titration study?

[plainhat]

I just got my CPAP thang a couple of weeks ago. I've been reading up and wondering that others talk about having a titration study. I've not had one nor has anyone suggested I have one. Is it normal that one does? (not that I want to go through another study, thanks!)

[dhoppe]

Did they hook you up to a machine during the sleep study?

[plainhat]

Nope! Glad they didn't. It has taken me three weeks to manage a four hour night with the dang thing. So, no. It is the Autosense machine so maybe they don't think they need to?

[LSAT]

I assume that you had a sleep study..either in a sleep lab or at home. If it was an at home study, the machine you used will give the doctor some indication what pressure would be needed to eliminate apneas. If it was a sleep lab they would hook you up to a machine that would determine pressures needed....that is a titration.

[plainhat]

I assume that you had a sleep study..either in a sleep lab or at home. If it was an at home study, the machine you used will give the doctor some indication what pressure would be needed to eliminate apneas. If it was a sleep lab they would hook you up to a machine that would determine pressures needed....that is a titration.

I had a diagnostic study in a lab. I didn't have a CPAP hook up whilst there. They did measure nasal air flow. Perhaps it was that?

[Pugsy]

They could be letting the machine do the titration. This seems to be happening more and more often and usually works well unless there ends up being some unusual problems that require additional sleep studies. I think that some insurance companies prefer to just use an apap to figure out the needed pressures...saves them on having to pay for a sleep study that might not come up with a suitable pressure anyway.
Often this is done when a person has extreme difficulty getting enough sleep in a lab setting.

Do you know your pressure settings?

If they didn't put a mask on you...there was no titration.
That nasal air flow prong thing was just to see if the air flow reduced or stopped.

[plainhat]

my pressure settings are at Min 5 Max 20 (cmH2O) with the EPR set at 2 (I'm going to ask them to set it at 3 since exhaling is damned exhausting).

[Pugsy]

With that minimum pressure starting point of 5 cm EPR can really begin to work well because the lowest the machine will go is 4 cm. So even if you set EPR to 3...at 5 cm it is still only going to drop to 4 cm.
EPR won't even do much until you are using at least 6 cm and then it can drop to 4 cm.

See if it is okay to increase the minimum to at least 6 cm because that will let EPR be more pronounced and it's easier to breathe with 6 inhale and 4 exhale than it is 5 inhale and 4 exhale. I know it sounds weird but it's the difference that offers the comfort...so more difference usually means more comfort.

To fully utilize EPR at 3...you need starting pressure of 7 cm so that the machine could make that drop to 4 cm and you feel the full drop.

The machine wouldn't usually be increasing the pressure above that 5 cm mark until you are asleep so EPR wouldn't really be working to full capacity until you are asleep...and wouldn't really be able to notice the difference.

[plainhat]

With that minimum pressure starting point of 5 cm EPR can really begin to work well because the lowest the machine will go is 4 cm. So even
The machine wouldn't usually be increasing the pressure above that 5 cm mark until you are asleep so EPR wouldn't really be working to full capacity until you are asleep...and wouldn't really be able to notice the difference.

Wow you folks are fast to respond. Thanks!

I understand now about the pressure difference. I'll be checking in with the CPAP clinic tomorrow. When I check in sleepyhead at the times I woke up struggling and gasping and dreaming I'm being rolled by a wave and drowning the pressure seems to have ramped up above 8 and as high as 10 and if I'm reading sleepyhead right I can see an effort at a deep inhale and a less efficient exhale just when I pulled the mask off. I wake up exhausted partially because I'm trying to adjust, but I also just really really miss being able to fully exhale. That's when the claustrophobia kicks in.

[Grace~~~]

I am also new to CPAP and did not have a titration study. I believe they are using the apap as my study. It was also mentioned that I didn't have any "comorbidities" (diabetes, high blood pressure, heart issues, obesity, etc.) that would warrant a titration study. Blue Cross seems to have hired a special group that makes these decisions and then connects you to the folks that sell the machines. Can we get any further removed from a doctor? CRAZY! My doctor ordered the triation study.

I have been VERY frustrated.

However, I have had life/death serious medical issues since 2013 and Blue Cross has paid for me to have lifesaving treatments and surgeries and so I am trying to keep this cpap issue in perspective. I am thankful that I had excellent care in critical moments.

I feel like I am doing this cpap ALL myself and ONLY with the help of this group of people on this site.

I realize there are other CPAP groups on the internet but I can't even really understand what's happening *here* yet, so I am not switching around and confusing myself more. I already am quite fond of the experts here.

I have decided that my eson nasal mask is causing me too much pain as I have developed a sore. I called today and supposedly they are getting me a dreamwear nasal mask that has the hose that comes out the top of the head. I tend to like things balanced on top of my head so I think this will be an upgrade.

I am totally freaked out about the EPR. I put my minimum in the 7s and put EPR on 3. I felt good about it. However, now I am concerned that this is going to have long term side effects of making my lungs weaker or just messing me up somehow.

Why do I feel this way?
I don't know.

Things I've read and only half understand?
I just have a "shadow doubt" as would be expected of someone who is messing around with things they know absolutely nothing about.
I can only imagine mixing my own chemo or deciding where I might want to try "a little radiation".

Blue Cross should be ashamed. I have a feeling they hired this other group to take the fall and so they can say
"we had no idea" and they can keep some kind of plausible deniability.

~~~anyway~~~

So I took off the EPR ... and now I am angry again. (since I liked it)

....but I will always do the hardest thing if it is the best thing.
I am a classic overachiever perfectionist PIA who always did the bonus points even with 100 averages.
If breathing against the pressure makes me stronger then I want to be as strong and healthy as possible.

However, if it is only a "comfort preference" then 3 EPR *was* more comfortable. (for me)

I am mad that I don't understand APAP or dangers of BIPAP or oxygenation vs ventilation.
I am making all kinds of half baked conclusions and I know it.

...but they've (my doctors. insurance, middlemen to the middle men) seemed to have left me here alone and act like this is all no big deal
(and maybe it isn't) I am getting it. Albeit VERY slowly.

...and my chemo brain ... I am mad at all the IQ points I lost in the last two and a half years
It makes learning things even harder.

However *I AM* happy to be here and not in hospice like so many of the friends I have made.
I distinctly remember praying "God please give me real life problems again like foreclosure or divorce" and I prayed "Please don't let me have to have that nephrostomy tube sticking out of my back" ... and my prayers were answered!

CPAP anger is a much better real life problem and this cpap tube that is not surgically installed in my body is a way better tube.
(also I did not have a foreclosure, bankruptcy or divorce)

So, please excuse my b!t@hing. I still have anger issues despite my extreme gratefulness to be alive.


It's all anger rooted in ignorance.

I don't know WHAT I am doing with this cpap stuff.

I'd upload sleepyhead but I haven't gotten a single night yet that really could tell you anything other than that
I am a failure and not very compliant.

I intend to sleepyhead as soon as I get any "real" data.

[yaconsult]

Hi, plainhat.

Listen to the advice of the experienced posters here regarding what you need for a minimum pressure setting. If you don't already have it, you will want to download the clinical manual for your machine. This explains all the information on the settings, what they mean, and how to change them. The clinical manual is usually not provided with the machine unless you buy it someplace like cpap.com.

Many people get used to being on the machine while they are awake and doing something else - like watching tv or using the computer. This is just to get you used to breathing with the machine and getting used to what it feels like. Then it's not such an alien thing when you go to bed and put it on. I look forward to putting my mask on at night because I know full well that it's the only way that I will get any rest at all.

[Julie]

Hi, you seem to be having so much anxiety around everything and I think it's keeping you from getting as far as you might... why not make a point of just learning one puzzle piece a day or week, etc, at a time and then move on to the next thing... it might not all make great sense at the time without being hooked to the others, but in time it will, and that's better than going on being confused about all of it all the time.

You're right that EPR's a comfort thing, so if you feel better at 3, then go back to it, you won't lose points and you'll likely see your AHI drop a bit.

And for heaven's sake stop thinking that tweaking your pressure a tiny bit or any other tweaks you make are comparable to e.g. DIY chemo! This is all about room air keeping your throat open just a bit more... not blowing up your lungs or anything remotely so radical. No one's looking over our shoulders and it's all about you, your equipment and how you feel, day to day - don't project each little thing into the future because it's all un-doable too whenever you want.

Good luck and relax already!

[Grace~~~]

Thanks (again) Julie ~~~

I have a stupid 17% chance of survival in the next 5 years.
...or actually 2.5 more years. (stage IIIC)

...and I tend to think every action I take or any bite of food I put in my mouth
...or now "every breath I take" could lose me another percentage point chance at survival.

I work on it.
wrapping my head around it.

...and I fake it way better in real life.
I am much worse here on the internet. Anonymous and all, I guess~~~

I do apologize if I am too edgy or extreme. Bad Grace!
I am SO appreciative of the information that freely flows here.

I do realize it is just AIR ... like a fancy fan.
At times I think they "diagnosed me" with apnea just to give me busy work.

[plainhat]

I have a stupid 17% chance of survival in the next 5 years.
...or actually 2.5 more years. (stage IIIC)

Wow! You're half way to the safety zone! And yeah, I've got friends who beat worse odds than that, but that won't help you where you are now. All I can say is keep up the good work! And if you want to hear some stories, I've got a few!

I do apologize if I am too edgy or extreme. Bad Grace!

heh... look in on that other CPAP forum for the same user and avatar I use here to see my epic rant against CPAP last night with far less reason. You might also read the replies I got. They helped me very much!

At times I think they "diagnosed me" with apnea just to give me busy work.

You are attributing them with far better motivations than I did :=)

As for the insurance companies removing you from your docs... yeah it goes further than that since they have to answer to the federal gov here. So ultimately, it all goes back to D.C. Cheers!

Sleepyhead has been a big help for me even though I've only managed one compliant night and about ten hours of use. For one thing it tells me that in that time I've only had one OSA event and that helps me feel that I can opt for more comfort and, with luck, more sleep! Looking at the clock, I guess I better go embrace the alien hose and try again

Good luck and as Julie said, relax a bit if you can. (I'm a fine one to talk! )