Second sleep study necessary?

I used a cpap for about 7 years, but I have not been using it regularly recently. Recently my blood pressure has been creeping up and my doctor suggested I get a another sleep study done so I did the take at home test and it turns out and I actually really do need to using a cpap every night.

I have 10 year old Auto CPAP and plan to upgrade my equipment (looking at the new Dreamstation Auto). The sleep study testing facility wants me to come back for a second sleep study to determine my titration levels. My question is there any reason to pay for second sleep study for titration if I plan on using an Auto CPAP? I figure within a couple weeks of looking at the data from the auto cpap I should know where my pressure levels should be if I want to tighten up the range. Do I really need to pay for this a second sleep study for titration? I would really appreciate some knowledgable advice.

Andrew J

With an auto machine, you should be able to titrate you own pressures. Since you used CPAP before, I would start with your previous pressure setting. Make the minimum 1-2 lower and the max 5 higher and see what happens over a few days. Be sure to get a machine that is fully data capable and download Sleepyhead software to monitor your pressure.

It's becoming more common for people (doctors, insurance companies) to bypass the in lab titration in favor of just using an apap machine to figure out pressure needs. Kaiser does it routinely and saves the in lab titration sleep studies for the problematic cases.
If it were me I would put the in lab titration on the back burner and try apap first and see how things go. You can always have the in lab titration later if you run into problems.

is there any reason to pay for second sleep study for titration if I plan on using an Auto CPAP?

I had to go for the titration or medicaid wouldn't have paid for my machine (I probably could've convinced my doctor to write the prescription for it anyway, but don't really have $300-500 for a machine out-of-pocket). I tried to use the same argument of "Won't an auto cpap machine essentially do the titrating for me?" - but they claimed it caused more harm than good, if they were to do things that way (which didn't and still doesn't make sense to me)

dbreweur wrote:

is there any reason to pay for second sleep study for titration if I plan on using an Auto CPAP?

I had to go for the titration or medicaid wouldn't have paid for my machine (I probably could've convinced my doctor to write the prescription for it anyway, but don't really have $300-500 for a machine out-of-pocket). I tried to use the same argument of "Won't an auto cpap machine essentially do the titrating for me?" - but they claimed it caused more harm than good, if they were to do things that way (which didn't and still doesn't make sense to me)

Who is "they" ?

If you are paying out of pocket, I'd follow Pugsy's advice. It's pretty easy to see what you need if you have a data capable machine. Otherwise, check with your insurance to find out if a titration is necessary. It is with Medicare, but not necessarily other insurance. This answer also assumes that apnea is your primary issue and that you don't have other things going on like lung underfuction or heart issues.

if the sleep study is FREE then do it because for insurance to pay for a new machine a new sleep study would help.
if sleep study costs more than a hundred dollars for example then just buy a new machine on the internet. I think this site sells them.

I am on SSI my sleep study was 100% free and my machine was free and I get a new mask every 3 months and a new hose every 3 months.


So it all depends on your insurance.

@LSAT - I was told that by the ENT's office. I don't know if that was them saying that it did more harm or if it was Medicaid saying that and the office staff was just passing along the message. Needless to say, I'm no longer going to that ENT for a variety of reasons (Including, but not limited to, calling me a drug seeker when I went off of my GERD medication for a week before a procedure and needed a refill to start it up again).

I had my 3 month follow up last week.
My pulmonologist turned sleep doctor was glad that I'd self-titrated and come up with pressure settings lower than he prescribed that still kept my AHI under 2.

Instead of having just one night of sleep in a strange place to determine the best pressure levels, you have al the time in the world to test various pressures when you do it yourself.

So, do whatever gets you the machine you want at the lowest out of pocket cost, and feel free to adjust pressure for the best results.

In my case, my AS10 likes to ramp up pressure to whatever the max limit is set for, even if that limit is much higher than needed to minimize my AHI.

As my doctor says, my current settings are 'practically turning an autopap into a CPAP', because I start out at 7.0 for 45 minutes so that pressure changes don't interfere with going to sleep, then I let it float between 7.0 and 8.0.

My settings determined by my lab titration were 5.0 until sleep onset, then auto 9.0-12.0. I soon found that a major leak would trigger a rise in pressure, and pressures above 11 on a nasal mask would cause me to wake up feeling suffocated as air roared into my nose and straight out my mouth.

I probably could have just started out with a 4-20 range and used Sleepyhead to figure out that 10 cm was more than enough, and gradually lowered the pressure from 10 to find my minimum therapeutic pressure.
I never did find out what my minimum therapeutic pressure was, by the time I got down to 7.0 dropping the pressure 0.2 per day, I realized that if I kept lowering the pressure much further I'd start feeling starved for air. Since anything between 7 and 8 is very comfortable to me and controls my OSA, I just let the machine do whatever it wants in that narrow range.

Taxmantoo wrote: I soon found that a major leak would trigger a rise in pressure

you're mistaken about that, leaks absolutely do not cause pressure increases. in fact, major leaks will cause pressure decreases as the machine tries to get the mask to seal.

something else is causing your pressure increase.

here's an example of major leaks causing pressure decrease: