Replies to This Discussion

Permalink Reply by Judy on July 22, 2009 at 6:52pm

Well, while we often are SURE we don't sleep in a particular position, our back or tummy or sides, it is not at all surprising that it turns out we really do spend some time of the night in that position and just are not aware of it. Its always a wise idea to at least TRY. If we really can't sleep in that position that will be ovious during the study as well but we should at least try.

They didn't start out at your current pressure because they wanted to ensure that those pressures were not too high and possibly causing centrals and the cause of your lack of relief w/your current therapy. The very fact that this study they came up w/13 and 9, rather than 18/14 is a good indicator of that.

Hopefully you won't have to wait too long for the full results - and even more hopefully some restful sleep!

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Permalink Reply by RockRpsgt on July 23, 2009 at 1:58am

Burden of proof. this is why they can't start you on the same pressures. In your situation you are still tired. The doc writes up an order with a Dx of daytime somnolence caused by possible inadequate titration. It is up to the tech to provide evidence of this Dx and present it to the Doc for interpretation. There are several reasons to start you at a lower pressure. Most of them for insurance purposes. A tech must first prove that you still need the treatment. This is done by lowering your pressure enough so that events can be seen again. Next the tech must find the lowest possible pressure that the events can be fixed( again). Finally they must provide evidence that nothing else is inhibiting your sleep. ie; RLS or parasomnias.

I did find a few things that I would like to question about your experience.

1-How could the tech say that you were overtitrated if you never slept on your back? Optimal titration usually produces Supine REM. I would very much like to see the data from your first titration to see if there was any supine sleep.

2-If you were being tested for daytime somnolence why was an MSLT not ordered after you psg? An MSLT is THE test for this Dx. The change in your pressure could have been a reason for canceling, but it still should have been ordered.

3-13/9 still seems like a very mechanical titration. I would ask the lab what their protocol for Bpap titrations are. If they raise both EPAP and IPAP at the same time for all events chances are you were not optimally titrated. I guess the fact that you did not sleep on your back would make that last statement a fact.

If they give you the option for a new machine get an auto loner. Check the numbers yourself. Just my opinion though.

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Permalink Reply by Duane McDade on July 23, 2009 at 5:02am

I will keep it simple. The Technician wanted you to sleep on your back because this is where you'll be the most obstructed.
It's not about snoring. Snoring is only a symptom. It's a indication that there is something that is impeding the air while it travels to your lungs. I'd say it's more important during the CPAP testing. To sleep on your back. Now let's talk about Overtitration and Central Apneas. When someone is overtitrated they have central LIKE apneas. Central Apneas are very rare. This is where your brain/survival function stops working until the oxegen level gets to the emergency wake up zone. 98.5% of sleep Apnea cases are O.S.A (obstructive sleep apnea) You don't want Central Sleep Apnea! Thats a symptom to some other PONS MYLAN stuff. In my lab if you say someones having centrals you have to show this to the doctor and present your case like a 1st year public defender.......19 times out of 20 it's mixed or Obstructive.

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Permalink Reply by bonesigh on July 23, 2009 at 8:54am

Thanks Judy. Don't remember ever having awoken on my back but I guess it's possible. I sure hope they adjust the pressure soon. Quite often the air trying to escape into my stomach would wake me up.

Judy said:

Well, while we often are SURE we don't sleep in a particular position, our back or tummy or sides, it is not at all surprising that it turns out we really do spend some time of the night in that position and just are not aware of it. Its always a wise idea to at least TRY. If we really can't sleep in that position that will be ovious during the study as well but we should at least try.

They didn't start out at your current pressure because they wanted to ensure that those pressures were not too high and possibly causing centrals and the cause of your lack of relief w/your current therapy. The very fact that this study they came up w/13 and 9, rather than 18/14 is a good indicator of that.

Hopefully you won't have to wait too long for the full results - and even more hopefully some restful sleep!

• ▶ Reply

Permalink Reply by bonesigh on July 23, 2009 at 9:17am

Thanks Rock. Hmm, I'd like to see if I slept supine in the first study too. When I tried to pick up all the paperwork at Kaiser Hospital they only had a few pages of dictated results. No graphs or anything! I'm going to contact Sleep Med today and ask for those papers. I hope they have them.

I'll have to look up MSLT as I don't remember what that is. I'll ask about the protocol. I tried real hard to go to sleep on my back, wish I could have. Are there usually more than one person in the sleep lab? I asked the tech if there were other people there and he said yes but I never saw anyone else. Guess I should have insisted on seeing them.

I'm going to beg the doc for a auto machine. Will this fix the titration for me if it's not too far off??

Rock Hinkle said:

Burden of proof. this is why they can't start you on the same pressures. In your situation you are still tired. The doc writes up an order with a Dx of daytime somnolence caused by possible inadequate titration. It is up to the tech to provide evidence of this Dx and present it to the Doc for interpretation. There are several reasons to start you at a lower pressure. Most of them for insurance purposes. A tech must first prove that you still need the treatment. This is done by lowering your pressure enough so that events can be seen again. Next the tech must find the lowest possible pressure that the events can be fixed( again). Finally they must provide evidence that nothing else is inhibiting your sleep. ie; RLS or parasomnias.

I did find a few things that I would like to question about your experience.

1-How could the tech say that you were overtitrated if you never slept on your back? Optimal titration usually produces Supine REM. I would very much like to see the data from your first titration to see if there was any supine sleep.

2-If you were being tested for daytime somnolence why was an MSLT not ordered after you psg? An MSLT is THE test for this Dx. The change in your pressure could have been a reason for canceling, but it still should have been ordered.

3-13/9 still seems like a very mechanical titration. I would ask the lab what their protocol for Bpap titrations are. If they raise both EPAP and IPAP at the same time for all events chances are you were not optimally titrated. I guess the fact that you did not sleep on your back would make that last statement a fact.

If they give you the option for a new machine get an auto loner. Check the numbers yourself. Just my opinion though.

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Permalink Reply by bonesigh on July 23, 2009 at 9:34am

Thanks Duane. I didn't know that central was rare. My husband supposedly has that with OSA. Is that what mixed is and are the centrals not real centrals? I wonder if his diagnosis is correct? His was done by Sleep Med too which I'm starting to not have much faith in. He still snores, slightly, with his machine. It was hard enough to get him to go for a sleep study in the first place and I've mentioned that he go back but I don't think he will. He doesn't even wear his mask all the time. He goes to sleep and then later puts the mask on, sometimes it's hours later and he still takes naps without it at all. It scares me. If it is central should he be having any other tests done?

Duane McDade said:

I will keep it simple. The Technician wanted you to sleep on your back because this is where you'll be the most obstructed.
It's not about snoring. Snoring is only a symptom. It's a indication that there is something that is impeding the air while it travels to your lungs. I'd say it's more important during the CPAP testing. To sleep on your back. Now let's talk about Overtitration and Central Apneas. When someone is overtitrated they have central LIKE apneas. Central Apneas are very rare. This is where your brain/survival function stops working until the oxegen level gets to the emergency wake up zone. 98.5% of sleep Apnea cases are O.S.A (obstructive sleep apnea) You don't want Central Sleep Apnea! Thats a symptom to some other PONS MYLAN stuff. In my lab if you say someones having centrals you have to show this to the doctor and present your case like a 1st year public defender.......19 times out of 20 it's mixed or Obstructive.

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Permalink Reply by RockRpsgt on July 23, 2009 at 2:23pm

I am not saying that this was a bad study. That would be very naive of me without being there. We do not know what that tech saw. Those are just some of the questions that came up for me when reading your original post. An MSLT is done during the day to test for daytime sleepiness.

http://www.sleepguide.com/forum/topics/narcolepsy-and-hypersomnia.

Mixed apnea are apneas that have both obstructive and Central characteristics. The important thing to remember is that central apnea always has an underlying cause.

http://www.sleepguide.com/forum/topics/central-sleep-apnea-sleep

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Permalink Reply by bonesigh on July 23, 2009 at 3:26pm

Rock, I didn't necessarily think you meant it was a bad study but it did make me think about not blindly accepting the diagnosis given the previous possible mistake. Thanks for the info as I am trying to educate myself as much as possible in order to help myself. I was thinking that possible non accurate titration would be a good argument for the doctor to give me an auto pap since I can't sleep on my back.

Again, is there supposed to be more than one tech at the sleep study?

Rock Hinkle said:

I am not saying that this was a bad study. That would be very naive of me without being there. We do not know what that tech saw. Those are just some of the questions that came up for me when reading your original post. An MSLT is done during the day to test for daytime sleepiness.

http://www.sleepguide.com/forum/topics/narcolepsy-and-hypersomnia.

Mixed apnea are apneas that have both obstructive and Central characteristics. The important thing to remember is that central apnea always has an underlying cause.

http://www.sleepguide.com/forum/topics/central-sleep-apnea-sleep

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Permalink Reply by Judy on July 23, 2009 at 3:47pm

No, BoneSigh. In fact, I think the "norm" is 1 tech per 2 patients. Altho there is no rule to that effect to my knowledge.

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Permalink Reply by bonesigh on July 23, 2009 at 3:48pm

Okay, thanks!

Judy said:

No, BoneSigh. In fact, I think the "norm" is 1 tech per 2 patients. Altho there is no rule to that effect to my knowledge.

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Permalink Reply by RockRpsgt on July 23, 2009 at 3:59pm

Judy is right. AASM guidelines require 1 tech per 2 pts.

bonesigh said:

Okay, thanks!

Judy said:

No, BoneSigh. In fact, I think the "norm" is 1 tech per 2 patients. Altho there is no rule to that effect to my knowledge.

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Permalink Reply by Duane McDade on July 24, 2009 at 3:23am

I'd would say that if there is snoring Central Apneas are not the problem. The Obstuction is causing the snores the snores are not made by the brain. I'm not going to say the diagnosis is wrong, but maybe the term Central Sleep Apnea needs to be researched by these folks. I've know what they are for 6.5 years now. When you have Central "like" apneas during a treatment it's a reasult of overtitration, it sort of like eating too much .....sometimes you stop to take time to swallow. We could get real technical and say it's because of twenty or thrity medical terms and five pages of pointless data. Maybe compare Rat apnea to mice apnea. I main reason for someone to use Bi-Level insted of CPAP will and should be tolerance.

bonesigh said:

Thanks Duane. I didn't know that central was rare. My husband supposedly has that with OSA. Is that what mixed is and are the centrals not real centrals? I wonder if his diagnosis is correct? His was done by Sleep Med too which I'm starting to not have much faith in. He still snores, slightly, with his machine. It was hard enough to get him to go for a sleep study in the first place and I've mentioned that he go back but I don't think he will. He doesn't even wear his mask all the time. He goes to sleep and then later puts the mask on, sometimes it's hours later and he still takes naps without it at all. It scares me. If it is central should he be having any other tests done?

Duane McDade said:

I will keep it simple. The Technician wanted you to sleep on your back because this is where you'll be the most obstructed.
It's not about snoring. Snoring is only a symptom. It's a indication that there is something that is impeding the air while it travels to your lungs. I'd say it's more important during the CPAP testing. To sleep on your back. Now let's talk about Overtitration and Central Apneas. When someone is overtitrated they have central LIKE apneas. Central Apneas are very rare. This is where your brain/survival function stops working until the oxegen level gets to the emergency wake up zone. 98.5% of sleep Apnea cases are O.S.A (obstructive sleep apnea) You don't want Central Sleep Apnea! Thats a symptom to some other PONS MYLAN stuff. In my lab if you say someones having centrals you have to show this to the doctor and present your case like a 1st year public defender.......19 times out of 20 it's mixed or Obstructive.

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