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Fireguy
Unread post  Post subject: Question updated titration study  |  Posted: Fri Apr 08, 2016 6:00 pm

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Hello all, I'm new to this forum but not bipap treatment. I have been using bipap for severe OSA for 4 years now. My doctor just sent me to the sleep clinic for a titration study due to headaches and daytime sleepiness. I was using a resmed s9 with resmed airfit p10 nasal pillows with a bipap setting of 8/4. The study was done with my mask but the clinic bipap. I was told my settings had to be changed to 14/8. I have been changed to a resmed aircurve 10 and have been struggling with sleep. The pressure is difficult to get used to and its forcing my mouth to open thereby affecting and treatment.
My question is does anyone know if it's possible that the titration study could be wrong? The reason I ask is because my ahi at 8/4 would be between 1and 4 most nights and with the new pressure it has remained the same. I have tried a chin strap with minimal success so tonight I am switching to the resmed airfit f10 full face mask. I'll see how that goes, but I really love my airfit p10! I don't feel much better so I have to question the pressure change. Any feedback would be greatly appreciated.


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diamaunt
Unread post  Post subject: Re: Question updated titration study  |  Posted: Fri Apr 08, 2016 7:34 pm
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certainly, the one night snapshot into your sleep could be wrong.

if you consider all the factors, strange environment, strange bed, strange wires and tubes and stuff on you, it's actually a bit amazing that they're ever right in the first place ;)

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Fireguy
Unread post  Post subject: Re: Question updated titration study  |  Posted: Sat Apr 09, 2016 5:26 am

Joined: Fri Apr 08, 2016 5:34 pm
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Yeah, I would agree it's amazing they are ever correct. My 1st study ever done said I didn't have OSA but a 1 1/2 years later and a study at another sleep clinic showed I had severe OSA. My Dr. said there is no way that you didn't have severe OSA with the first study! This is kind of why I question this study. Just not sure that my pressure number can double in 3 years with no other change except gaining 10lbs. I am 5'9" and was 165lbs. now I am 175lbs. Just curious if anyone else has experienced incorrect titration studies?


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diamaunt
Unread post  Post subject: Re: Question updated titration study  |  Posted: Sat Apr 09, 2016 11:43 am
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you've got a full data machine, are you using resscan or sleepyhead to monitor your data?

were you looking at your data before? most of the answers are probably in there.

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Fireguy
Unread post  Post subject: Re: Question updated titration study  |  Posted: Sat Apr 09, 2016 12:46 pm

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I did look at the AHI before on the s9 and its remained about the same on aircurve v10 even with the new pressures. I hate to admit it but I don't know much about sleepyhead or rescan. From your post and others on this forum it looks like that something I should be looking into. I just don't know how to read that data.


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diamaunt
Unread post  Post subject: Re: Question updated titration study  |  Posted: Sat Apr 09, 2016 1:48 pm
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AHI is trying to summarize an entire night into a single number....

it's of statistical interest, but it tells you nothing about WHY it was a bad night.

go read through this: https://sleep.tnet.com/resources/sleepyhead

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Fireguy
Unread post  Post subject: Re: Question updated titration study  |  Posted: Sat Apr 09, 2016 2:40 pm

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Wow, what a great link. Thanks diamaunt, I will spend some time reading this and downloading the software. You have been very helpful!!


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Fireguy
Unread post  Post subject: Re: Question updated titration study  |  Posted: Mon Apr 11, 2016 8:44 am

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Attachment:
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Okay I downloaded sleepyhead but have no idea how to interpret the data! I have attached a few screen shots if you have any thoughts please pass them on. Not sure if I attached them correctly. Forgive me I'm a newbie to this.
Thanks


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diamaunt
Unread post  Post subject: Re: Question updated titration study  |  Posted: Mon Apr 11, 2016 1:39 pm
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this (one of the links on the page I gave you first) shows how to organize, and screenshot a *single* page of data from sleepyhead, so as to present the majority of useful information in one screenshot:
https://sleep.tnet.com/resources/sleepyhead/shorganize

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Fireguy
Unread post  Post subject: Re: Question updated titration study  |  Posted: Mon Apr 11, 2016 3:56 pm

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Thanks again Diamaunt! Here is the one screen shot with hopefully all the important info. Any thoughts?


Attachments:
screenshot-20160411-184632.png
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diamaunt
Unread post  Post subject: Re: Question updated titration study  |  Posted: Mon Apr 11, 2016 4:15 pm
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hopefully our clever host will have something on this, the fact that you had all UAs is strange, normally, one only gets UAs on the adapts, and if your leaks are really bad... and yours aren't.

from that one night, I don't have a feeling of which way to go... more pressure, less ps... anything.

if it were me, I'd probably put the machine in vauto mode, and see what it wanted to do, something like minepap 8, ps 3, maxipap 15...

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Fireguy
Unread post  Post subject: Re: Question updated titration study  |  Posted: Mon Apr 11, 2016 5:07 pm

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I like your last thought regarding the auto mode and it's what I was contemplating. Again, I was just switched form 8 ipap and 4 epap to 14/8 and I'm thinking the study was flawed because the closer I set my bipap to those higher numbers the worse my sleep is.
I do hope our expert host or anyone else has some input!
Many thanks for the tutorial links to sleepyhead as it's something I should have looking at previously!


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Fireguy
Unread post  Post subject: Re: Question updated titration study  |  Posted: Tue Apr 12, 2016 4:28 pm

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So last night I changed to ipap 9 and epap 6 and this is the data. Looks better than the previous night with 11/8? Again I still really don't know how to read the charts but I feel I slept better! Anyone with any thoughts? Which way to go from here Up or Down with the epap and ipap?


Attachments:
screenshot-20160412-191908.png
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diamaunt
Unread post  Post subject: Re: Question updated titration study  |  Posted: Tue Apr 12, 2016 5:56 pm
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what i can't figure out is why they're showing up as UAs when your leaks are reasonable... *scratching head*

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Fireguy
Unread post  Post subject: Re: Question updated titration study  |  Posted: Wed Apr 13, 2016 3:45 pm

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Just checked last nights data and the UAs came down again but still there. Other than the words I have no idea what a UA is (lol) but as long as they keep dropping I think it's good!
I have decided to lower tonight's setting to 9/5 and see what happens over a few nights.
Although not a goal, I'm almost back to my original settings of 8/4 which really makes me wonder about my most recent titration study. Not that I think anyone did anything wrong but I do feel at this point it was somehow flawed! I am I crazy or is this a little weird?


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diamaunt
Unread post  Post subject: Re: Question updated titration study  |  Posted: Wed Apr 13, 2016 4:04 pm
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Unidentified Apnea.

here's a video explaining how the machine determines a CA or OA, (central or obstructive apnea). if it can't figure out which, it logs a UA.

https://www.youtube.com/watch?v=4GW97Xk ... tml5=False

as to how crazy you are.... remember sleep tests are NOT a good sample of how you sleep. you're in a strange bed, wearing strange wires, in a strange environment, possibly with a different mask, and someone fiddling with your machine settings (remotely) and then taking what may be the best 20 minutes of the night and saying "HERE'S WHAT YA NEED! hurdadurrr.

it's not a wonder that they get it wrong, it's a wonder that it's ever right.

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Fireguy
Unread post  Post subject: Re: Question updated titration study  |  Posted: Wed Apr 13, 2016 4:57 pm

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Wow you took something I thought was fairly scientific and methodical and broke it down to a very clear example of how they should never be accurate! Lol What a great analogy. Our host does have a video that kind of explains how they sometimes go wrong when things are rushed!

I did watch the video and and my take away is that the machine would seem to be better at identifying an OA as opposed to a CA. Just my thought based on the mechanics of a blocked airway. I'm just trying avoid the OAs as I play with the settings. My Dr. said he trusted me to tweek the settings as long as I stayed at 8 epap because as per this study it would avoid the OAs. But it's clear to me that over several nights the 6 epap setting has kept the OAs at bay!


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diamaunt
Unread post  Post subject: Re: Question updated titration study  |  Posted: Wed Apr 13, 2016 8:37 pm
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the process is fairly scientific and methodical...

the squishy meatbag that the process is applied to is anything but.... ;)

at best, it's a single frame out of the feature length movie that is your sleep life...

once you've been on cpap for a while, and you've settled on settings, you'll have good days and (if you're lucky) less good days without changing *anything* on the cpap, because... squishy meatbag...

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Fireguy
Unread post  Post subject: Re: Question updated titration study  |  Posted: Thu Apr 14, 2016 5:35 am

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Haha, you're too funny with that analogy!


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Fireguy
Unread post  Post subject: Re: Question updated titration study  |  Posted: Fri Apr 29, 2016 4:41 pm

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Okay, so i have been staying with 9 ipap and 5 epap for a few weeks now and here is the last 2 nights of data. This has been the average most nights with a few higher ahi nights.
Two questions remain:
1- why the ua is still there?
2- should i further raise the pressure to bring down the ahi and ua?
Anyone with thoughts?


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