titration what should I expect?

[nussy]

I am not sure I spelled it right but I have an appointment tomorrow night for them to see how much pressure I need. I had the machine for 2 weeks now and I am slowly getting used to it. BUT I dont see the difference with the machine. Its set at 5.

How long does it take them to see how much pressure I need? Should I expect to spend the whole night? To say the least Im not looking forward to all the wires and uncomfortable bed.

[OCNorsk]

It's titration. From what I understand a 5 is almost never prescribed as it's too low.
If your appt is for night, I would think that you would be there until morning.

Titillation is something else entirely.

[nussy]

A Freudian slip and I cant change it.

[JohnBFisher]

I am not sure I spelled it right but I have an appointment tomorrow night for them to see how much pressure I need. I had the machine for 2 weeks now and I am slowly getting used to it. BUT I dont see the difference with the machine. Its set at 5.

How long does it take them to see how much pressure I need? Should I expect to spend the whole night? To say the least Im not looking forward to all the wires and uncomfortable bed.

The tradition definition of titration comes from chemistry, where it means:

The process, operation, or method of determining the concentration of a substance in solution by adding to it a standard reagent of known concentration in carefully measured amounts until a reaction of definite and known proportion is completed, as shown by a color change or by electrical measurement, and then calculating the unknown concentration.

Of course, they are not going to add a solution to you drop by drop. But they will slowly but surely increase the pressure as you are asleep. They are trying to find just the right amount of pressure needed to keep your airway open.

Your doctor has taken an interesting approach to the titration study. I guess you had clearly obvious signs of apnea, otherwise he might have first ordered a sleep study to see if you need it. But by providing the machine first, as you note, you slowly got used to the machine. Now that you are used to the machine, they can measure you to determine the effective pressure. I am impressed. It is a good approach. You have a doctor that wants to get things right for you without lots of additional trip.

You might be interested in the following video:

http://www.youtube.com/profile?user=cpa ... ZTzrVGSOvw

Hope that helps you get used to the idea of the titration sleep study.

[nussy]

My first study found I had 32 episodes an hour. I understand thats moderate/high.

[JohnBFisher]

My first study found I had 32 episodes an hour. I understand thats moderate/high.

First, I note you adjusted the title. Cool! It's good to know we can do that. Since we've all been there and needed to do that in the past.

Second, yup. 32 apnea/hypopnea events per hour is moderate to high. Think of it. It means that your heart and brain need to slightly arouse you every other minute. All night long.

As you have probably read, the oxygen deprivation does bad things for you. Left untreated it WILL adversly impact your health.

So, good for you. You took it seriously to get the problem addressed. While it's a hassle to use CPAP, you should find that you will stay healthier and happier with the therapy than without it.

By the way, because of the way your doctor is introducing you to the CPAP unit, it should make the titration study easier and more effective. You should have a better chance of it helping you. As I noted, I am impressed.

Since you already had a sleep study, this will essentially be the same as the last, but they will add the CPAP to the mix. This time, rather than just measuring the apnea events, as they occur (and after the pressure remains steady for 30 minutes or so), they will increase the pressure. They want to see if the snoring and apnea eventually goes away. Sometimes, if they start to see central apneas as they increase pressure, they might switch to BiLevel (or BiPAP) mode. This means they use a lower pressure when you breathe out. The higher inhalation pressure (IPAP) and lower exhalation pressure (EPAP) is sometimes needed by some patients. However, most have no problem with CPAP.

So, go and enjoy the experience. Ask the sleep technician about the process. Remember they are trying to help and generally most enjoy what they do. The science involved is fascinating. It not only helps the time pass, it makes for an interesting conversation, and frankly reminds them you want it to work. That can sometimes make all the difference in the world for you and them.

[DreamOn]

Welcome, nussy!

Five is a VERY low pressure, so it isn't surprising that you're not noticing any difference as the machine is set right now. In fact, you may actually find it easier to breathe at a somewhat higher pressure.

Since you've already had one sleep study, you are familiar with all the wires and stuff. Titration night will be the same, except that you will be on a CPAP machine. They'll start you off at a low pressure and raise it as you get into deeper sleep, to determine the optimal pressure needed to keep your airway open. Chances are that you won't even notice any pressure increases.

I think you can expect to spend a full night at the sleep lab. Take advantage of any opportunity that night to try on as many different types of masks as possible and write down which you prefer, taking note of sizes too. It helps to know what may work best for you before visiting the DME supplier for your equipment. Other than that, just bring a comfortable pillow, relax and dream sweet dreams!

~ DreamOn

[nussy]

I was told to bring my own mask and hose. They booked this appointment 2 weeks after I got the setup so I can get used to it.

[DreamOn]

I was told to bring my own mask and hose. They booked this appointment 2 weeks after I got the setup so I can get used to it.

I wish I had been given a machine to try at low pressure for several weeks before my titration study! I didn't know anyone even did that. At least you're somewhat acclimated to CPAP already. I remember being so shocked when I opened my mouth to speak during the titration study -- air blowing out like a hurricane as I was attempting to say something even remotely understandable!

~ DreamOn

Edit: I just wanted to add something.... During my first sleep study, I was given a room with a very uncomfortable bed. It was noisy too, as I could hear the sleep tech walking in front of the door constantly. Very annoying! So when I returned for my overnight titration study I asked them for a better room. It was great -- I felt like I was staying in a hotel. The bed was much better, and it was quiet too! So you may want to arrive a little early and let them know you'd appreciate a more comfy bed.

[nussy]

I just got back from my sleep lab appointment. I don't think I slept for more than an hour. This has to be one of the worst experiences I had so far.


The tech told me that she set the pressure at 7 and she thinks I will be fine. But I have to see the doc so he can write a prescription for the CPAP supplier to change my machine from 5 to 7.

My question is can the person at the sleep lab tell what pressure to set in such a short sleep time? I noticed the pressure changing while I think the tech was experementing with different settings......AM I WASTING MY TIME? Will 7 make any difference?


HELP

[cotech50]

I had my first study which was a disaster but gave enough data to show an ahi of 14. that in itself was justification for a cpap but the pulmonologist had me put on an auto cpap with a range of 7-15 pending my second study. I am currently running a 2.5- 3.3 ahi and a 905 at around 12. Taking my Sd card to the RT today so she can run the data and give me a printout to take to my study. I have read where the auto machines have mimicked actual manual titration. Get your DOC to write the script for an auto cpap.

[DreamOn]

nussy,

I'm sorry that your titration study didn't go as well as you'd hoped, but I'm sure that your optimal pressure can be worked out. There's a chance that a pressure of 7 will work fine, and it's worth a try to see how you feel during the daytime. Adjustments can be made as you go along, if needed. We all have different pressure needs. I use a set pressure of 6, which is low, but it is effective in keeping my airway open.

It would be very helpful if you could tell us exactly which model of CPAP machine you have now. Depending on the model, it may be possible for you to get information from the machine's LCD screen directly in order to evaluate the effectiveness of your therapy. We can help you learn how to do that if your machine has that capability. Please fill out your machine profile (via the User Control Panel, at the top of the screen), and that will give us more information to assist you. There are many people here happy to help.

~ DreamOn

[rubymom]

The whole purpose of the titration is to determine the appropriate pressure. And those studies are conducted by trained techs supported by instrumentation. But no, the tech doesn't decide what pressure you'll be at, but yes, the tech is the person who will report the data to your physician who ultimate decides what the pressure would be. The tech may even make a recommendation.

Did the tech say you only slept for about an hour? I do believe some (many?) patients underestimate the amount of time they actually slept during their sleep study. Not long ago, Regis Philbin had a widely publicized sleep study where he claimed he didn't sleep at all yet the data from the monitoring showed different.

I'd encourage you to calm down and be patient. Ask lots of good questions of your doctor. And then ultimately make a decision about your treatment.

Good luck!

[DreamOn]

I do believe some (many?) patients underestimate the amount of time they actually slept during their sleep study.

That's so true, rubymom. I slept about four or five hours during titration night, but the next day I felt like I'd only slept an hour! It's also difficult to gauge how long it takes to fall asleep.

I'm certain that if the assigned pressure isn't quite right for nussy starting out, it can get worked out to find what is most effective. Please let us know how it goes, nussy.

~ DreamOn

[nussy]

nussy,

I'm sorry that your titration study didn't go as well as you'd hoped, but I'm sure that your optimal pressure can be worked out. There's a chance that a pressure of 7 will work fine, and it's worth a try to see how you feel during the daytime. Adjustments can be made as you go along, if needed. We all have different pressure needs. I use a set pressure of 6, which is low, but it is effective in keeping my airway open.

It would be very helpful if you could tell us exactly which model of CPAP machine you have now. Depending on the model, it may be possible for you to get information from the machine's LCD screen directly in order to evaluate the effectiveness of your therapy. We can help you learn how to do that if your machine has that capability. Please fill out your machine profile (via the User Control Panel, at the top of the screen), and that will give us more information to assist you. There are many people here happy to help.

~ DreamOn

I have the basic Resmed C series Tango.....with a humidifier. I dont see it on the list.