How Effective was Your Initial Titration?

NightHawkeye · Post by **NightHawkeye** » Fri Feb 10, 2006 9:03 am

How effective was your initial titration? Did your sleep lab and DME get it right?

Ric · Post by **Ric** » Fri Feb 10, 2006 10:13 am

SS titrated me at 7, DME gave me the APAP at 4-20, the ongoing data consistently tells me I'm a true 9 (based on 90% cutoff). Ironically, despite a SS-AHI of 71, I was having a really "good" night that night, easily corrected with a relatively low pressure. Subsequent data suggest that a CPAP set on a constant 7 (as suggested by the SS) would correct/prevent only 40%, not 90% of OA/H events. I have since adjusted the lower setting to 6.5, upper is at 13. Within that range that I have had only one non-responsive apnea event in the last 400 hours usage.

I now sleep the whole night through, awake refreshed, full of energy, jog to work in a straight line leaping over tall buildings on the way. (And no more 2 o'clock nap time, which somehow used to leave reverse impressions of the keyboard on my forehead, not sure how that happened.)

Thank goodness for APAP, clinicians manuals, the internet, and y'allz good advice and encouragement. High-Fives to everyone here.

wading thru the muck! · Post by **wading thru the muck!** » Fri Feb 10, 2006 10:46 am

Hey Ric,

Popping a cookie once in while will also help the AHI.

Ric · Post by **Ric** » Fri Feb 10, 2006 11:22 am

wading thru the muck! wrote:Hey Ric,

Popping a cookie once in while will also help the AHI.

YES !!!

Goofproof · Post by **Goofproof** » Fri Feb 10, 2006 12:35 pm

Ric wrote:
wading thru the muck! wrote:Hey Ric,

Popping a cookie once in while will also help the AHI.
YES !!!

laurel · Post by **laurel** » Fri Feb 10, 2006 12:51 pm

I think maybe you overlooked an option or else I'm not reading the poll right.

I was titrated at 13 and have purchased an APAP (after using CPAP at 13 for a while). And now the software with the APAP are pretty much telling me that I was titrated exactly right. 13 really seems to be where I should be, according to the data I have so far (10 days worth).

Sometimes they do get it right! I'm still glad to have an APAP so I have flexibility and of course I like looking at the stats, etc.

Wulfman · Post by **Wulfman** » Fri Feb 10, 2006 1:04 pm

NightHawkeye wrote:How effective was your initial titration? Did your sleep lab and DME get it right?

I'd like to qualify my survey answer to: "Provider Adjusted - I readjusted, or now use APAP."
I think in my case it should be "Doctor prescribed - I readjusted".
The "provider" (CPAP.COM) HAD to set the machine to the doctor's prescription which was 18....so my DME did their part. My "titration" part of my sleep study (split) consisted of a straight CPAP set to 16 (or so I was told). The sleep lab person recorded the data and sent it on to the main clinic to be analyzed....so she did HER part. Another doctor at the main clinic looked at the data and charged about $600....and then sent it on to my "sleep doctor" in the local satellite clinic. My local "sleep doctor" THOUGHT (for whatever reason) that I should be set to 18 and wrote out my prescription (he also prescribed extra oxygen, which I never used). He also thought I might have to have a "roto router" job on my throat to let in more air.
Upon getting my equipment, and after about 45 minutes at that pressure, I thought a setting 10 would be a better place to start.....so I reset my machine to that pressure.....and that's where it's been ever since.
My weekly averages typically have been running around 0.5. My lowest weekly average was 0.3 in the first week in December. I have had quite a few 0.0 nights. Since last October, I've been averaging about 2 or 3 apneas per MONTH......so most of the AHI is hypopneas.

I don't know what would have happened if I'd have left it at 18.....maybe I'd be floating in the sky above Yellowstone Park......

Bottom line is, I believe the DOCTOR got it WRONG!

TAKE CONTROL OF YOUR THERAPY!!!

Best wishes to all.

Den

NightHawkeye · Post by **NightHawkeye** » Fri Feb 10, 2006 1:14 pm

laurel wrote:I think maybe you overlooked an option or else I'm not reading the poll right.

I know. Kinda hard to account for all options. I was toying with several more options, but narrowed it down to the ones given. (Maybe I didn't do a very good job of refining it though.)

The pollster's bias figures in as well. (i.e., me) What I was really wondering is how many folks here have stayed with their initial titration settings after realizing there were more options available, especially after having learned about APAP.

I'd judge that you, Laurel, should choose the third option, since you've obviously migrated to APAP.

Regards,
Bill

Mile High Sleeper · Post by **Mile High Sleeper** » Fri Feb 10, 2006 1:43 pm

I requested and got just a baseline sleep study (no titration from a split study), since with fear of CPAP, I thought there was no way I'd be able to fall asleep if I knew CPAP was a threat later in the night. That was a good choice, I got a fine study, plenty of time to observe sleeping patterns. Sleep tech said that's the better way to do it, gives them plenty of time if it's two nights, but most insurance doesn't pay for 2 studies.

Doc prescribed APAP 4 cm to 20 cm and AHI went down dramatically in spite of leaks, rainout, aerophagia (now mostly solved). I'm feeling better but not beyond very basic treatment. Thanks to y'allz, I finally discovered after 2 months that the low of 4cm wasn't giving me enough air, leading to insomnia, and DME incorrectly set the machine for a 4 hour ramp/split study, and I sometimes accidentiially hit the ramp button during the night if fiddling with the machine, giving me I-don't-know-what kind of treatment. Then I set it to 6 to 17 cm with no ramp.

Now, since 2 MDs recommend titration and the insurance company approved it after much deliberation, I'm going in to be titrated. Results should be interesting to compare with APAP software when I'm finally able to read it. I hope this will give me info on my actual mask(s), too (leakage and sleep data). With a number to start with, I should be better able to hone in on the best pressure range.

onlyme · Post by **onlyme** » Fri Feb 10, 2006 1:50 pm

Titrated at 16. Bought my own apap. Very comfortable at 8.4 to 12.4 setting. Usually readout is between 8.4 to 9.6, occasionally rises to 10.2 about once a month. AHI well under 5.0

slumberer · Post by **slumberer** » Fri Feb 10, 2006 2:55 pm

Was titrated at 10cm on a straight CPAP (Remstar Plus)....no Cflex. I decided to get an APAP and have discovered my 90% to be consistently above 10 (as much as 12 one night). This adjustability makes my therapy very effective. So far, the "worst" night produced an AHI of 1.0.

Today's numbers are in:

Usage = 7.33 hours

AHI = 0.4
Total Apneas = 1
Total Time in Apnea = 12 sec.
Total Hypopneas = 2
Total NR Apneas = 0
90% pressure = 10.4cm

Thanks to everyone here, and at CPAP.com for your help and support

Amigo · Post by **Amigo** » Fri Feb 10, 2006 3:42 pm

"Provider adjusted" for me was my Pulmonologist. He thoroughly examined the vast amount of data collected at the sleep lab during my titration (explaining it all to me), and arrived at a setting of 14 which was conveyed via prescription to my initial DME provider.

I have been on this setting, using a CPAP with C-Flex, for over two years, and feel great.

WAFlowers · Post by **WAFlowers** » Fri Feb 10, 2006 4:14 pm

I answered "Provider adjusted -- now use APAP" which skews the results because it is true but not the complete truth.

My titration was exactly perfect. If I wanted to use constant pressure I don't think I could do better than what my titration concluded. But I bought an APAP and have it set to a small range around my titration value.

Does this mean my titration was off? No, but it will appear that way in the poll results.

Bellcrest · Post by **Bellcrest** » Fri Feb 10, 2006 4:20 pm

Haven't yet had a titration study. Only one sleep clinic in the area and after being diagnosed Dec 20 I now have an appointment for titration study May 18. Pretty sad isn't it.

All is not lost though as I am getting a new Remstar Auto CPAP with heated humidifier and smart card. I'll eventually get the pressure right. I am looking forward to getting my APAP and learning how to read the software.

Ric · Post by **Ric** » Fri Feb 10, 2006 8:08 pm

Wulfman wrote:Bottom line is, I believe the DOCTOR got it WRONG!

But more importantly, the DOCTOR got PAID!

(Can YOU say "uvulopalatopharyngeoplasty" fast ten times backwards and forwards while standing in line at the bank and juggling several large unequal size bags filled with money and holding a set of golf clubs on your shoulder??? I'll bet your DOCTOR can!)

Goofproof wrote:Info needed, What kind Vanilla, Oreo. or my favorite Chocolate Chip?

CHOCOLATE CHIP !

How Effective was Your Initial Titration?