New Member - Thoughts on Self-Titrating

[Kebo]

I want to say first, my heartfelt thanks to the contributors to this board. I can't even begin to tell you what a help this has been to me. And it’s been helpful in many different ways including technical knowledge and the emotional support of knowing I'm not alone with this.

When I was diagnosed with severe OSA 2 months ago I was able to learn enough from your postings to at least tell my DME that I wanted to know what my choices were for machines. Given my 20cm Rx, I asked about APAP but was told it wasn't an option. They did agree to bring me one of their "newer, smaller" machines (I still wonder what they were going to bring had I not called to ask about choices). Since then, I've been 100% compliant; got the sleep center to send me my PSG results, bought the software, and learned how to change settings on my machine. Already I'm feeling so much better – and again, in many different ways.

My AHI's have been over 5 since I began. I lasted about a week at 20cm then changed it to 19cm on my own because the mask was leaking so bad. In reading my PSG, I noticed that at 12cm, I had no OA's, HI's or centrals. So last night I changed my pressure to 12cm. The software reported an AHI of 1 - my best ever though some snoring appeared (which was not there previously).

On to my questions ... I feel good today and the leaking was much improved but can I rely on the software that this is an improvement? Should I talk my sleep doctor or DME about the results of my experiments or will that just upset them? Are there any other issues I should be concerned about with my experimenting?

[Guest]

On to my questions ... I feel good today and the leaking was much improved but can I rely on the software that this is an improvement? Should I talk my sleep doctor or DME about the results of my experiments or will that just upset them? Are there any other issues I should be concerned about with my experimenting?

Yes, you can rely on the software. It takes at least a week of using the exact same settings to give you a reasonable average.
Your doctor works for you. If you want to discuss the results of your experiments with him, then do. If you don't, then don't.

[tomjax]

I wonder what the DME would have answered if you asked WHY an apap would not be an option for 20?

I do not know if there is a reason he said this or not.
I would definitely keep a record of your AHI on different pressures and would take these to your doc and ask him/her if this shows an apap would be preferable for you.

I vote for APAP

[bdp522]

Welcome to the forum Kebo.

If you show the doctor why you changed the settings and the results He shouldn't be upset with you. If he is, you need to get a new doctor.

It seems to me that most DMEs don't care what you do as long as they get paid. At least that's how my DME is, but then I have apria.

Brenda

[Kebo]

I wonder what the DME would have answered if you asked WHY an apap would not be an option for 20

It was the something along the lines of "that's what we use here at the center .... those machines are for sleep labs".

Anyway, posted AHI of .2 last night so I'm glad I decided to experiment.

[Snoredog]

I'd be trying to figure out why you were Rx'd 20cm pressure when your PSG indicated only 12cm. Did someone goof?

You can rely on the software, it is fairly accurate when it comes to AHI. The machine itself can sometimes confuse a central event and log it as a obstructive one.

If your PSG indicated 12cm along with some central events, be careful setting the Max. pressure much higher than the 12cm. The lab tech would have seen those centrals and stopped with any pressure increases beyond the first series of centrals seen (or should have).

Your AHI was probably a lot higher at the 19/20cm pressure because at that pressure it is easy for it to fire off pressure induced centrals, machine may even record them as obstructive.

[oldgearhead]

Are you saying your sleep study indicated a titration of 12 cm/H2O, but
someone wrote a scrip for 20?

Its my understanding, only Bi-Paps can
be used at 20, because straight xPAPs don't go that high.

Machine spec 4 -20 + or - 1.0 cm/H2O = 19 cm/H2O max.

I think it may be a good idea to just do it all yourself, and forget those
"Professionals".

[Kebo]

I'd be trying to figure out why you were Rx'd 20cm pressure when your PSG indicated only 12cm. Did someone goof?

Are you saying your sleep study indicated a titration of 12 cm/H2O, but someone wrote a scrip for 20?

The sleep report says "Titration was performed but a therapeutic CPAP pressure was not reached. Nasal CPAP at 20cm is recommended."

On the post-treatment table it shows minutes, apneas and O2 by pressure, I thought 12 looked good because the apnea readings were all zero. However, on closer inspection, I see I only spent 5 minutes at that pressure and the O2 sat is a little low. At 14cm, a bunch of CAs and HYPs appear, those go lower as the pressure is increased to 19cm but not entirely, hence (I assume) the "not reached" comment above. Still, I wonder if the benefit of the higher pressure is negated by all the leaking I experienced. It really sounds like I would benefit from APAP.[/code]