How can one night in a lab give accurate titration

Man, I have learned alot in my 10 days as a CPAP-ER (kudos kudos kudos to all of you on here and thanks).. However, since I have been playing with my APAP it is clear that one days worth of data doesnt mean too much and that we have to paly with settings at days of weeks at a time.. I understand why and see wild differences in each night of sleep that I have.. So, this being the case, isnt getting titrated for life on cpap based upon 5 HOURS OF SLEEP IN A STERILE/NON-WARM AND FUZZY location) prettty much guarantee that they will miss the mark?? As I read more and more and as the days go on and on (and this absurd obsession that I hope stops , it just seems that there are so many variables......

neillebo wrote:Man, I have learned alot in my 10 days as a CPAP-ER (kudos kudos kudos to all of you on here and thanks).. However, since I have been playing with my APAP it is clear that one days worth of data doesnt mean too much and that we have to paly with settings at days of weeks at a time.. I understand why and see wild differences in each night of sleep that I have.. So, this being the case, isnt getting titrated for life on cpap based upon 5 HOURS OF SLEEP IN A STERILE/NON-WARM AND FUZZY location) prettty much guarantee that they will miss the mark?? As I read more and more and as the days go on and on (and this absurd obsession that I hope stops , it just seems that there are so many variables......

Yes! BUT......"they" (the system) want to make sure they keep you coming back and spending more of your (out-of-pocket and insurance) money by giving you the cheapest mask and non-data-capable machine they have, to get you started. They KNOW that the failure rate is around 50% so IF you don't tough it out, why give you better equipment if it's only going to end up in the closet. And, IF you manage to decide to stick with it, you'll probably be mouth-leaking with that cheap nasal mask they handed you and that low-end CPAP with no exhale relief (and definitely no data capabilities) will only increase those probabilities. You'll go back after a few months and complain that you aren't seeing any results yet......so, without any data to check (that you ARE mouth-leaking), they'll up the pressure some more......and "enhance" your existing problems. And.....on and on.....

I was titrated at 16 cm and prescribed 18 cm. With a data-capable CPAP (not even an APAP) and software, I was able to determine that a pressure of 10 - 12 cm was quite sufficient for "good" therapy for me.

Yep! Lots of variables.

Best wishes,

Den

neillebo wrote:isnt getting titrated for life on cpap based upon 5 HOURS OF SLEEP IN A STERILE/NON-WARM AND FUZZY location) prettty much guarantee that they will miss the mark??

I understand what you're saying, neillebo. For some people on some nights, that can happen...the lab titration missing the mark.

However, I think sleep lab titrations usually do find an effective treatment pressure most of the time, for most people.

I am finding after a lot of exhaustive testing (no pun intended) that the sleep lab was pretty much spot on with my Titration. I am currently keeping my APAP on 10 - 12 in order to give myself some leeway when I sleep in different positions or when other things that can affect my therapy happen.

However, if it wasn't for the folks on this forum I don't think I would be having such a good result with my therapy. I can also adjust my therapy myself if needed. I bet that would scare the crap out of sleep labs if they weren't already swamped as it is.

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CPAPopedia Keywords Contained In This Post (Click For Definition): Titration, APAP

neillebo, I have to ask. Are you just monitoring the data from your therapy w/your apap or are you adjusting the pressure, expiration pressure relief, changing masks, taping or not taping or using a chin strap some nights and not others, etc?

IF you are making changes every night or every couple of nights .... you shouldn't. You should ONLY make ONE change a time and then STAY w/that change for ONE FULL WEEK. Then work w/the AVERAGES for that ONE FULL WEEK to determine what further changes might be needed. Then and only then should you make ONE change based on those data averages and stay w/THAT change for one full week, check the data before deciding on any other ONE change if it still looks and feels like one is needed.

neillebo, I have to ask. Are you just monitoring the data from your therapy w/your apap or are you adjusting the pressure, expiration pressure relief, changing masks, taping or not taping or using a chin strap some nights and not others, etc?

I am playing with pressure ranges every day, even though I know it makes little sense for statistics. If i get a 2.4 ahi and the next day i get a 5.8, i try to get something lower. hoping to find the magic answer of .5 or .7 sooner than later. Some say they get that every night, so if i hit it right, maybe i will also. But, again, that is my question that if we cant rely on one night's data, how can a lab? I keep the aflex, humidification, masks etc the same. only change pressure (btw, i dont think i mouth breath with my nasal pillows even though i mouthbreath big time without cpap. mouth is no longer dry.. would the program show me if i was mouthbreathing somehow?[/quote]

The reason that you wait a week before you adjust (in my opinion) is that sometimes, it's just the matter of us adjusting to our previous adjustment. Sometimes it takes a little time, so be patient.

neillebo wrote:hoping to find the magic answer of .5 or .7 sooner than later.

There's nothing whatsoever magic about those numbers.

Any AHI numbers consistently below 5 are fine.

You need to be systematic and methodical about any changes you make. Changing pressure every night is plain crazy

neillebo wrote:But, again, that is my question that if we cant rely on one night's data, how can a lab?

A PSG in a lab measures many additional factors that you cannot measure in your home. The PSG gives a lot more data vectors to allow assessment the severity of the condition and the effectiveness of xPAP treatment.

Cheers,

Bill

AND during the PSG they can adjust the pressure up or down in response to an event right then and there rather than waiting until morning to check out the events and making any pressure adjustments as you are doing. You are chasing windmills they way you are doing things.

ok. thanks all. So, would you suggest since i was titrated at 9 and my 90% preessure over the past week+ has been 11 (but i have always changed the range) that i just keep a wide range (of say 6-12) and give it a week or start more narrow? the only issue i have mentally with 5 is that it still wakes me up every 10 or 12 minutes and figure i still wont get into deep sleep. better than every 90 seconds that it did before, of course.

I never had a titration study because I told my pulmonologist that I didn't want to. It was the worst night of sleep I ever had, and it took me more than a day to recover.

So he prescribed me an APAP. I haven't had any problems with my pressure. The range is 6-15, and I spend most nights between 9.6 and 11.

Neilebo:

My experience has been that keeping the range narrow and the low end close to what the titrated pressure was has worked well for me. I was titrated at 9 and I'm now using the auto at 8-11 with very good results. Apparently the machines ramp up at fairly low rate to respond to apneas, so setting it too low means it's going to be slower at reacting.

I'd probably try 8-12 and watch the results for a few days, then if the 90% was at 11, maybe bring the top end down to 11.5 or 11. Some folks report that having the pressure change causes them to wake up, so there's another reason to keep the range tight.

But what do I know? I'm just a hosehead!

neillebo wrote:
I am playing with pressure ranges every day, even though I know it makes little sense for statistics. If i get a 2.4 ahi and the next day i get a 5.8, i try to get something lower. hoping to find the magic answer of .5 or .7 sooner than later. Some say they get that every night, so if i hit it right, maybe i will also. But, again, that is my question that if we cant rely on one night's data, how can a lab? I keep the aflex, humidification, masks etc the same. only change pressure (btw, i dont think i mouth breath with my nasal pillows even though i mouthbreath big time without cpap. mouth is no longer dry.. would the program show me if i was mouthbreathing somehow?

Indirectly, yes! It will show leaks. Because I had a pillows mask and was doing nothing to keep my mouth closed, I was mouth leaking. By stopping the mouth leaks, I could then find out what an appropriate pressure was. Since I was titrated at 5, it became very clear that, though there were few leaks, I was still getting a lot of hypopneas at the lower end and my machine was ramping up a lot to take care of them.

So I raised the lower pressure first and that took care of the hypopneas. then I raised the upper pressure because I was still getting apneas. It took a few months to finally discover that my ideal pressure is 9.0. With this pressure, as long as there aren't leaks, my AHI is generally under 1.0. However, it took months of tweaking to get to that point.

You should use the software to detect leaks and take care of that issue first.

I agree with RG that the titration study usually gives a pretty good pressure. If you have a good lab, that is. My sleep lab and sleep tech were neither one of them accredited. I believe that most titration studies were better than mine. Having the software showed me what I needed to know. My doctor supported me in doing all this .

Anonymous wrote:So, would you suggest since i was titrated t 9 and my 90% preessure over the past week+ has been 11 (but i have always changed the range) that i just keep a wide range (of say 6-12) and give it a week or start more narrow?

I'd try a range of 8-12 and *leave* it for a week.