Sleep Study and Titration Study over...now what will happen?

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Allessio77 +0 points · 9 months ago

These are the results of my studies:

Original Sleep Study

Sleep Efficiency 78% REM Sleep 9.7% Apnea Events 12/hr Hypopnea Events 18/hr AHI 30/hr 0 Obstructive Events, 73 Central Apneas, 0 mixed, 111 hypopneas 0 RERA Cheyne Stockes was observed 158 desaturations Lowest SaO2 78% Average SaO2 89% 219 Arousals: 78 Respiratory, 69 Leg, 67 spontaneous, 5 snore PLMS Index 36/hr

Titration Study

Sleep Efficiency 49% REM Sleep 5.4% Apnea Events 13/hr Hypopnea Events 13/hr AHI 26/hr 0 Obstructive Events, 45 Central Apneas, 0 mixed, 43 hypopneas 0 RERA Cheyne Stockes was NOT observed 86 desaturations Lowest SaO2 87% Average SaO2 92% 152 Arousals: 53 Respiratory, 26 Leg, 70 spontaneous, 3 snore PLMS Index 3.8/hr

I go to the Doc next Wednesday...what will she prescribe? what should she prescribe?

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wiredgeorge +0 points · 9 months ago Sleep Enthusiast

Folks will shy away from second guessing what your doc may say. It doesn't appear as though the titration study pinpointed an appropriate pressure(s) but I am not sure I can read those stats well enough to say. Suggest you wait till tomorrow and see what your doctor says as they are pros and not patients like we are.

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sleeptech +0 points · 9 months ago Sleep Commentator

I will refrain from commenting until you have spoken to your doctor, because they should be your primary source of medical info. However, once you have, I will be happy to offer an opinion.

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Allessio77 +0 points · 9 months ago

I was hoping to get some info going into the appointment. What issues should I look to discuss? I want to be my own advocate. I will of course post the results of the appointment.

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wiredgeorge +0 points · 9 months ago Sleep Enthusiast

Obviously you should ask the doctor to interpret all the techno mumbo jumbo into English. You blood/oxygen saturation did improve somewhat during the titration study so perhaps therapy did have some positive effect but the other numbers were hard for an amateur (like me) to make sense of.

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Allessio77 +0 points · 9 months ago

Finally I get to see the doc...based on the data above she immediately prescribes an ASV machine (which is what I suspected based on all the CA's).

Then going over my Echocardiogram to see if there is a correlative heart problem, she stumbles upon the fact that I took my sleep test at a different elevation than the elevation of my residence. (I live at 3500 ft and the test was done at 7200 ft.).....SO she says I have to have another test at that lower elevation.

Seeing how dejected I must have looked, she suggest that If I take a APAP machine now and try it for a month, she will be able to tell if the CA''s are gone, or if I need a new titration for the ASV at the lower elevation. She suspects that the CA's will not be there at the lower elevation, given I don't have any heart problems or other ovious causes for the CA's.

So, that is where it stands. I will get the APAP hopefully next week, and begin to accumulate data for her to analyze.

I am very disappointed...I was looking forward to some relief from this tiredness and headaches...but if this works, it would be quicker than scheduling another 'split study' at my residential elevation (which would probably take 4-6 weeks).

Will this plan work? Can the APAP show CA's? Will the APAP relieve any of my symptoms? Does the ResMed APAP send data directly to the doc? I have my next appointment 1/10/18

Why can't anything ever go smooth? Sad.

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wiredgeorge +0 points · 9 months ago Sleep Enthusiast

I don't think the Doc has anything to do with the data. I am pretty sure compliance data goes to the DME and ResMed gets the data itself which is then available to you using the myair program. I think if some of the metrics are beyond a limit, the MyAir programe kicks out automated emails like check mask fit, etc. but I don't think a human, other than you sees actual metrics from ResMed.

Be patient and stay with the doc's recommendations as they are surely more educated than forum members who are mostly just amateurs with subjective personal experience. I think 3500 feet means little but the 7200 feet would make a person a little short of breath I think. When the Spurs play in Denver, it is like watching a bunch of zombies due to the atmosphere and last year when they played in Mexico City, they definitely were sucking air. I think the elevation may be complicating results for sure.

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sleeptech +0 points · 9 months ago Sleep Commentator

Your sleep study results suggest that CPAP was ineffective. There may have been a hint of underlying obstruction but the central events seem to be the main problem (bear in mind I'm only going by the data you reported above). The APAP will report central events if they happen, and it SHOULD also resolve any obstruction, so it could confirm this diagnosis. I believe your doctor can get a report from the data transmitted by your machine (so the rep told me last week), but we don't do that here yet so I don't have first hand experience of what that data would be like. ASV could well help, but it is not the magic bullet for central apnoea that some doctors think it is. I imagine that the elevation would affect your baselone oxygen saturation, and possibly emphasise desaturations, but beyond that I'm not sure.

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Allessio77 +0 points · 9 months ago

I just spent my first night with the APAP. As you suggest, the device prevented most obstructive events, but the central events remained. I had a AHI of 3.6 with 21 CA, 3 OA, and 4 Hypops--so 75% of events were Centrals. If this is confirmed , how long do you think i should wait to contact the doc...I think she would have access to this info through MyAir (the Resmed cloud app).

(These results are far better than my orig PSG with an AHI of 30.2 in which I had no OA, but did have significant Ob Hypops.)

Also, you mention that an ASV might help, but is not a magic bullet...could you elaborate?

Thanks for ur comments.

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sleeptech +0 points · 8 months ago Sleep Commentator

An AHI of 3.6 is pretty good and suggests that you may not need BiPAP. 21 central apnoeas over a night is not a lot. Many people have some central events just as they are falling asleep (which we call sleep onset) but they disappear once sleep is properly established. These are called, rather unimaginatively, onset events. Onset events would more than account for 21 events and they are not a problem unless they regularly prevent you from getting into proper sleep. Also, the machine will always overestimate your AHI. It's designed that way, as most medical equipment it. The idea being that if there is something wrong it will pick it up but f it says there is nothing wrong it is pretty reliable.

When I say that ASV is not a magic bullet, it is because it was designed for one very specific purpose - the treatment of Cheyne-Stokes in the setting of low CO2 (I have met the people who invented it). It does this very well, but this is a very rare condition. ASV stands for Auto Servo Ventilation and, unfortunately, some doctors see "Auto" and assume that means that it is an automatic BiPAP that will automatically fix any problem. It doesn't. It is far more common that people who use BiPAP do so because they need to get more air in and out when they breathe and ASV does not do this. If anything, ASV is actually deigned to reduce the amount of air you are breathing (because Cheyne-Stokes respiration is a result of hyperventialtion - breathing too much). Sometimes ASV can be effective in treating central events when oxygen and carbon dioxide are otherwise normal, but definitely not always. Does that help you at all. I'm afraid it's all a bit technical.

After all that, as I said before, you may well not need BiPAP with those results.

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AmicableLimeMule6438 +0 points · 9 months ago

I'm the mother of a teenager who has been recently diagnosed with sleep apnea. I've been browsing this forum to educate myself, I'm no expert but I may be able to offer you some advise. My son had his first sleep study at a low elevation (about 500 feet). Sleep apnea was not on the radar, so I was surprised by the diagnosis of mild sleep apnea. At the advise of one of my son's local doctors we did another sleep study at the elevation we live (7000 feet) and the findings were substantially different. His AHI was 13 higher than it was at the lower elevation. He had 0 central apneas at the lower elevation but at higher elevation his central apnea index was 5, and his oxygen saturation was also substantially lower. Based on my very limited experience I think your doctor is wise to want to reevaluate because the study was done at higher altitude than you live. Your doctor's plan sounds reasonable. If I were in your shoes I would go ahead and schedule the sleep study. If the doctor can successfully treat you with the data from the machine you can always cancel the appointment, if your still not satisfied after 6 weeks you'll have things lined out and won't have to wait on the sleep study.

Because my son is hypoxic his doctor did not want to wait on a titration study. She plans to look at the data from his CPAP machine and have the DME company adjust the pressure as needed. The key to getting my son's data from the CPAP machine to the doctor was the DME company. When you pick up your machine ask them to program the machine to send the info to your doctor. As I said I am no expert and I don't know anything about your specific machine. My son's machine has a modem that automatically sends data to the DME and my insurance company. The DME company told me all they had to do to get the doctor the data was to add her to the list of places the CPAP machine sends data to.

Good Luck!

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Allessio77 +0 points · 9 months ago

Teen Mom...I do believe my machine was hooked up by the DME to send data to a place where my doc might look at it. I hope I can get her to do so....and I hope the data is sufficient for her to see what is going on.

(See my comment to SLEEPTECH above about my 1st nights results).

Thanks for your interest.

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Allessio77 +0 points · 9 months ago

I am on my second night with my New Resmed APAP and use Sleephead to look at my data.

My AHI has decreased from 30.2 on Orig PSG to 3.6 and 75% of those events are Centrals.

I also was alarmed to notice that on the 2nd night I had 14 minutes of Cheyne Stokes...continuous. (CSR was observed on my orig PSG also).

How serious is this matter/ Should I call the doctor now or wait for more date...this is only my second night.

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sleeptech +0 points · 8 months ago Sleep Commentator

14 minutes is not long. Also, it is rare for genuine Cheyne-Stokes to occur for such a short period, so the machine may have misread it. It would normally occur for most of the night (approximately 80% of your sleep). I wouldn't be too concerned just yet.

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wiredgeorge +0 points · 9 months ago Sleep Enthusiast

Hard to assess how serious a stroke is but if it were me, I wouldn't play around. Call your doc. I also believe that unless a doc gets an account with ResMed and requests specific patient's data, I wouldn't think they get the same MyAir data... My PCP and "sleep doc" sure don't get mine. My DME gets enough to make the call on compliance. Sounds like therapy is going OK except for the Cheyne Strokes and I doubt many here can offer educated advice on that issue except to talk to doc ASAP. Good luck!

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Allessio77 +0 points · 9 months ago

thanks George, I do have a call into the doc and am anxious to see what she says. It doesn't sound to me like something to fool around with. I will post the results of our conversation here for anyone interested in this case.

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Allessio77 +0 points · 9 months ago

The Medical Assistant for my doc called and told me to watch the charts for a couple of weeks and then call back if this persists or worsens. She indicated she would inform the doc of my phone call--I sure hope she does. (The doc was ready to prescribe and ASV at my original diagnostic appointment until she noticed that I took my PSG at and higher altitude than my residence (by 3500FT) and wanted to see if these central and CSR exist at the lower altitude. THEY DID AT LEAST LAST NIGHT!)

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