First Post - No overnight titration study, is that normal?

averian · Post by **averian** » Mon Dec 22, 2008 1:22 am

Hello everyone. This is my first post, so I wanted to say hello, and mention all of this of course is quite new to me. I'm really excited to have found such a great resource of people and information. I've very recently been diagnosed with mild sleep apnea (~16 AHI), and I have been using an APAP unit for a little over a week now.

In reading up on the forum, I have noticed many people talking about a titration study. I have only had one sleep study done and they did not put me on a xPAP machine that night (IE, no split-night). The Dr. prescribed me a test of an APAP unit in order to get the titration for me and then choose whether an APAP unit or CPAP unit would be preferable long-term. Is it normal for a Dr. to simply use an APAP unit for titration rather than having a second sleep study done?

This is just something that caught my attention since I've been reading a lot about people getting an official titration study and wondered if my scenario was common. Kind regards,

-Mark

bdp522 · Post by **bdp522** » Mon Dec 22, 2008 5:32 am

I don't know how normal it is, but I think it's a good idea. You're getting a couple of weeks of info gathered for use in the decision of pressure needs. I had a titration(1 night) but it didn't go well. They still titrated me at a pressure of 7. Thanks to the wonderful people here, I retitrated myself with my auto and have been doing great ever since!
As for your permanent machine, at the very least demand a machine that is fully data capable.

Brenda

RipVW · Post by **RipVW** » Mon Dec 22, 2008 8:55 am

Hello & Welcome, averian! Glad you found this forum--SO much useful info and SO many helpful people here!

Re no titration study, I think this is normal. In my case, my titration study resulted in a TOTALLY wrong pressure setting, half what it reallly needed to be. When I got my APAP machine a year later, IT found my correct pressure, and all's been great ever since. Good luck!

"You are getting sleepy . . ."

Pinhead · Post by **Pinhead** » Mon Dec 22, 2008 11:26 am

My Dr. told me that Medacaid was looking into using the Auto Machines to do the titrations to save money. I think the night at the sleep center cost about $2,000. I also think that it would give alot better data using the machines for two week. I was able to sleep fairly well both nights at the sleep center, but I spend over 30 nights a year in Hotels, I know alot of people don't sleep at all during the tests.

Jack

mbridget · Post by **mbridget** » Mon Dec 22, 2008 11:47 am

They sent me home with a machine that is recording everything. Good thing, too. I am EXTREMELY claustrafobic and my first 7 nights were hell on earth. There is NO WAY that they would have been able to get any info from me in one night. (beside the fact that I need therapy!!! HAHAH)

JayC · Post by **JayC** » Mon Dec 22, 2008 11:50 am

Mine was a (rushed) split night. Was put on CPAP at 3:30am due to several desats....and not from obstructive apnea.

Was Rx'd an auto cpap.....

The pressure numbers according to my sleep study DO NOT prove out night after night. Luckily, having an APAP is letting me further optimize my therapy to the appropriate number/range.

The multi nights of data --- while sleeping in your usual situation --- is going to give you some good information.

If oxygen stats were an issue in the sleep study, make sure they have a plan to test your stats during all this trial process.

All the best!!

J

Gerald · Post by **Gerald** » Mon Dec 22, 2008 7:46 pm

Mark.....

Whatever you do, don't let them con you into a lower grade machine. Demand (nicely, of course) that you be prescribed an M-Series Auto with AFLEX and an integral Humidifier. Try to get them to prescribe "Encore Viewer" software....and a card reader. You may, however, have to purchase the software and card reader yourself

The Auto M with AFLEX machine is a "5-in-one"......it can be set up to run as.... straight CPAP, CPAP with AFLEX, CPAP with CFLEX, Auto CPAP with CFLEX, or Auto CPAP with AFLEX. Through experimentation, you'll learn which settings are the most comfortable ....and which help you achieve success.

The AFLEX machine is "data capable"....meaning that, with Encore Viewer software, you can manage your own therapy.....you can run your own "titration lite" study....every night if you want to.

Gathering data over a long period of time will show you the best machine settings. All of us are different....and we all require require slightly different settings.

A cheap machine......without software.....is a prescription for failure. It's like trying to catch a greasy little pig....in a dark, foggy room. To catch the little bugger, you have to turn on the lights, and get rid of the fog.

Once you are set up with a good machine.....the nice people on this forum will help you get that pig on the pit......Most of us carry "fog blowers".........

Gerald

bigk · Post by **bigk** » Mon Dec 22, 2008 7:57 pm

averian wrote:Hello everyone. This is my first post, so I wanted to say hello, and mention all of this of course is quite new to me. I'm really excited to have found such a great resource of people and information. I've very recently been diagnosed with mild sleep apnea (~16 AHI), and I have been using an APAP unit for a little over a week now.

In reading up on the forum, I have noticed many people talking about a titration study. I have only had one sleep study done and they did not put me on a xPAP machine that night (IE, no split-night). The Dr. prescribed me a test of an APAP unit in order to get the titration for me and then choose whether an APAP unit or CPAP unit would be preferable long-term. Is it normal for a Dr. to simply use an APAP unit for titration rather than having a second sleep study done?

This is just something that caught my attention since I've been reading a lot about people getting an official titration study and wondered if my scenario was common. Kind regards,

-Mark

I had an at-home sleep study from which the Dr recommended a CPAP trial with an APAP machine. We don't have to have a prescription for CPAP here so after the trial they looked at the data and recommended treatment.

roster · Post by **roster** » Mon Dec 22, 2008 8:32 pm

I had a full night PSG and then a full night titration study. They got the pressure too low and I suffered for two years. Then I had another full night titration study and they set the pressure too high leading to more suffering.

In quick order I got a machine with software and titrated myself with help from members here. In about ten days experimenting at home I found the optimal pressure and I have been using it ever since. It would sure have been better for me to skip the two nights titration and begin my own home titration.

You need to make sure you get a fully data capable machine so you can see leak rates, AI and HI. The best is a machine with software and a card reader.

Members here will be happy to help you.

jnk · Post by **jnk** » Mon Dec 22, 2008 8:35 pm

averian wrote: . . . Is it normal for a Dr. to simply use an APAP unit for titration rather than having a second sleep study done? . . .

I think it is becoming more common. But I don't like it. And, no, it is not standard practice according to a recent (April 2008) PAP Titration Task Force of the American Academy of Sleep Medicine:

"After a patient is diagnosed with OSA, the current standard of practice involves performing attended polysomnography (PSG), during which positive airway pressure is adjusted throughout the recording period to determine the optimal pressure for maintaining upper airway patency." http://www.apneasupport.org/viewtopic.php?t=16738

Skipping that step, to me, is mostly just a way to save money. I don't see how skipping it is in the best interests of the patient, unless the patient can't afford it. And even if everything seemed pretty straight-forward in the diagnostic study, there are numerous advantages to a well trained tech watching to see how a patient responds to pressures, in my not-so-humble opinion.

Having said that, though, I would think that the best way to go about it, if I were in charge and had to make up a system, would be, after the diagnostic PSG, (1) to give a patient an APAP for a few weeks to see what pressures the machine came up with and THEN (2) to start with that pressure in a real titration study in a sleep lab (or, center [nod to SAG]) to see how that pressure worked in REM and deep sleep while closely observing for other possible issues. That way the patient would already be used to the mask and the air, so that those things, at least, might not cause arousals by then.

But that is probably waaaaay outside the box, and I'm likely just dreaming.

Sorry for going off. I do that sometimes.

roster · Post by **roster** » Mon Dec 22, 2008 9:37 pm

jnk wrote: ........I'm likely just dreaming.

.....

Jeff,

It is good to dream but you know well we already can't afford the health care we want. This is headed in the opposite direction of your dream. There is maybe 90%, pick your number, of people with osa who have yet to be diagnosed and treated. There is already a dearth of your well-trained technicians in sleep labs today and a dearth of people qualified to train them.

We have to push for technology to produce good home diagnosis equipment and self-titration equipment. Like you are empowered to titrate and treat yourself, let's make that the model.

Education of patients needs to be addressed also. You got yours (education on osa and cpap) but I suspect your IQ is well above average. We want average and below average to also get diagnosis, education and good therapy.

The sleep center should be used for "problem" cases. To cover the masses, garden variety osa needs to be diagnosed and titrated in a cheaper environment.

BTW, you are a humble guy. Rest easier.

averian · Post by **averian** » Mon Dec 22, 2008 11:54 pm

Wow! Thanks for all these great replies so far! I did go ahead and order a card reader and get software, so that should arrive soon. I figure that is a small price to pay for a better view of the data. Heck, I've spent more on temperature data acquisition for home coffee roasting (haha, clear to me now why that habit has been so integral to my life! Good ol' caffeine)

As for the machine itself, should I push for one with AFLEX or just try and keep the CFLEX one I have? Should I also look into getting an oximeter? (I just checked my sleep study stats and they say 90% saturation during REM).

jnk, your proposed methodology makes logical sense to me, but I'm guessing the insurance companies don't look at it the same way ; )

-Mark

RipVW · Post by **RipVW** » Tue Dec 23, 2008 7:58 am

Since pressure needs can vary throughout the night, as well as over time, I definitely think the best machines are APAPs.

The recording oximeter measures blood oxygen saturation, checks it once per second, records the data to upload to a computer program so one may check for any drops in oxygen saturation (the damaging effect of untreated or unresponsive apnea events). It also records pulse rate data. A great device to double-check CPAP therapy efficacy. It has a "thimble" that you wear on your finger overnight. I don't use it nightly, just periodically to check to assure that all's well.

I rely on mine to give me evidence that my therapy is really working as it should. I love my SPO 7500!

Here's the one I have--worn on the wrist with a cord to the thimble:
http://www.med1online.com/p-40265-spo-m ... 7500f.aspx

Georgio · Post by **Georgio** » Tue Dec 23, 2008 8:12 am

The C-flex machine provides exhalation relief. (Reduces pressure to allow you to breath out)
The A-flex machine, when A-flex is on, provides the benefit of exhalation relief as well as adjusts the pressure when you inhale.
The A-flex is the latest technology, in my opinion is the most comfortable, and feels most like your natural breathing.

In my opinion, auto machines are more comforable than fixed pressure machines.

You can post your reports here when you have them and get some good advice.

Good luck with your therapy,

Georgio

Gerald · Post by **Gerald** » Tue Dec 23, 2008 9:23 am

Mark.....

Push for an AFLEX machine.....because of its versatility.

I have both......a CFLEX.....built before AFLEX became available. It's the one I prefer.

I also have an AFLEX machine......and I use it as a travel/backup machine......BUT, I use it in CFLEX mode. I have it set to exactly match my daily-use machine.

I don't like AFLEX......probably because I started out with CFLEX.

The Oximeter is good to have....because it gives you a 2nd way to observe your therapy. In effect, you're looking at the same problem (sleep apnea) from two different points of view......AHI score which records breathing difficulties......and an Oximeter that records pulse rate and O2 saturation in your blood.

Anytime we can look at a problem from two different directions, we get "depth"......a better understandiong of the monster that's trying to devour us. When we can get the monster (sleep apnea) in a crossfire, it's hard for him to get past us.

I use my Oximeter about once every month....just to double-check....to be sure that I've still got the monster "pinned down".

I use an SPO 7500....and I like it a lot.

Gerald

First Post - No overnight titration study, is that normal?

First Post - No overnight titration study, is that normal?

Re: First Post - No overnight titration study, is that normal?

Re: First Post - No overnight titration study, is that normal?

Re: First Post - No overnight titration study, is that normal?

Re: First Post - No overnight titration study, is that normal?

Re: First Post - No overnight titration study, is that normal?

Re: First Post - No overnight titration study, is that normal?

Re: First Post - No overnight titration study, is that normal?

Re: First Post - No overnight titration study, is that normal?

Re: First Post - No overnight titration study, is that normal?

Re: First Post - No overnight titration study, is that normal?

Re: First Post - No overnight titration study, is that normal?

Re: First Post - No overnight titration study, is that normal?

Re: First Post - No overnight titration study, is that normal?

Re: First Post - No overnight titration study, is that normal?

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