Overtitration!!! Now I know why you guys like AutoPAP!

Joe A.. · Post by **Joe A..** » Fri Sep 23, 2005 6:56 am

Guys:

A retitration study indicated that I was overtitrated by 25%. Was titrated on BiPAP at 16/12 and was feeling lousy! Chronically tired, couldn't think, poor memory and focus.

My recent study has me on CPAP at 12! After using BiPAP at 16/12...straight 12 feels like nothing....but it works!

Sleep studies give you a 1 night snapshot! A little nasal congestion, or some other issue can throw off the whole study! Yet it costs $4500 bucks to find out that they got a poor read!

Now I have a BIPAP machine that is being run as a CPAP! My Patient share on the BIPAP is twice what I could buy a CPAP machine for on CPAP.com and I have to wait 5 years before my insurance company will buy a new machine.

So long as I can use a full face mask with the unit...my next machine will be an Auto-PAP complete with Software! And it will not be purchase from a DME!

This mesage board has taught me alot about OSA and treatment options. Kind of like going to an AWAKE meeting daily! Even better, because most folks are gung ho about there treatment!

wading thru the muck! · Post by **wading thru the muck!** » Fri Sep 23, 2005 9:21 am

Joe A, Thanks for sharing your story..

You are very right to conclude that an auto would have avoided the extra expenditure of many many $$. Not to mention your time and inconvenience and discomfort.

Wulfman · Post by **Wulfman** » Fri Sep 23, 2005 10:35 am

Joe A.,

Another "thanks" for your story.

I believe that I was also "over-titrated" for my prescription by about 56% (actually the sleep doctor just took a GUESS). The doc guessed at 18 cm. and I've been doing just fine on 10 cm. (I changed the pressure after about 1/2 hr. at 18). At least according to my software, I believe I'm doing fine.....my weekly AHI has been running at about 0.5.
In June, when my AHI was about 1.0, my sleep doctor couldn't believe I was doing that well on that pressure. He proceeded to question the accuracy of the machine, the software, the reports, etc. He also made some un-called-for remarks.....so I fired him!

I'd be interested in hearing if there are others that have been over-titrated or over-prescribed.

Thanks again for the post.

Den

Guest · Post by **Guest** » Fri Sep 23, 2005 10:42 am

Wading thru the Muck:

This overtitration could have cost me my livelyhood! My boss tore me a new one when I fell asleep at a meeting. (BTW...he is the one that thinks all sleep events can be cured with weight loss.). Since then I have been a shuffling Zombie for 2 months! though I adressed the matter right away it took me amost a month to get into the sleep lab!

I am better now...but I still cannot access the colateral damage this has taken on my career! I'll find out at review time!

I am hoping that in 4 years that AutoPAP will be better embraced by the medical community and that there will be units that are usable with a Full Face Mask. Right now sleep labs would rather hear you mention Osama Bin Laden than AutoPAP.

Sleep Labs will still operate even if AutoPAP is accepted. After all...you still need a diagnosis...you still need a presciption...and some folks do indeed need BiPAP(Like if you have centrals!Or a very high pressure!). Also there will still be some who will opt for a 300 dollar CPAP if they have a high co-pay or patient share.

Right now sleep labs are backed up 3-4 weeks!

Guest · Post by **Guest** » Fri Sep 23, 2005 10:50 am

Wulfman:

What I was amazed at was that a pressure 25% OVER what was needed was worse than no machine at all! Also for everyone overtitrated...how many are under???

I also posted this to educate folks who adjust their own machines....too much pressure is just as bad as not enough!!! Be Careful! Only attempt this if you have a way to effectively evaluate how you are sleeping (Software).

Blindly raising or lowereing pressure is reckless and dangerous!!!

Nenetx2004 · Post by **Nenetx2004** » Fri Sep 23, 2005 11:05 am

Joe,

Tell your boss that for OSA weight loss is not the only answer and often is not even the cause of OSA. I'm slim, athletic and been on an autopap for almost a year now. My recovery has been slow but I am noticing a differenc.

Jeanne

WillSucceed · Post by **WillSucceed** » Fri Sep 23, 2005 11:51 am

actually the sleep doctor just took a GUESS

Very nice! I'm glad that you have moved on to a new Dr.

My Dr. admitted that my sleep study was a poor one but prescribed a pressure of 15 anyway. AutoPAP says I only need 8, with periodic increases to 11. I fired my Dr. pretty quickly and found a new one that likes autoPAP just fine.

Wulfman · Post by **Wulfman** » Fri Sep 23, 2005 12:00 pm

Joe,

I agree that BLINDLY changing one's pressure CAN be reckless or dangerous, but with that said, according to your analogy that makes the doctors who don't get it right....RECKLESS (and/or dangerous), too. (I will agree to that.)
It could also be said that it's "dangerous" for us to wait so long before getting through a sleep lab and then waiting weeks or longer for the analysis of our sleep studies and then waiting for the equipment. Ironically, the doctors don't seem to be too terribly concerned that it's taking months for us to get through this process.
MY philosophy/approach to setting MY machine was that ANY amount of air I would be getting was going to be better than what I had been getting and if the software showed that it wasn't quite right, I could work up or down from there.

I will reiterate what you said....."Be Careful! Only attempt this if you have a way to effectively evaluate how you are sleeping (Software)."

Best wishes with your situation (boss),

Den

LoneRider · Post by **LoneRider** » Fri Sep 23, 2005 12:09 pm

So, the next step is, with APAP, is possible to just get a machine, set it to 10 - 14 cm of pressure, then look at the results and adjust.

Or, I guess I should ask, is there a chance that just using a CPAP machine at 10cm of pressure could put your life in jeopardy, where a supervised titration would mitigate those risks?

There is a thought going through my head, that if my GP get the results, and I am definitely have OSA, could he just prescribe a machine. Thus saving me another couple of weeks of waiting for the titration an analysis.

Just a thought.

cheers,
Tom

ProfessorSleep · Post by **ProfessorSleep** » Fri Sep 23, 2005 12:54 pm

I wonder why split night studies aren't more widespread? That would save a considerable delay and expense, wouldn't it? Provided the first half is sufficiently diagnostic and there is enough time for adequate titration. For a lot of people, though, the split procedure seems to work.

NOzsnAZ · Post by **NOzsnAZ** » Fri Sep 23, 2005 2:15 pm

LR,

I don't know if your doc could prescribe a machine without first knowing what pressure (or range of pressures) to put ON the prescription - unless of course he prescribed an auto CPAP .

Unfortunately I think he would need to show that titration "worked" for your OSA in order to prescribe a CPAP.

Grabraham · Post by **Grabraham** » Fri Sep 23, 2005 2:17 pm

My Dr. prescribed a CPAP @ 7cmH2O without having a tritation . 3-4 weeks later i had my tritation study and it is now set at 14.

LoneRider · Post by **LoneRider** » Fri Sep 23, 2005 2:38 pm

ProfessorSleep wrote:I wonder why split night studies aren't more widespread? That would save a considerable delay and expense, wouldn't it? Provided the first half is sufficiently diagnostic and there is enough time for adequate titration. For a lot of people, though, the split procedure seems to work.

I was really hoping for a split, but I did not really fall asleep until about 2 or 3 in the morning.

And, assuming I am OSA confirmed, I hope I have a simular experience as Grabraham. But with the 420e I should be able to figure out the pressures, at least to the point where it does not record any event.

cheers,
Tom

SickAndTired · Post by **SickAndTired** » Fri Sep 23, 2005 2:45 pm

I wonder why split night studies aren't more widespread?

...and miss out on yet another money-making opportunity?!?!

After waiting weeks to get in for my sleep study, and then weeks waiting for the results, I found that I had severe OSA (AHI=133), and now needed a titration study.

After waiting a month and half to get in for the titration study, and another 2 months for the results; the last paragraph, on the whopping 3 page report, read: "patient requires CPAP therapy with a pressure of 20cm and CFLEX with a pressure of 3cm. If the patient experiences any trouble tolerating this therapy, he should be immediately scheduled for a BiPAP titration study"!?!? BTW, has anyone ever been able to tolerate straight CPAP at 20cm???

Even after I explained to the doctor who referred me to this particular sleep lab (there is at least one other in my town), that I didn't think they knew what they were doing since not only does CFLEX use a setting of 1,2 or 3, not a pressure setting, but that CFLEX isn't even a valid technology for any xPAP machine except for those made by Respironics (which just happens to the brand used by the sleep lab... what a conincidence eh?), he still seems to think I would be better off going back to these crooks, rather than waiting for the new Auto-BiPAP machine, so that I can do my own titration study...

So, now that I'm looking for a new doctor...

dsm · Post by **dsm** » Fri Sep 23, 2005 5:06 pm

Re the over pressure issue. I am intrigued at this line of thinking.

I had started a thread asking if people had had their recomm cms lowered & what the results were but didn't get too many responses.

Some of the posts here are saying much the same thing. What I am keen to understand is if there are any other detailed discussions on this ?

I am trying to sort into objective & subjective commentary ..

objective would be based on written papers
subjective is people say 'I changed that and this is what happened'

Because this SA/OSA field is so new there is so much to understand. The purpose of the xPAP device is to keep the airway open from the external supply of air into the lungs. SA/OSA tries to close the flow (with OSA in particular, trying block flow from inside to outside - exhalation) - logically too much pressure merely guarantees the airway stays open - a 'logical' downside of too much pressure is going to be the effects on sleep if the patient is struggling to breathe out against excessive therapy pressure - so a patient may not be experiencing traditional SA/OSA flow blocks but is suffering because the therapy is creating its own blocking/flow slowdown.

The bottom line here in this theme is

Is too much pressure as bad as too little ?
If so why ? (what is it that is happening that makes it so)

Cheers

DSM

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