Sleep study over

[vancity]

Hi again, had an overnight sleep study done on May 23rd.
Hooked me up with all the leads, very similar to the study 4 years ago I had...even had the exact same room.
The tech asked me some questions about my current machine settings etc. Told her I currently was on Autopap @ 10.5 to 13 cm range for pressure.
She said she would start at a straight CPAP pressure of 7.0. I said it would be too low, bit she said "Dr's orders". She would be monitoring everything and adjusting pressure remotely.
I took an Ativan 10 min before laying down on the prison bed. After 20 minutes of just laying there I took a 2nd Ativan to help me sleep.
That seemed to do it. The next thing I knew she was waking me up. It was morning. She said to take a shower and the "Dr" would be in to see me for a "few" minutes.

I overheard the tech and Dr talking in the next room before I saw him. She told him that a pressure of 7 was pretty food for me. He came in my room with a Rx of 7 cm ( CPAP). I told him I was already using Autopap 10.5 -13 and that was working not to bad for me these days ( see charts before overnight study below). I said to my self that I would try a CPAP pressure of 7 and see what happens.
This is what happened last night.. Pressure 7 (straight CPAP mode)



The following 2 charts were from the 2 nights before the sleep study. Autopap 10.5 - 13




So as you can see the 2 nights before were pretty good. The Dr giving me a Rx of 7cm after the sleep study resulted in an AHI of 9.9 , but funny there where no OA on that chart...only H.
Really confused now. Why would the overnight study give a pressure of only 7 cm? The machine they used was a big one (twice the size of mine) Was the pressure of 7 on their machine equal to 10 or 11 com om mine?? It's like she didn't even monitor me during the night...she was suppose to increase pressures as I was getting OA's and H's. Totally shocked at this.

My follow up isn't until June 24. I also have to an overnight oximety done, but I think it kinda wasted at a pressure of 7.
I sometimes wonder if these people actually know what they are doing.

ps On the first chart there are no OAs, only HAs. Is these because they are not being read because the machine eas on strait CPAP mode? There was not bottom chart either.

Thx for listening. Any suggestions/feedback appreciated.

[Stormynights]

Makes you really feel sorry for the poor people that don't know about this forum.

[nanwilson]

I don't get it either as straight cpap should have shown your ahi the same as your apap at home. Your ahi at home's 90% was 11,.... should be the same on either machine.
We have known sleep centers to completely blow the assessment before (many times), hopefully those that know more will chime in soon and give some better advice.
Nan

[Kate M]

I don't get it either as straight cpap should have shown your ahi the same as your apap at home. Your ahi at home's 90% was 11,.... should be the same on either machine.

This assumes that the sleep center would keep adjusting the pressure upwards to find the optimal pressure setting. To us, optimal means the lowest possible AHI and the most restful sleep! However, from what I've read and been told, it appears that most sleep centers' titration protocols are to stop adjusting upwards when the AHI is <5 with a Sa02 >90%. I don't think they continue to titrate once they reach this, as their goal in titration is not actually to find the lowest AHI, but the lowest pressure that results in an AHI <5 with a Sa02 >90%.

Also, the number quoted means that 90% of the time, her pressure was at OR BELOW 11, so the 90% number is not necessarily the optimal pressure as I understand it.

Blessings,

Kate

[Stormynights]

I don't get it either as straight cpap should have shown your ahi the same as your apap at home. Your ahi at home's 90% was 11,.... should be the same on either machine.

This assumes that the sleep center would keep adjusting the pressure upwards to find the optimal pressure setting. To us, optimal means the lowest possible AHI and the most restful sleep! However, from what I've read and been told, it appears that most sleep centers' titration protocols are to stop adjusting upwards when the AHI is <5 with a Sa02 >90%. I don't think they continue to titrate once they reach this, as their goal in titration is not actually to find the lowest AHI, but the lowest pressure that results in an AHI <5 with a Sa02 >90%.

Also, the number quoted means that 90% of the time, her pressure was at OR BELOW 11, so the 90% number is not necessarily the optimal pressure as I understand it.

Blessings,

Kate

What did I miss? 9.9 isn't lower than 5. I am not trying to argue just trying to learn.

[nanwilson]

I don't get it either as straight cpap should have shown your ahi the same as your apap at home. Your ahi at home's 90% was 11,.... should be the same on either machine.

This assumes that the sleep center would keep adjusting the pressure upwards to find the optimal pressure setting. To us, optimal means the lowest possible AHI and the most restful sleep! However, from what I've read and been told, it appears that most sleep centers' titration protocols are to stop adjusting upwards when the AHI is <5 with a Sa02 >90%. I don't think they continue to titrate once they reach this, as their goal in titration is not actually to find the lowest AHI, but the lowest pressure that results in an AHI <5 with a Sa02 >90%.

Also, the number quoted means that 90% of the time, her pressure was at OR BELOW 11, so the 90% number is not necessarily the optimal pressure as I understand it.

Blessings,

Kate

What did I miss? 9.9 isn't lower than 5. I am not trying to argue just trying to learn.

Do the math Stormy....9 was always a higher number than 5 when I went to school... but as my grandkids would say " Gram you went to school in the dark ages".

[vancity]

Yes, it's bewildering to me also. I don;t think they really looked at the whole nights data. The tech didn't seem to interested in anything.
It's like four years ago when I had my initial sleep study done...the next morning they said nothing really remarable last night sir, then weeks later at the follow up they told me I had Sleep apnea and PLMD. SO hopefully I will get a more detailed explanation next month. They just don't seem to give a dam.

I think I will try straight CPAP moving it up 1 cm each night. Last night was 7...tonight will be 8 etc until I get back to my 10/10.5 cm range.
I will surely have many questions for the sleep "professional" next month. Lots of print outs to show him.

7 cm pressure after a detailed, overnight sleep study...is redickulous! I really think she didn't even monitor me the whole night.

[vancity]

ps, just to clarify, these 3 charts I posted are from my machine, at home...not from the sleep study. Have no idea what they found out there as they didn't give me any indication of results etc, just I overheard the tech say that 7 cm seemed good for me and the "Dr" gave me the Rx for a 7 cm pressure. ... event hough I told both that I was in the 10-13 range on Autopap.

[DoriC]

Could it be that the double dose of Ativan messed things up with few events and the pressure of 7 was OK for that one night?

[Kate M]

What did I miss? 9.9 isn't lower than 5. I am not trying to argue just trying to learn.

You didn't miss anything The OP didn't tell us what the AHI was during the sleep study titration and as we know, the AHI can be quite different from night to night! The 9.9 was after the study at home on the lower pressure. If they stopped at 7cm during the study, that means they had to think that his AHI was <5 at that pressure during the titration or they would have continued to increase it.

Do the math Stormy....9 was always a higher number than 5 when I went to school... but as my grandkids would say " Gram you went to school in the dark ages".

This is very true, nan, and thanks for the refresher! But don't forget also that May 24th is the day after May 23rd At least it used to be when I learnt my calendar

Yes, it's bewildering to me also. I don;t think they really looked at the whole nights data. (snip)
7 cm pressure after a detailed, overnight sleep study...is redickulous! I really think she didn't even monitor me the whole night.

Contact the sleep center and ask for a copy of your sleep study. You may certainly be right. Either you had a particularly good night of sleep at the sleep center that night (as Dori asks might be due to the Ativan?) or they made a mistake. The only way to know for sure is to have another look at the study results!

ps, just to clarify, these 3 charts I posted are from my machine, at home...not from the sleep study. Have no idea what they found out there as they didn't give me any indication of results etc,

Thanks for the clarification. This is what I understood from reading your initial post.

Blessings,

Kate