Last night was night 7, and although I've adjusted well - several nights over 7 hours, great leak rate - my AHI and particularly AI still seem high, and my blood pressure was creeping back up.  Not wanting to distract from getting adapted to the equipment, I didn't do a pulseox study until last night, but thought it was time.

Strangely, last night I woke and wanted to take the mask off after only 2 1/2 hours.  The fingertip pulseox monitor was lying underneath me, and that's never happened before (without CPAP).  My body was jonesing O2, so I turned on the O2 concentrator and wrote it off to an odd night.

But this morning I checked the O2 report and it's no surprise my subconscious woke me up - several long and significant desats, and a pulse rate ramping up all night long.  But great pressure and NO leaks on the CPAP.

I'd never gotten the "full" reports from either my initial or titration study, although I'd seen the 1 1/2 page summaries.  I didn't worry about it too much, because I discussed the titration outcome with the tech before I left, and know there's a bit of trial and error involved starting up anyway.  But based on not improving as much as I expected, and the rather scary O2 results, I thought I'd best go track them down.

Well, there's a whopping ONE more page available for each night.  It's a graphical data summary, very hard to read, and not at all what I was expecting.  I asked repeatedly - is this it? - and they said that's all they have.  My bet is they don't know how to print out the detail report.

But what I could tell, is that despite what the tech told me, they never got me titrated supine or on my right side with AHI below 10.  So no great surprise I'm not where I would expect out here in the cold, real world.

Yes, this is an accredited lab.


_________________
Marie
Newbie with Severe OSA
ResMed S8 Elite II CPAP with EPR and H4i humidifier
ResMed Mirage Quattro full face mask
Contec CMS 50-E Pulse Oximeter

mreewh wrote:

But what I could tell, is that despite what the tech told me, they never got me titrated supine or on my right side with AHI below 10.  So no great surprise I'm not where I would expect out here in the cold, real world.

Yes, this is an accredited lab. :evil:

Unfortunately, I am not shocked to see this. Accredited labs need to be scrutinized as much as non-accredited labs, so thats that.

Anyway, you can always call the DME to see if they can get the physicians office to bump up your pressure.

What does the impression on the sleep report say? Does it make mention of the markedly high supine AHI?

RAM_Sleep wrote:

What does the impression on the sleep report say? Does it make mention of the markedly high supine AHI?

From trying to interpret the one page data summary, it looks like there was probably less than 10 minutes in the supine position while I was actually asleep in the initial study.

The report says "This study was performed in the lateral positions."   Are sleep tests normally done in non-lateral positions?  No quantification of percentages whatsoever, let alone AHI numbers in left, right, supine, or "front".

Years ago I had a large lesion in my liver and trained myself to sleep on my left side to prevent it from keeping my stomach from emptying while asleep.  Since that time I've reverted somewhat to occasional sleeping on my right side, but I rarely sleep on my back.  My fiance tells me that's when my most spectacular snoring is done, though.

I remember the sleep tech asked me via the intercom toward the end of titration to lay on my back.  Looks like I stayed that way for about 20 minutes, then rolled to my right side.  It looks like the final titration pressure of 13 included about 7 minutes supine and 45 minutes on my right side, with an AHI of 6.67.

I realized the pressure to start CPAP is sortof a !@#! anyway, but it would sure have been helpful if the sleep doc who supposedly read the report had said something like "not really enough time supine, closely monitor results for first week to possibly increase pressure".

And speaking of the sleep doc, I see no evidence he read the preliminary report or put any thought into the final - it's copied verbatim from the sleep tech's initial report.

This is a small city ... I ran into my sleep tech out shopping this weekend.  She was complaining to me about how she always pulls her mask off in her sleep after about 4 hours, and how she's got to be re-titrated for BiPAP, because "it's just not working".


_________________
Marie
Newbie with Severe OSA
ResMed S8 Elite II CPAP with EPR and H4i humidifier
ResMed Mirage Quattro full face mask
Contec CMS 50-E Pulse Oximeter

Are sleep tests normally done in non-lateral positions?

Well, a good titration should have a few values...

Baseline (120 minutes or more) with dozens of respiratory events.

Optimal pressure in the lateral position (including a REM session)

Optimal pressure in supine position (including a REM session)

-=-

If an optimal pressure in the supine position can not be reached, then the physician can write that up in the report. Also, if a patient can not tolerate a high pressure, then its possible that the pressure be dropped (assuming that you are forcing yourself to sleep on your side only).

Thanks for your input, RAM.  I suspect that even if I had a more detailed report, it would still be a pretty incomplete picture.

I'm going to bump the EPR down tonight and see if I can tolerate it, if it improves my AHI at all, and what my O2 / pulse looks like.

It's frustrating because I've been wanting to go on vacation for months, and this process has been dragging on since July.  I really don't want to bring the standard oxygen concentrator on this trip if I don't have to - and Apria requires 2-3 weeks notice to get a portable one.

And I had been able to get my blood pressure down on just O2, and I don't want to see that continue back up again.
.


_________________
Marie
Newbie with Severe OSA
ResMed S8 Elite II CPAP with EPR and H4i humidifier
ResMed Mirage Quattro full face mask
Contec CMS 50-E Pulse Oximeter

mreewh wrote:

Thanks for your input, RAM.  I suspect that even if I had a more detailed report, it would still be a pretty incomplete picture.

I'm going to bump the EPR down tonight and see if I can tolerate it, if it improves my AHI at all, and what my O2 / pulse looks like.

It's frustrating because I've been wanting to go on vacation for months, and this process has been dragging on since July.  I really don't want to bring the standard oxygen concentrator on this trip if I don't have to - and Apria requires 2-3 weeks notice to get a portable one.

And I had been able to get my blood pressure down on just O2, and I don't want to see that continue back up again.
.

Keep in mind that your DME may be able to authorize a bump in pressure, if you need.

Also, you may want to try a night where you prop yourself up on your side.

An adjustment to the EPR may make your machine recorded AHI better, but it is likely that that setting will not impact your "actual" event total(s).

mreewh wrote:

I'm going to bump the EPR down tonight and see if I can tolerate it, if it improves my AHI at all, and what my O2 / pulse looks like.

I tolerated it relatively well.  I can feel it this morning - not as much as I felt the first couple of days for CPAP overall, but can tell I made a change.  Like the muscles in my upper chest got a bit of a workout - not a bad thing.

My AHI was the best yet at 11.x.  My O2 still wasn't where I'd like it to be at 92.9, but it's a bit better.  My pulse was a bit elevated for the first 4 hours or so, but actually came down for the last part of the night.  The trend is in the right direction.

RAM_Sleep wrote:

Keep in mind that your DME may be able to authorize a bump in pressure, if you need.

It would help if they would return my calls.  And then they'll have to get my doctor's office to return their calls, which typically takes up to 3 business days.

Quote:

An adjustment to the EPR may make your machine recorded AHI better, but it is likely that that setting will not impact your "actual" event total(s).

The Pressure value displayed in Results was a bit higher today.  I wish there was information provided on what that number really means.  I'm accumulating a list of questions to ask ResMed and this is one.  Despite a significantly higher leak rate, it still appears to be within a functionally acceptable range.


_________________
Marie
Newbie with Severe OSA
ResMed S8 Elite II CPAP with EPR and H4i humidifier
ResMed Mirage Quattro full face mask
Contec CMS 50-E Pulse Oximeter

The EPR is decreasing the pressure, so that it is not as difficult to breath out against. Turning the EPR off will indeed increase the average pressure from the night because the machine isn't ramping down a million times during the night.

However, EPR is not used in the titration process and better used for patient comfort. The problem is that data collected from the machine is not really THAT accurate, so what I would assume is happening is:

With EPR, the shift in pressures (alongside not being titrated properly) is causing arousals, which can very easily create post arousal apneas and movements, which all register on the machine (as events). Heck, a spontaneous arousal can be picked up by the machine as a respiratory event. Turning the EPR off may eliminate a few of those spontaeous arousals and thus make your overall AHI better or more confusing still, the constant pressure (eith EPR =0) may be enough to keep a few of the light hypopneas out of sight, therefore making the overall AHI slightly better.

I hope that everyone gets back in touch with you because it appears that you have a few more cms of h20 until you are properly titrated. It stinks to go through everything only to find that you are still at mild to moderate OSA.

If I can help in anyway, then let me know!