Wasted Titration Sleep Study ??

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Wasted Titration Sleep Study ??

Postby CrohnieToo » Sun Sep 10, 2006 9:16 am

I just did my titration sleep study this past Thursday. It was a total bust. I should have cancelled it and didn't. About an hour before I was to leave for the sleep clinic my sister in law called from Maine (we are in Michigan). My hubby's brother had been taken off life support and it was just a matter of time. I didn't want to leave my hubby alone after receiving the call but he insisted that I could not cancel at such a late hour and that I have the titration study done. Against my better judgement I did go.

I would swear I did NOT sleep a wink all night except for a short 5-10 minute doze about 1-2 AM. I woke up from that short dozing breathing easier than I was able to breathe all night once we started the "pressure". Shortly after that "nap" it got more and more uncomfortable trying to breathe. It became an effort to breathe. So I just started breathing thru my mouth, it was easier and more comfortable. We had tried 3-4 masks and ended up deciding to go w/the nasal pillows. It was early morning before I had enough sense to tell the tech that it was too uncomfortable and too much effort to breathe and that it was easier to breathe thru my mouth. She said I shouldn't even be able to breathe thru my mouth but I could -and much more comfortably! So we tried again when she told me I should tell her when it was an effort and uncomfortable to breathe w/the mask on which I started doing.

I don't understand this "ramping" bit at all. She tried to explain it. I just really wasn't "with the program" and wasn't grasping what she was trying to tell me. It was an effort to exhale so I asked her to turn the pressure down. It turns out according to her that I was having more problems at 5 than at 6 or 7. I never had any problem w/inhaling at any pressure, but exhaling WAS. It was too much effort and uncomfortable, feeling like I wasn't able to breathe sufficiently. Why would it be harder to exhale at a pressure of 5 than at 6 or 7?

While I swear I did NOT sleep other than that short 5-10 dozing "nap" about 1-2 AM my tech insisted that I did drop into stages 1 & 2 sleep twice during the night. But never got more than that nor reached any other stages of sleep. I have never had such a bad night of sleep that I can ever remember in my life! #-o

I can't imagine that we learned ANYTHING of any value from this titration study at all! Will they still try to script a C-PAP for me based on this titration study? After two previous sleep studies, one about 1998 and one early this year the pulmo said "he" would have suggested a Bi-PAP rather than a C-PAP, but last night only the C-PAP was tried. I was told that I would be contacted by the DME supplier w/in 24 hours of this study to bring out the equipment and I told them NOT to order ANYTHING until I saw the entire report and graphs and talked to the sleep study doc who is only in this clinic once every 3 weeks. The sleep docs at this sleep clinic alternate.

So, what do you sleep RTs think? Was this titration study sufficient? I will be able to pick up the report and graphs, etc. Tuesday or Wednesday. I was unable to get a flight for both of us and was fortunate to purchase the last seat on a flight from here to Maine for my hubby so he will have to go to the funeral alone but will be staying with a favorite brother and sister in law and will have 4 brothers and 1 sister plus the in laws there plus a favorite nephew.
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It's Too Soon To Tell

Postby sleepydave » Sun Sep 10, 2006 6:22 pm

Hi crohnietoo:
I see you got a few questions floating around here, so briefly, in no particular order:

Wait till the results arrive before you decide what value the study was or wasn't. If they were as bad as you say, they will speak for themselves.

Video monitoring rarely if ever provides any significant clinical data (unless maybe a parasomnia or a seizure shows up). Otherwise it's only used to verify position, keep track of the patient to see if they need help, make sure they're not lying on the pulse oximeter probe--- stuff like that. All the data is in the NPSG.

Linda gave a great explanation of ramp, but since I have one too, I'll put it in to make it look like I have a long post.

Ramp simply allows a CPAP machine to start at a lower than prescribed pressure, and then gradually build to the therapeutic pressure over a period of time, generally up to about 45 minutes, depending on the machine. This may allow patients on uncomfortably high levels of CPAP to achieve sleep before the high pressure hits. Whenever you awaken, you can then hit the ramp button again, so whenever you're awake, low pressure, when you're asleep, therapeutic pressure.

In looking back over your posts, I don't see where you ever used CPAP before. Is this the first time you ever actually tried any kind of pressure therapy? If not, the difficult exhalation on minimal pressure sounds odd. I wonder if the exhalation vents were functioning properly (very unlikely if you tried several masks), or if that was in fact, 5 cmH2O.

If this is the first time, then I'd look at nasal narrowing/congestion, and be thinking about a full-face mask, hybrid, or something along that line.
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Postby CrohnieToo » Sun Sep 10, 2006 8:33 pm

Thank you so much, Dave. I had a sleep study and titration study w/a C-PAP back in 1996-1998, somewhere around in there. I had exhalation problems then too but I figured out how to get along w/the C-PAP by adjusting how I held my tongue whilst awake before I drifted off. I felt that it "taught" or reminded me to exhale more strongly and would have continued w/it but I didn't have a good mask fit and either it was leaking and blowing into my eyes or if I moved it down a bit I got raw between the lip and the nose. When I talked to my DME supplier they told me I would have to personally BUY each mask I wanted to try and the price was outrageous so after 3 1/2 months I took the equipment back to the DME supplier and told them what they could do with it and have gone w/o all these years. I have, and did have at that time as well, COPD.

I'm still skepical on whether I need C or Bi-PAP. I was somewhat skeptical after the sleep study in March and asked my family doctor about trying overnight 02 which he scripted. The DME supplier's overnight oximetry indicated that I did qualify for 2L 02 overnight as did the overnight oximetry for Medicare and I've been on the 2L of 02 for 6 months. The sleep pulmo suggested an overnight oximetry at 3 months after starting the 2L of 02 which I thought looked good but he suggested otherwise so I agreed to this titration study.

What has me really confused was that back in 1998 he was the followup pulmo after that titration study and he said he would have tried me on Bi-PAP rather than C-PAP. And again after this year's sleep study he indicated he thought that I would do best on Bi-PAP. My copy of my report he had written: Bi-PAP. Bilevel pressure therapy. Yet, what did they try but this C-PAP.

Actually, I haven't slept good since a whiplash and blackout in 1994. I was always until then a tummy sleeper. I had to teach myself not to sleep on my tummy after that whiplash (and still can't) due to not being able to turn my head either direction that long.

I do on occasion experience RLS, the jerking, but so far as I am aware only just prior to sleep and its never woke me up if I do encounter it whilst sleeping. I have on occasion not only had that startled type jerking of the legs but also a quick jerk or spasm of the entire body. Rarely tho. And prior to dozing off during this titration study just the left leg did do the twitching or jerking bit. But never that I am aware of other than that early bout before I dozed off. We shall see. I sure hope this titration study wasn't a waste of time but the circumstances leading up to starting didn't make for anywhere near a usual night's sleep. I realize you do not get a "normal" night's sleep during a titration study. I didn't expect to but I sure didn't expect what I did encounter. At least I got some sleep that I was aware of and knew I had that 1998 titration study!

Thanks for the ramp explanation. We did try 3-4 face masks w/pressure before we tried the nasal pillows and the pillows did work the best. I had leaks no matter what we tried w/each of the masks. Frankly, I so suspect some nasal narrowing or congestion. I always seem to have a small amount of nasal congestion on the right. I've always suspected due to both an NG tube for 6 weeks that left 3 bloody rings on the tube and got very painful the last week before I lost my temper and pulled it out myself. Plus I had an RV awning support come down hitting across the bridge of my nose from left to right that caused me to black out for a short time. But its never been enough of a problem that I would even consider surgery for a deviated septum!!!

When I get my report and the graphs I'd sure appreciate it if you wouldn't mind advising me of what you think if someone can handwalk me on how to reproduce it for you. Thank you again so very much!

Oops! I forgot. During this March's sleep study that led up to the titration study I had "events" ONLY when supine. And I trained myself well because I still never slept on my tummy!
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Humidifier: Resmed H3i
Year Diagnosed: 2006



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