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svo · Post by **svo** » Sat Mar 05, 2016 12:24 am

..last night I had that tritation study but after a horrible night,,,the tech informed in the am that she was not able to "complete the tritation because I kept waking up evry hour or so"..well I don't think I can go through another night like the one I had..she was not pleasant (but I was going to take her to dinner either..)...2 pillows stacked up...change 3 different masks...I was afraid to disconnect wires or tubing etc...so the question is will I have a problem and will have to come back again?....tritaion is to finf what pressure the machine will be st at right?....can the doctor based on the previous sleep study recommend an " estimate" on the pressure?....needles to say I a m not a happy camper...it will take a long time for me to get used to this.....

thank you all for the help...

robysue · Post by **robysue** » Sat Mar 05, 2016 2:17 am

Your best bet is to see whether the sleep doc would be willing to prescribe an APAP set in Auto mode. The APAP could then be used to titrate you over a period of a week or two. At that point, the machine could either be set for a narrow APAP range, or, if changing pressures turn out to bother you, the data from the APAP would give a good idea of what fixed CPAP pressure should be used. The APAP could then be switched from Auto mode to CPAP mode, so you wouldn't even need to swap the machine out.

svo · Post by **svo** » Sat Mar 05, 2016 7:35 am

...thank you very much....your advice is really appreciated

ChicagoGranny · Post by **ChicagoGranny** » Sat Mar 05, 2016 8:20 am

robysue wrote:The APAP could then be switched from Auto mode to CPAP mode

Or better yet, what minimum pressure to use in an APAP setting with max pressure 20.

amenite · Post by **amenite** » Sat Mar 05, 2016 8:35 am

I have had only one study, a split night study - less than one hour asleep and they put me on CPAP probably because the sleep lab's insurer wouldn't have liked it if I died in my sleep from an AHI over 100. I never went back for a titration study because they came up with 4-5 hours of CPAP data on me that first night and that worked.

Eventually I got a PRS1 560P autoset machine that further confirmed my pressure was dialed and has been more helpful in my treatment than the sleep doctor I was seeing (excepting that the machine cannot write prescriptions)

Without a baseline pressure you could run an auto machine wide open 4-20 cm and dial in the minimum over course of a few nights assuming a good mask, no major leaks, etc. Also note that PRS1 460 machine (and others perhaps?) has an auto titration mode you can run for I think 30 nights that will give you the same effect as the 560 full auto machine and help you get settled on your eventual fixed pressure.

Whatever happens, if you need this therapy please get it started one way or another - it is so important to your health and good people here will get through the bumps in the road.

Thatgirl · Post by **Thatgirl** » Sat Mar 05, 2016 10:13 am

I'm kinda surprised titration studies are done at all any more with the quality and affordability of today's APAP's, and the limited data received due to most people's poor sleep during them. APAP's give you more flexibility for long term treatment, and more data over an extended period- how weather, illness, meds, and fatigue effect your pressure needs- not just what's seen in a few hours in the lab. The exception for titration studies would be, of course, more complex machines and more complex issues than plain Jane OSA. Of course the sleep labs love to have expensive titration studies done, but I'm surprised that insurance companies don't push back more.

amenite · Post by **amenite** » Sat Mar 05, 2016 10:42 am

Thatgirl wrote:... I'm surprised that insurance companies don't push back more.

It's funny you say that because in my case I was the one pushing back. Titration study was suggested to me at time when the doctor had already let the cat out of the bag that they didn't even look at machine data and I had 6 months worth of it. As if it was somehow a waste of their time to review that data, or somehow unreliable.

I was going to call them idiots for not looking it over but it would really depend on why they dismissed it - because they really don't trust the machine data, don't know how to interpret it in context, or because there's no diagnosis code to bill the 30 minutes it would take to analyze and report back on it.

I've also concluded that my next sleep doctor choice will need to be an OSA sufferer. That should get me what I need in a sleep doctor

Sir NoddinOff · Post by **Sir NoddinOff** » Sat Mar 05, 2016 11:06 am

robysue wrote:Your best bet is to see whether the sleep doc would be willing to prescribe an APAP set in Auto mode. The APAP could then be used to titrate you over a period of a week or two. At that point, the machine could either be set for a narrow APAP range, or, if changing pressures turn out to bother you, the data from the APAP would give a good idea of what fixed CPAP pressure should be used. The APAP could then be switched from Auto mode to CPAP mode, so you wouldn't even need to swap the machine out.

Has anybody had any luck trying that tactic Seems like it would cut into their profits.

chunkyfrog · Post by **chunkyfrog** » Sat Mar 05, 2016 11:13 am

Starting every patient out on Apap would save insurance companies a lot of money,
due to eliminating unnecessary titration studies.--Some insurance companies have figured that out.
Others (or their officers) are content to take kickbacks from sleep labs . . . ?
The suggestion that you plan to work on losing weight, and pressure needs have been PROVEN
to change with weight loss/gain, asking your doctor for an Rx for an APAP just might work.
Of course, the failure of a sleep lab to successfully titrate you may be all you need.

robysue · Post by **robysue** » Sat Mar 05, 2016 12:10 pm

Sir NoddinOff wrote:
robysue wrote:Your best bet is to see whether the sleep doc would be willing to prescribe an APAP set in Auto mode. The APAP could then be used to titrate you over a period of a week or two. At that point, the machine could either be set for a narrow APAP range, or, if changing pressures turn out to bother you, the data from the APAP would give a good idea of what fixed CPAP pressure should be used. The APAP could then be switched from Auto mode to CPAP mode, so you wouldn't even need to swap the machine out.
Has anybody had any luck trying that tactic Seems like it would cut into their profits.

I believe that some of the large HMOs are actually moving to this model for most (all?) of their newly diagnosed OSA patients. If I recall correctly, Janknitz has posted that Kaiser routinely does this out in her part of the country.

Thatgirl · Post by **Thatgirl** » Sat Mar 05, 2016 12:53 pm

Sir NoddinOff wrote:
robysue wrote:Your best bet is to see whether the sleep doc would be willing to prescribe an APAP set in Auto mode. The APAP could then be used to titrate you over a period of a week or two. At that point, the machine could either be set for a narrow APAP range, or, if changing pressures turn out to bother you, the data from the APAP would give a good idea of what fixed CPAP pressure should be used. The APAP could then be switched from Auto mode to CPAP mode, so you wouldn't even need to swap the machine out.
Has anybody had any luck trying that tactic Seems like it would cut into their profits.

My mom wouldn't sleep in the lab at all. She had a home sleep study, then was given a script for an APAP. No issues with insurance, the DME, or her doctor. Her doctor is a CPAP user- so that helps. In two weeks the DME is going to look at the 95% pressure and forward that info to the doctor and see if they want to do straight CPAP at that pressure. We'll see.

I attempted to do a titration study, but couldn't fall asleep and left after 4 fruitless hours. My doctor wrote for an APAP because she's very against untreated sleep apnea and felt is was negligent not to. My insurance was no where near as easy going as my mom's (she didn't even need prior auth- was approved that day), but I got my APAP, then upgraded to a Vauto via Dr. Craigslist.

My original APAP was used to convince my mom she needed to be tested for OSA, and is now replacing my dad's S9 Escape (Thanks be to God).

Krelvin · Post by **Krelvin** » Sat Mar 05, 2016 4:35 pm

Thatgirl wrote:I'm kinda surprised titration studies are done at all any more with the quality and affordability of today's APAP's, and the limited data received due to most people's poor sleep during them.

One basic reason why in the U.S...
$$$$$$$$$$$$$$$$
Lots of money to be made doing studies.

Lucyhere · Post by **Lucyhere** » Sat Mar 05, 2016 8:34 pm

amenite wrote:I've also concluded that my next sleep doctor choice will need to be an OSA sufferer. That should get me what I need in a sleep doctor

Hmmm... interesting. My sleep specialist's father has SSA. Could be why she is so knowledgeable and pushes for data capable machines.

svo · Post by **svo** » Sat Mar 05, 2016 10:04 pm

...I really thank you all for all the itemes discussed....what is the difference between APAP and CPap machines?..BPAP I learned (hopefully..) is dual for inhale and exhale correct?...but I have to admit, I thought I was begining to understand some of the jargon, but now I feel that I don't know S%^&T...lol....after the last sutudy I am more confused that when I started...the tritation report will be send to the doctor and he will write a prescription for the machine...also for nose piece?....will I be contacted by someone or will I have to do my "due deligence".....oh....what is AHI???....

thanks

Ralph L...

palerider · Post by **palerider** » Sat Mar 05, 2016 10:49 pm

svo wrote:what is the difference between APAP and CPap machines?..BPAP I learned (hopefully..)....what is AHI???.....

most of these questions can be answered by reading the wiki:
wiki/index.php/AHI
wiki/index.php/APAP

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Machine	Mask

Additional Comments: Vauto EPAP min 5, IPAP max 25, PS 6