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sleep study results - please help
#1
sleep study results - please help
Hello, I attached my sleep study results and was wondering if someone could please help me.  I have been on CPAP for almost a year.  If is airsense 10.  My results from the machine have always been good.  AHI always under 1 and all other scores are great.  I also have an o2 monitor which does show my saturation under 90 for around 10 minutes a night.  I spoke to dr about this and he recommended another sleep study.  I wore my cpap machine and got the attached results.  I checked my machine the day I took the sleep study and my AHI was .9 while the sleep study was 6.  Now my dr wants me to take in lab titration study.  I asked him why the results are so different than what my machine says and he said his is more accurate.  I am now monitoring my results through sleepy head and still are getting really good results.  Can someone help me with the below questions:

1)  why are the results so different between my machine and his watchpat home study test
2)  can I adjust my machine without going through a 3,500 titration study
3  why wouldn't my self adjusting machine not control all my sleep issues
4)  do you recommend I bite the bullet and pay for this very expensive titration study just in case there are more issues
5)  why cant my dr just use the data from my machine to adjust it

thank you for your help in advance


Attached Files
.pdf   Scan_0011.pdf (Size: 647.11 KB / Downloads: 71)
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#2
RE: sleep study results - please help
I'm hoping an expert will be able to swing by, but here's what I can offer in the meantime.

A Watchpat home study of the kind you had is in some ways not more accurate than the data you are getting from SH. It can't distinguish between CAs and OAs, for example. It also indirectly deduces the occurrence of apneas and hypopneas from data concerning your peripheral arterial tone (PAT), plus the other data the test generates. While there's a solid level of correlation between AHI and what the Watchpat report says, the fact remains that the Watchpat has no way to measure obstruction in your airway, as our machines can do.

Your oxygen desaturation index (ODI) was 2.8, with most of the desats apparently occurring right at the end of your sleep, which is also where your events are clustered. I am going to guess you rolled over onto you back at that point, but the version of the Watchpat you used doesn't provide that information. Your O2 sats went below 88 for less than two minutes over the course of the night.

In your place, this would be my course of action:

* Decline the expensive in-lab sleep study for now.
* Upgrade from SH to Oscar. (SH is no longer supported. Use the Oscar link at the top of the page, and read the Guide first. It will tell you how to switch from SH to Oscar.)
* Invest in an O2 monitor that is compatible with Oscar:
Contec CMS-50D+, CMS-50-E, CMS-50E
Contec CMS-50F, CMS-50H, CMS-50I (v3.7 firmware or later)
Pulox PO-200/300/400/500
There's a Wizard that will facilitate putting the data from these monitors into your Oscar charts so you can see it synced up with your other data over the course of the night.
* Post a Daily chart or two for review here.
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#3
RE: sleep study results - please help
I agree with Dormeo. Get OSCAR here https://www.sleepfiles.com/OSCAR/ and post one or more daily charts. See the links below for instructions on organizing and posting the charts. Yes, you can adjust your machine without a titration study.
Download OSCAR

Organize Charts
Attaching Charts

Mask Primer
Soft Cervical Collar

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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#4
RE: sleep study results - please help
Very commendable response from Dormeo.

Basically, the answers to your pointed questions will depend on from whom you get replies. Reading between the lines, you pretty much know the answers, and not without justification. What your adjustable machine doesn’t get right for you is what we do best here. We work hard to save lost time, unnecessary expense, and anxiety.

Please do get working on OSCAR at the top marquee and we’ll work with you on that account.
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#5
RE: sleep study results - please help
(07-03-2020, 12:00 PM)Kramer Wrote: Hello, I attached my sleep study results and was wondering if someone could please help me.  I have been on CPAP for almost a year.  If is airsense 10.  My results from the machine have always been good.  AHI always under 1 and all other scores are great.  I also have an o2 monitor which does show my saturation under 90 for around 10 minutes a night.  I spoke to dr about this and he recommended another sleep study.  I wore my cpap machine and got the attached results.  I checked my machine the day I took the sleep study and my AHI was .9 while the sleep study was 6.  Now my dr wants me to take in lab titration study.  I asked him why the results are so different than what my machine says and he said his is more accurate.  True! I am now monitoring my results through sleepy head and still are getting really good results.  Can someone help me with the below questions:

1)  why are the results so different between my machine and his watchpat home study test
Watchpat is NOT a CPAP!  Any CAPA even at minimal pressure is providing some theraputic value.
2)  can I adjust my machine without going through a 3,500 titration study
Yes, This is what we do on Apnea Board.  IF, only if, another sleep study we feel is warranted we will suggest that you get one.
3  why wouldn't my self adjusting machine not control all my sleep issues
Rarely we see a machine that is actualy optimized, and then it was usually a matter of luck.
4)  do you recommend I bite the bullet and pay for this very expensive titration study just in case there are more issues
No.  The Watchpat identified the need for treatment, you have an excellent machine and you have access to more detailed data than your doctor does.
If we see issues we will let you know.

5)  why cant my dr just use the data from my machine to adjust it
It was a home test and it doesn't show all the details that you would see with a full blown PSG and he want to see some more detail that would show up on the PSG.  We often compare using OSCAR as essentially getting a PSG everynight.

thank you for your help in advance

Download OSCAR <-- link  And post screenshot of your daily charts (Easy, use F12 on Windows)  see the organize link in my signature.

Once you post the charts we will be better able to help you.
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#6
RE: sleep study results - please help
Thank you for all that responded.  The info is priceless.  I have been away for the fourth of July holiday and now just responding.  I have attached my last 2 nights results.  After joining the group I have gained a lot of knowledge.  I adjusted my erp to only on during ramp and also my minimum pressure to 7 instead of 6.  Not sure if this is related but since last 2 weeks I have been getting large leaks which I never got before.  I have different masks and now they all seem to leak.  They are all about a year old and that is how long I have been on cpap.   Before the above changes I used to have some CAs and OAs.

Also as a reminder my dr wants me to do a $3500 sleep study (i.e. titration) at the end of this month. My Watchpat results are included in this post from earlier this year.

Thank you in advance.


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#7
RE: sleep study results - please help
What is to be gained from the sleep study?, especially a titration.
You have a machine, and it is delivering excellent results. That is supposed to be the end result of a titration study.

That is unless it is to fund a yacht.
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#8
RE: sleep study results - please help
Oh yes, doc wants to buy a shiny Airstream, and he wants you to help pay for it. The Nancy Reagan slogan "just say NO" comes to mind. You already have a PAP machine and it's working. Why sign up for another pain and torture test?
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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#9
RE: sleep study results - please help
Kramer, you're getting clear advice from the people on this thread to DECLINE the sleep study. It serves absolutely no purpose for you. Let us know if you are concerned about proceeding in this way.

Do you consider getting an O2 monitor that you can use to feed data into Oscar?

About leaks, well, they are a pain royale, no doubt about it. The P10 straps tend to stretch out over time. Washing and drying will help some, but they do need replacing somewhat more often than the headgear for other masks.

The fact that you're getting more leaks with several masks might be due to your changes in pressure, but they could also be due to changes in your sleep behavior (side/back, restlessness), changes in the contours of your face, or an uptick in mouth breathing. Any guesses about what the culprit might be?
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#10
RE: sleep study results - please help
My ahi is always less than 1.  I took the watchpat test while wearing my CPAP and it showed that I had an ahi of 6 and multiple desaturations.  (Please see sleep study attached earlier.) Not sure Why there is a difference.  On the night of the test I had an ahi from my machine of .9.  I did some adjustments Such as erp off except during ramp and min pressure of 7 instead of 6 and now getting Even better results as you can see from the Oscar screen shots I’ve attached. Only issue seems like I am getting large leaks now.  I also monitor  O2 and the last 2 nights no o2 less than 90 and desaturation of only 1 and 4 respectively.  

Still very puzzled by watchpat sleep study results but if you think I’m good then I will cancel the titration.
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