Titration test necessary?

I finally got my results back....Severe OSA....which I had already presumed...I had up to 79 events with low O2. They want me to do a Titration test and possibly a Bipap. Is that test absolutely necessary? I kinda have a feeling my insurance will deny it...they denied the in lab study, so I did a 2 night test at home. Is a bipap better than an apap? How bad as far as comfort is a titration test? I tried to youtube it but there really isn't anything.

Personally, I think they will probably approve the titration study. Most insurance companies start with the home study, then allow an in laboratory study if indicated as necessary. If they approve the test, it will make thing much easier if you do need the bi-level machine. I had a titration study before I got my machine, and was prescribed a bi-level machine as my first machine. If they do not do the titration study, they will probably start you out with an APAP to see what pressure you need. Then, if that does not adequately treat your condition, you will have to fight with your insurance to get them to pay for a second machine.

See if you can get the event category breakdown of that AHI.
It might give us a clue why they are talking bilevel so soon before even starting anything.
But in general...bilevel opens up some potentially useful doors to therapy that aren't available with traditional cpap/apap.
One big plus...of the 2 main bilevel machine makers...ResMed or Respironics...you don't have to worry about the DME trying to sneak a brick no data machine in. All the bilevel newest line of bilevel machines from those 2 manufacturers are full efficacy data machines.
If they want to give you a bilevel machine...take it. There's no down side to it.

Pugsy wrote: ↑

Wed Apr 04, 2018 6:49 am

See if you can get the event category breakdown of that AHI.

When they called, they said that they didn't have the full completed result, but had enough to let me know the diagnosis. Explained that I hand 79 events and what not...I emailed them and asked if they could send me what they do have so that I can go over them again...she was talking so fast on the phone, i was cooking dinner at the same time...it was hard to get all the info she rattled out...lol

I'm a lil more relieved to hear that the bipap machines are good ones if that is what it comes to.

Thanks for the info guys...I'm feeling better about this process the further I go along. Now, they told me to figure out what mask I want to try...that will be the hard part...lol I'm a mouth breather..so I think I will try a full face first. One of the members on here was nice enough to send me free of charge a new Dreamwear FFM kit. So i'm looking forward to trying that one out after reading a lot of the positive reviews on it.

AirMech74 wrote: ↑

Wed Apr 04, 2018 7:36 am

When they called, they said that they didn't have the full completed result, but had enough to let me know the diagnosis. Explained that I hand 79 events and what not...I emailed them and asked if they could send me what they do have so that I can go over them again..

I would wait to see what the detailed results are before you make any final commitments. The 79 is probably the AHI which is the total events per hour, so more than one a minute which is high. My wife was diagnosed with about the same. I was diagnosed with an AHI of 37. We both use an auto CPAP and she gets a treated AHI in the 1.0 range. I have averaged 3.7. Under 5.0 is considered acceptable. Why the difference? Well she has almost all obstructive apnea events (OA) which are well treated with a standard auto CPAP, while I have a significant number of central apnea events (CA), which are not well treated with a standard machine, and may even be increased. So the key part to consider in this is your ratio of CA events to to the total number of events in the sleep study. If the CA's are in the 50% or higher range then for sure you would be a candidate for more than a standard auto CPAP, and you should be titrated to see what works. There is a range of fairly basis bilevel machines to some very sophisticated ones that are bordering on a ventilator system.

On the mask, if they are going to provide one for a test, I would suggest you try the nasal pillow type like the ResMed AirFit P10, as well as the full face one you have. You could find it much more comfortable. Yes, mouth breathing can be a problem, and we all do it to some degree I'm sure. But, we can learn not to do it, and if you only mouth breath occasionally it can be only a minor issue.

In case you want information here is a PDF that kind of goes over what sleep tech is doing.
https://www.google.com/url?sa=t&source= ... noXCbbI-DC

As far as discomfort it's just weird having all the wires on and it will be your first time with a mask it sounds like.

You could ask if you can use melatonin to help you sleep. I was told taking it wouldn't effect results at all.

It's not a bad process at all.

My doctor prescribed Ambien for me to take during my last two sleep studies. I slept most of the night with no problem.

Okie bipap wrote: ↑

Wed Apr 04, 2018 6:32 pm

My doctor prescribed Ambien for me to take during my last two sleep studies. I slept most of the night with no problem.

That seems a bit strange. I think drugs like that can increase central apnea events which could skew your test results.

Ron AKA wrote: ↑

Wed Apr 04, 2018 7:34 pm

I think drugs like that can increase central apnea events which could skew your test results.

And why do you think that?

Ron AKA wrote: ↑

Wed Apr 04, 2018 7:34 pm

Okie bipap wrote: ↑

Wed Apr 04, 2018 6:32 pm

My doctor prescribed Ambien for me to take during my last two sleep studies. I slept most of the night with no problem.

That seems a bit strange. I think drugs like that can increase central apnea events which could skew your test results.

If you take certain drugs I know you have to let then know so they can notate it when looking at results. I was told they didn't need to know about melatonin, at least at my location that was the case.

Taking one Ambien for one sleep test night is NOT going to induce centrals or anything else - ridiculous! Possibly even a majority of people here have taken one for their study and been fine... and if they did not take it, and had trouble sleeping, they complained loudly about how useless the study was given it's usual circumstances.

Some medications are known to suppress respiration and thus increase the chance of centrals happening but Ambien isn't in that league of meds. It's commonly prescribed to be taken during sleep studies to help people sleep at all in that foreign sleep lab setting.
My sleep doctor routinely prescribes it for both the diagnostic test and the titration study if it's done on a separate night.

Muscle relaxers....can make the OSA worse. That's it makes the already floppy saggy airway tissue even more floppy.

Meds that can suppress the respiratory system can make centrals worse but it isn't a given that they will make centrals worse.
It depends on the person and the med and whatever. Those that can suppress respiration ..... mainly pain meds of the heavy duty variety...opiods...methadone...that kind of stuff.

Now all this doesn't mean that a person can't take these meds if they have OSA or central apnea...just means that extra caution needs to be used. Some years back I did something stupid and fell and broke my wrist bad enough requiring surgical pins. It hurt BAD....and I most definitely needed the opiod type of pain meds at bedtime to sleep. You know what....didn't have any more centrals on the opiates as I saw normally. Not everyone will have a problem with these types of meds.
So don't be afraid to take them if you need them but just be careful and always with your doctor's supervision.

As to Ambien causing centrals...extremely, extremely unlikely in most of the population.

palerider wrote: ↑

Wed Apr 04, 2018 9:48 pm

Ron AKA wrote: ↑

Wed Apr 04, 2018 7:34 pm

I think drugs like that can increase central apnea events which could skew your test results.

And why do you think that?

I was recalling that Tiger Woods was using Ambien when he had the little run in with the fire hydrant, or was it a tree...

Ron AKA wrote: ↑

Fri Apr 06, 2018 1:41 pm

palerider wrote: ↑

Wed Apr 04, 2018 9:48 pm

Ron AKA wrote: ↑

Wed Apr 04, 2018 7:34 pm

I think drugs like that can increase central apnea events which could skew your test results.

And why do you think that?

I was recalling that Tiger Woods was using Ambien when he had the little run in with the fire hydrant, or was it a tree...

I don't understand why you make a connection between ambien and the resultant sleepyness with any kind of breathing disturbances.

palerider wrote: ↑

Fri Apr 06, 2018 4:17 pm

Ron AKA wrote: ↑

Fri Apr 06, 2018 1:41 pm

palerider wrote: ↑

Wed Apr 04, 2018 9:48 pm

Ron AKA wrote: ↑

Wed Apr 04, 2018 7:34 pm

I think drugs like that can increase central apnea events which could skew your test results.

And why do you think that?

I was recalling that Tiger Woods was using Ambien when he had the little run in with the fire hydrant, or was it a tree...

I don't understand why you make a connection between ambien and the resultant sleepyness with any kind of breathing disturbances.

Central apnea is caused by issues with the autonomic nervous system. If you take something that affects the way the autonomic nervous system works, you can potentially influence the incidence of central apnea. No I have not done specific research on it, I was just saying it could be an issue. I guess if it is prescribed as a matter of routine when sleep tests are done, then perhaps someone has actually researched it and eliminated it as a complicating factor. I was not prescribed any when I did my sleep test.

On a quick look, I found this study which concluded that it was not a problem.
https://www.ncbi.nlm.nih.gov/pubmed/16944674
A quote: "CONCLUSIONS: Acute administration of zolpidem 10 mg does not impair the efficacy of an effective level of CPAP in patients with severe obstructive sleep apnea."

And this article which suggests there may be a problem.
http://www.mysleepapneamd.com/blog/slee ... pnea-worse