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

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?

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.

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.

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.

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.

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.

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.

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.

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!

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.

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!

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!)