OK, I need the experts for this one!

I have OSA and have been on the hose for 2 1/2 years. My husband has apnea too, and has had a study, but the tritration was a nightmare, and he left the lab in the middle of the night.
Here is the thread I posted back in August.
viewtopic.php?t=22883&highlight=

Anyway, he has FINALLY agreed to let me titrate him. He will NOT go back to the lab. I got an Everest II machine the other day, for power outages , so I can let him use my machine for a night. I also have an FP HC 431 full face mask in his size.

How should I set the APAP? Wide open? I want him to see that he is having events, but I also want him to get a good night's sleep. That probably is not possible.
Any suggestions? Any one have a Oximeter they can recommend?
I hope this goes well, because if I can prove he is having events, he will get treatment.

Normally, it's not "ideal" to set the minimum pressure at the lowest setting as you're well aware, however in his case there might be some exceptions.

Does he snore? (probably a silly question, but....... )
That'll probably increase the pressure in pretty short order.

You could try it wide open during a nap or sometime other than during the night (shorter duration) to see what happens with the pressure.

Or.......you could just strap it on him (wide open) at night and see what happens.

And......even if you started at a higher pressure......if he's got OSA, it'll probably show up even at a higher starting pressure (for more comfortable breathing).


Den

Generally speaking when I do a titration on a new pap user my settings are 5cm to 20 cm h20. It is very difficult to just look at a person and judge how much pressure is enough. I have had to use much pressure on small people and very little pressure on some very large people. Have you though of using the auto setting as the primary theraputic mode? The reason I ask is that if a diagnostic sleep study has been done you can use that to get a cpap and supplies from your insurance carrier. Usually they only require the diagnostic portion of a sleep study. This way you dont have to go back to a sleep lab unless there is some very complex stuff going on! You will have to also consider if titration with auto bipap is good. Obviously some problem arose during the cpap titration. Many local dme's will perform a titration for free with both cpap and bipap so they can get your business, you can use this to your advantage until you find a final setting for him to use. Do you have access to auto titrating equipment?
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CPAPopedia Keywords Contained In This Post (Click For Definition): bipap, Titration, CPAP, DME, auto

rtkeat wrote:The reason I ask is that if a diagnostic sleep study has been done you can use that to get a cpap and supplies from your insurance carrier. Usually they only require the diagnostic portion of a sleep study.

A doctor's prescription for the machine is still required, right? No matter what diagnosis turned up in the diagnostic sleep study, insurance companies aren't going to pay for any kind of machine unless a doctor has prescribed it...are they?

rtkeat wrote:Many local dme's will perform a titration for free with both cpap and bipap so they can get your business, you can use this to your advantage until you find a final setting for him to use.

Perhaps I'm not understanding what you're saying. Are you saying there are local DMEs (in the U.S.A.) who will provide a machine to "perform titration" without a doctor's prescription? Simply if the person has had a baseline diagnostic sleep study?

Or, if there is a doctor's prescription for "cpap", are you saying there are many local DMEs (in the U.S.A.) who will let a person also try a BiPAP (bilevel) machine at home? I'd have thought a DME would have to provide the type of machine the Rx called for. At most, I could see them giving a person an autopap set for cpap mode when "cpap" and a single pressure was stated on the Rx.

rtkeat wrote:You will have to also consider if titration with auto bipap is good.

If you are talking about a machine like the Respironics BiPAP Auto with Bi-flex, that is a bilevel machine that can do auto-titration. But it is not a cpap or auto-titrating cpap machine. I'd think a DME would require a prescription for "bilevel" or "bipap" (not just "cpap" or "auto-titrating cpap") before the DME could hand a BiPAP Auto machine over to a person. A doctor has to prescribe the EPAP/IPAP for a bilevel...even the BiPAP Auto.

I would set it 6 cm to 20 cm and see what happens.

if it moves up from 6, you know he is having apnea or events that drive pressure up.

Lee Lee wrote:if I can prove he is having events, he will get treatment.

Lee Lee, I thought that it was already proven that he has OSA (has events..apneas and hypopneas while he sleeps) since he already was diagnosed with moderate sleep apnea at his diagnostic study.

Lee Lee wrote:Anyway, he has FINALLY agreed to let me titrate him. He will NOT go back to the lab.

If it were me, I'd let him start out by using your APAP machine in cpap mode while awake -- sitting in a recliner watching TV -- until he's comfortable breathing several different straight pressures (like 5, 7, 9 ... and more if he wants to see how higher pressures feel.) Show him how to change the pressure himself. Perhaps physically pushing the settings buttons himself would make him feel more in control and get him more interested in the whole thing.

If that "awake" time goes well, show him how to set the machine in auto-titrating mode and let him choose (and set) the pressure range himself. Possibly the more he can feel like he's the one in charge of the machine, the more he might be willing to keep trying to make it work.

You've had a real uphill battle getting him to agree to titration at home. This is a big step forward for him, thanks to you, Lee Lee! Hope it goes well.

Rested Gal-
The whole problem started when he had Septoplasty and Turbinate reduction. He thought this had cured him of OSA, no matter that he still is exhausted and miserable, and yes, Den, he snores and stops breathing.
He is a 48 year old handsome, wonderful man, who should not have to live his life half asleep. But he is STUBBORN, and your advice is excellent. If he feels like he's in control, it'll work better.
I'll let everyone know what happens.
Lee Lee

Not an expert but... My new DME (SleepQuest) which is part of a national chain, does home titration in the same manner as Kaiser and others now do. They send you home with a recording auto and read the card then write it up for the doc to Rx from. I have read a few official studies that conclude home titration is at least as valid as lab titration.

Since he won't do a sleepover but is willing to titrate the SleepQuest, or whoever you find to do it, is a good option to consider. You won't get a machine over the counter without an Rx, you won't get an Rx without a doc writing it, doc won't write it without an 'official' titration. The only exception I see is if the doc can read the card and make the call.

Good luck with it.

Lee Lee,

I have a somewhat different suggestion for the settings for trying titration at home. I had a very miserable night during the titration study, though walking out on studies is not quite my reaction I slept only about an hour that night, although I slept fine for perhaps many many years without cpap, when I had mild to moderate apnea until it was discovered by chance at my suggestion -- none of the classic symptoms.

Also when I tried AUTO at home (with doc's permission) for 4cm-15cm, it did hit 15 every so many times and I had a very hard time those nights. It turns out that I simply wake up on even mild pressure changes, this is a known but rare condition. Finally I am having a very good sleep and very low AHI numbers with a fixed setting of 6! Your husband's titration night might have been similar to mine.

Since you have more than one night when you can do the titration, to reduce the potential for the very bad first night experience, my suggestion is to try at some very low range at the beginning. Say 4-10.

Another important point. I had a very hard time simply breathing at 4, but it is quite fine at 5 or above. There is a chance that might be a problem for your husband too. That you can easily test at the beginning while he is wide awake. If so, set the range at 5-10 or 6-10. Hopefully you have the software so you can see the details of that night's data. You may want to increase it, or even decrease, or even try at different fixed levels. None of this type of trials are feasible in a clinic, where my titration study night cost me $4700 US, albeit I live in a high med-expense area of the country.

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CPAPopedia Keywords Contained In This Post (Click For Definition): Titration, CPAP, AHI, auto

OldLincoln wrote:Not an expert but... My new DME (SleepQuest) which is part of a national chain, does home titration in the same manner as Kaiser and others now do. They send you home with a recording auto and read the card then write it up for the doc to Rx from. I have read a few official studies that conclude home titration is at least as valid as lab titration.

Since he won't do a sleepover but is willing to titrate the SleepQuest, or whoever you find to do it, is a good option to consider. You won't get a machine over the counter without an Rx, you won't get an Rx without a doc writing it, doc won't write it without an 'official' titration. The only exception I see is if the doc can read the card and make the call.

Good luck with it.

OL,

You forgot one other option....... ("read between the lines")
Lee Lee can buy herself a "backup" machine (or as many as she wants) on her prescription......from someplace like CPAP.COM.

If a person has simple OSA and the means to treat it, they don't really "need" a prescription. There are lots of people who have circumvented the system.

Den

Any titration that is done with a dme will require a dr order. many dmes will do home auto titration with a dr order for free in the hopes of getting new business. Its my understanding that a diagnostic study has already been performed in this case. As long as that sleep study exists stating that osa is the diagnosis with an ahi calculated you can biull an insurance company with a drs order. The order can be for a titration or even an auto titrating machine set in auto mode as the main theraputic mode. You have to talk with the doctor. Sometimes doctors are unaware of the new equipment and capabilities.

None of this type of trials are feasible in a clinic, where my titration study night cost me $4700 US, albeit I live in a high med-expense area of the country.

Now that's expensive! Where do you live?