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+--- Thread: Titration results - Should I be mad? (/Thread-Titration-results-Should-I-be-mad)
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Titration results - Should I be mad? - ShallowBreather - 09-16-2021
Hi everyone
It took a couple weeks, but i finally got my titration results. Let me know what you think
Study ran from 10:56 pm to 6:19 am. Total sleep time was 143 Minutes or 38.0% sleep efficiency of 377 minutes. 28 awakenings with total awake time after onset of 187 minutes. Sleep latency was 46 minutes and REM latency was 98 minutes. 64.5% supine.
Stage 1 - 12.5% Stage 2 - 80.1% Stage 3 - 3.8% Stage REM - 3.5%
76 arousals for arousal index of 31.8 and 83 stage shifts.
CPAP was initiated at 8 cmh20 and snoring was eliminated at 8. There were 66 respiratory events of 56 apneas (0 osa, 0 mixed, 56 central) and 10 hypopneas. The mean oxygen during the study was 96% with a min of 81%. There was 3.8 minutes of sleep time below 90% and 3.1 minutes below 88%. No cheyne -stokes.
I was transitioned to bipap due to persistent centrals. A backup rate of 11 breaths/minute was added to bipap of 18/14 cmh20. Leaks were minimal.
Pap. Backup. TST %Sup. SupAHI. REM. RAHI.CAI. HI. AHI. Arldx. Nadr. AvgO2.
08 0 17.5 min 100% 65.1 0 min -- 51.4 13.7 65.1 30.9 81% 94%
10 0 47min 100% 15.3 0 min -- 10.2 5.1 15.3 15.3 88% 94%
12 0 21min 90% 34.7 5 min 12.0 34.3 2.9 37.1 31.4 87% 96%
14/10 0 15min 40% 50.0 0min -- 52.0 4.0 56.0 40.0 85% 96%
16/12 0 31.5min 0% -- 0min -- 1.9 0.0 1.9 19.0 90% 95%
18/14 0 10min 15% 40.0 0min -- 42.0 0.0 42.0 54.0 87% 96%
18/14 11 1.5 min 100% 0.0 0min -- 0.0 0.0 0.0 0.0 95% 98%
5 periodic limb movements, 3 associated with arousals. PLM 1.3
Average heart rate 68. 65 - 80 range. No arrhythmias.
Diagnosis
Obstructive sleep apnea
Treatment emergent sleep apnea
1. At 16/12 bipap the off-supine apnea/hypopneas and arousal indexes normalized. Snoring eliminated. Oxy sat maintained above 89%. (To me,this should be the end of the discussion). At 10 cmh20 less centrals were seen during supine NREM sleep.
2. Abnormal sleep architecture due to respiratory events, PAP, and first night effect.Sent
Recommendations
CPAP of 10 cmh20. Should AHI remain elevated, patient should return for a full night titration starting at 16/12 with backup rate of 11. (You don't say, Sherlock!?)
Okay, I'm a side sleeper. The 16/12 with 0 backup fixed me!! My low sleep/REM times makes it difficult to get my diagnosis right, I'm sure, but am I crazy to say that when you can hit a home run you shouldn't settle for a base hit?
RE: Titration results - Should I be mad? - srlevine1 - 09-16-2021
(1) Why would you be mad? It's a snapshot in time that produces data.
(2) I would return and await the results of titration.
(3) Then get a script for a data-capable Bi-Pap machine and try the recommended settings before experimenting.
(4) You may wish to consider getting a ResMed 10 unit as there is some question of whether the new ResMed 11 series allows data access by OSCAR.
You don't say how you feel?
Best of Luck with resolving your sleep issues.
RE: Titration results - Should I be mad? - SarcasticDave94 - 09-16-2021
If I read this right, you had all centrals and they moved you to BPAP without backup rate? They're idiots. Go ahead be mad. Tell them Dave says they're stupid.
Ok an edit there was a backup rate and they're still stupid. So how many tests with boat payments are really required? GREEDY STUPID QUACKS
PS I'd have kept this in your therapy thread. Now the story is broken up.
RE: Titration results - Should I be mad? - Gideon - 09-17-2021
What were the results of your diagnostic study? We're Centrals dominant there?
The normal process, not our choice, for any SDB, Sleep Disordered Breathing, seems to be start on CPAP, if you fail, usually because of centrals, try a BiLevel without backup, which will most likely fail, then a BiLevel with backup, fail there then try an ASV which is actually designed to treat centrals
RE: Titration results - Should I be mad? - ubersteiny - 09-17-2021
Gideon, I just looked at their initial thread and their sleep study results with no mask on were "15 apneas (3 obstructive, 1 mixed, and 11 central) and 27 hypopneas. AHI was 35.5 and CAI (central apnea index) was 9.3."
RE: Titration results - Should I be mad? - Geer1 - 09-17-2021
This data looks borderline useless in part because you didn't get enough sleep and in part because they are avoiding ASV. They recommended trying CPAP at 10 cm which actually had the lowest arousal index. 16/12 sounds like it fixed most of the obstructive looking events although your initial study seemed like 6 cm did the same. The period of 11 backup rate was useless data as it was only 1.5 minutes long.
The diagnosis of treatment emergent centrals is possible (seems to get exaggerated) but you have had centrals at every level of testing done (no CPAP, basic CPAP and now with CPAP and bilevel.
Two options. Get a machine and try it out to see if things improve or get a second titration study in which they focus almost primarily on treating centrals. This should be done with ASV as it is far superior to fixed bilevel with backup rate when it comes to treating central apnea. Fixed bilevel with backup rate is old technology so these doctors are either living in the past or avoiding ASV for some unknown reason.
RE: Titration results - Should I be mad? - Sleeprider - 09-17-2021
Unless they are willing to trial ASV you won't get the therapy you need. The only satisfactory titration was at 18/14 with a backup rate of 11 on ST bilevel. Their prescription of CPAP at 10 is a failure at over 15 AHI and SpO2 to 88%. What this test proved is that you need a backup rate, and should be retested for ASV in order to find appropriate lower pressure that allow you to sleep and that properly treat your condition. I think you should be blunt in questioning why ASV was not tried or even suggested for future titration. Depending on what you hear, you can probably conclude this medical group is not going to help you, and you need to locate a practice that understands and treats central and complex sleep apnea, or self-treat.
RE: Titration results - Should I be mad? - SarcasticDave94 - 09-17-2021
"15 apneas (3 obstructive, 1 mixed, and 11 central) and 27 hypopneas. AHI was 35.5 and CAI (central apnea index) was 9.3."
To me, this says ASV is needed. CA are about 3.7 times more than obstructive. Again, you may quote me, they're stupid.
RE: Titration results - Should I be mad? - ShallowBreather - 04-23-2022
Okay, playing catch up here. After the second titration listed above, I got into a tiff with my primary doctor. And he referred me to the sleep disorder specialists.
And that's when I met Kassandra in October, who after about 15 minutes agreed that I need the better machine. And she set up a 3rd sleep study (with Lunesta). Her orders were "Since he has a primary CSA at baseline and not just treatment emergent CSA, a full night Bilevel S/T titration starting with Bilevel S/T 11/6 cmH2O and BUR of 11 bpm. with Transcutaneous CO2 monitoring was ordered."
Enter incompetent sleep tech Melvin. I showed up for my third sleep study, got hooked up and went to sleep. In the morning, I asked Melvin, "How'd we do?" He said, "Great, we never even got above 12 cmH2O." That seemed odd since we were supposed to start at 11. "And," he added, "I never even had to turn on the bipap." I said, "But that's what I came."
Melvin left me at 5 for 45 minutes, 7 for 40 minutes, 9 for an hour, 10 for 35 minutes, and 12 for 2 full hours. Yep, he treated me like a new patient.
When I went in to "discuss the results" of my study, I said, "Alright, first I'd like to know why Melvin did what he did." She had no answer of course.
Due to some changes in my job, I was without insurance for a couple months. Then I met a new sleep therapist lady. She made me redo my 3rd titration in March of 2022 (and credited the one that Melvin messed up). I began this saga 7/29/21. What's another titration?
PAP BUR TST %Sup SUPAHI REM RAHI CAI HI AHI ArIdx Nadr AvgSa02
11/6 11 8.5m 100% 63.5 0.0 -- 0.0 63.5 63.5 35.3 84% 88%
12/6 11 38.5m 100% 18.7 0.0 -- 0.0 18.7 18.7 20.3 84% 91%
13/6 11 40.0m 84% 5.4 15.0m 12.0 1.5 12.0 13.5 13.5 82% 92%
14/6 11 24.0m 0% -- 0.0m -- 15.0 20.0 35.0 30.0 81% 93%
15/6 11 30.0m 0% -- 9.0m 0.0 0.0 8.0 8.0 24.0 90% 93%
16/6 11 109.5m 15% 14.5 24.5m 0.0 0.5 3.3 3.8 18.6 84% 93%
17/7 11 27.0m 2% 120.0 7.5m 0.0 6.7 2.2 8.9 11.1 85% 94%
192 limb movements.
They really seemed to like the 16/6 with 11 backup rate.
For awhile it looked like I might get an ASV machine, but at the last second, they gave me an AirCurve 10 ST.
I've only had it about a week. My current settings are:
IPAP 15
EPAP 9
Resp Rate 10
ramp 400 ms
TiMax 2.1
TiMin .3
Trigger Med
Cycle High
I started with a F&P Simplus, but for some reason the start of exhalation felt like I was falling off a cliff. They tried to put Cycle at Low, but I think that made it worse. Then I realized that I was actually after a more "effortless" exhale, so I raised the Cycle to High. But I think maybe the harsh exhale had to do with the mask itself, maybe the one-way valve in the port???
Current mask is Swift FX.
With those setting and mask, here is last night. And a close-up of some odd breathing patterns that I had about 5 am; I was super relaxed but not asleep. I couldn't sleep because I kept cycling into hypopnea. Thoughts on that?
RE: Titration results - Should I be mad? - ShallowBreather - 04-24-2022
Night of 4/23/22.
At 4:30 am, after bathroom break, I tried to drop the ramp from 400 ms to 300 ms. It made me breathe easier, but I seem to have become less stable and O2 dropped.