Titration Study Results

[hookedonstitch]

Just got my titration study results and I could use some of your feedback on what the Dr. advised.

I took a sleep aid and it still took me 55 mins to fall asleep (usual time it takes without a sleep tablet), no recorded apneas and pressure started at 6,0 and wasn't changed.  Oxygen 98%, no abnormal heart rhythm, 37 periodic limb movements per hour (down from 44 in first sleep test).  Apparently I do better on the APAP setting than the CPAP setting.

I did tell the Dr. that I am still exhausted and still waking up 4-6 times per night.  I also mentioned that I have feelings throughout the night that I feel like I am not getting any air from the machine/mask.

Recommended Directions:  
Pressure 4.0-7.0 cm APAP for her
Gabapentin for PLM (until iron supplements raise my low levels)
Try a full face mask 

Checkup in 3 months

Thoughts?  I will attach the OSCAR data from last night.  Halfway through the night I raised the pressure from 7.0 to 8.0.  By the way I quickly realized that I feel/sleep much worse without the machine so I am back to trying to adjust to this.

[staceyburke]

I can not see if you are using EPR (exhale pressure relief). If not I would suggest setting EPR =3. It will help with flow limitations. FL are just smaller apnea (see the classification of apnea at the bottom of the post) and can cause sleep interruption. 

If you feel like you are not getting enough air turn up the min to anywhere 7-10. But keep it to at least 7 to let the EPR work. 

You can set the max to a little higher setting. The machine wii not go higher than it needs to in autoset mode.

[SarcasticDave94]

I'd agree with Stacey, you need a higher setting and EPR at 3 will help this. That flow limit trace looks to be a likely source of all night sleep disruptions.

[hookedonstitch]

I can not see if you are using EPR (exhale pressure relief). If not I would suggest setting EPR =3. It will help with flow limitations. FL are just smaller apnea (see the classification of apnea at the bottom of the post) and can cause sleep interruption. 

If you feel like you are not getting enough air turn up the min to anywhere 7-10. But keep it to at least 7 to let the EPR work. 

You can set the max to a little higher setting. The machine wii not go higher than it needs to in autoset mode.

I am currently using EPR = 3 but what I don't understand is why the Dr. has advised my pressure settings to be so low.  All she told me was the titration study shows I only need a small amount of pressure to fully open my airway.

[hookedonstitch]

I'd agree with Stacey, you need a higher setting and EPR at 3 will help this. That flow limit trace looks to be a likely source of all night sleep disruptions.

Nothing was mentioned about my flow limits.  Dr. thinks likely source of night time waking is PLM.  Is this possible as well as flow limits?

[hookedonstitch]

Will a full face mask make any difference to the flow limits?

[SarcasticDave94]

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.

[staceyburke]

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.

[sheepless]

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.

[SarcasticDave94]

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.