (treated) with less than 5 AHI. As for me that is to high - 2or below is what I would aim at.

I'm still learning all this cpap stuff but even I knew you can't set the machine to start at 4.0 as the EPR won't work at this setting.  I'm beginning to wonder if both the Dr. and the Tech are "quacks".

Thank goodness for this forum!
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#14
RE: Titration Study Results
(04-13-2021, 01:01 PM)sheepless Wrote: it's great your doc is willing to address your plm. you may see far fewer flow limitations to the extent treatment for plm is successful. plm can cause frequent awakenings and is disturbing even when you don't wake up. the resmed apap response to my plm breathing was runaway pressure producing leaks, aerophagia and awakenings. pap won't help with plm and plm screws up pap treatment. your setting needs will likely change once the plm is reduced.

I will keep this in mind if I can get the PLM sorted out.
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#15
RE: Titration Study Results
(04-13-2021, 01:41 PM)SarcasticDave94 Wrote: FWIW flow limits are typically not considered during treatment planning. So that's probably why Dr. Ducky didn't discuss, but in their world of treatment FL isn't considered worthy of their time. You need to translate FL and other things like PLM as sleep disruptions or something like that. They seem to understand not feeling well rested but would probably not hear FL issues.

I didn't bring up the issues I'm having with flow limits because I wanted to see if the Dr. would even bring it up as an issue.  I think Dr. Ducky might need to be fired.  

I did mention that I feel like I'm being woken up about 4-8 times per night still.  Dr. Ducky contributed it to the PLM.
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#16
RE: Titration Study Results
(04-13-2021, 04:16 PM)Gideon Wrote: Flow Limits are not tracked on any sleep study.  Some studies do track RERAs and we use that as a flag to say you have a lot of Flow Limits.  According to Dr. Krakow, for all practical purposes, the following three terms are interchangeable:

UARS (upper airway resistance)
Flow limitation
RERAs (respiratory effort-related arousal)


Most doctors assume that an auto machine will automatically dial in the optimal pressure.  That is absolutely not the case.  without question every once in a while they find someone whom is perfect for those settings but that is very rare.

on min pressure, there are two goals
1. eliminate/minimize obstructive apnea, (and other obstructive events) this is the only thing the sleep lab is looking for
1a. on a bilevel, increase PS (on a ResMed we use EPR for this, the lab never looks at this) to decrease flow limits, RERAS, hypopneas

2. increase min pressure as needed for comfort. Note, the sleep lab NEVER does this.

so there is typically no problem adjusting pressure up.  Go ahead and find what is comfortable.

I'm going to play around with the dials on my machine over the next few nights and test out a few different pressure ranges.  Tonight I will being with 7.0 - 10.0 and see how I feel.

I'm very thankful for everyone's assistance here.
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#17
RE: Titration Study Results
We're here to help, so try something and post OSCAR and your feedback on if you think it's working or not. We can get the therapy on track better than the quack anyway. It's hard to pay attention when you're counting the boat payments.
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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#18
RE: Titration Study Results
If you haven't taken Gabapentin before, read up on the problems it can cause. I use http://www.drug.com usually. This drug is a God-send or pure hell for some people. I'm kind of in between but I had some troubling symptoms on a fairly low dose I took for sciatica--vision problems, hands that would jerk suddenly, and I think there was at least one other thing that I can''t recall.
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#19
RE: Titration Study Results
(04-14-2021, 12:33 AM)SideSleeper Wrote: If you haven't taken Gabapentin before, read up on the problems it can cause.   I use http://www.drug.com  usually.  This drug is a God-send or pure hell for some people.  I'm kind of in between but I had some troubling symptoms on a fairly low dose I took for sciatica--vision problems, hands that would jerk suddenly, and I think there was at least one other thing that I can''t recall.

I have taken it before for nerve damage/pain caused from a probable case of shingles.  I seemed to do OK with it but that was over 10 years ago now.
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#20
RE: Titration Study Results
I am not surprised to hear you have PLM. It is probably what is waking you up as well as making you so tired. APAP can only help the breathing issues unfortunately. You have three sleep issues ... sleep apnea, PLM, and sleep onset insomnia .... and each one has their own solution.

My sleep doctor had me taking iron and 250 vitamin C to increase my stored iron. He said the stored iron is a different blood test, but I assume your GP can order it to monitor your iron on an ongoing basis. If you get your blood tests at a LifeLabs you can see blood work results the next day.

Let's hope the iron and Gabapentin do their work and give you a good night's sleep.
Sleep-well
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