Should I cancel my titration?

[StephenP]

I've been on CPAP since Tuesday night. The first night, I slept for 2 hours on it, woke up feeling crappy and tired the next day. The next two nights I managed to do 4 hours. By Friday night, I was so sleep-deprived that I was cranky, emotional, and anxious. I couldn't fall asleep, and I knew with my current mindset I wouldn't be able to. Saturday night was a similar story. I kept dozing off, only to jolt right back awake again. Had to take the mask off just to feel like I could breath. The feeling that the mask is my only source of air is really doing a number on my head. I feel claustrophobic regardless of the A-Flex settings I choose. The Ramp feature is disabled, and because it's an autopap, it starts out at a pressure of 4, and doesn't increase unless I need it. I feel like I need it right off the bat and have no way to control the pressure.

Tuesday is my CPAP titration. If I can't sleep with it by then, what is the point of going to the sleep clinic? Would be a waste of my time, money, and sleep. I hate that the APAP machine was thrown at me seemingly without exploring other options. Stress/anxiety runs in my family, and I feel like the CPAP therapy is a lost cause for treating any kind of hypopnea (mild hypopnea at that) until something can be done about my stress--not to mention that the main cause of my hypopnea may very well be a problem with my nasal airway. I don't see how I can be expected to sleep with this mask when I can barely fall asleep in a room that's too quiet, too noisy, too hot, too cold, too bright, etc.

[jules]

NO

the tech is going to see the breathing problems and up the pressure pretty fast in the study I bet

[Wulfman]

I've been on CPAP since Tuesday night. The first night, I slept for 2 hours on it, woke up feeling crappy and tired the next day. The next two nights I managed to do 4 hours. By Friday night, I was so sleep-deprived that I was cranky, emotional, and anxious. I couldn't fall asleep, and I knew with my current mindset I wouldn't be able to. Saturday night was a similar story. I kept dozing off, only to jolt right back awake again. Had to take the mask off just to feel like I could breath. The feeling that the mask is my only source of air is really doing a number on my head. I feel claustrophobic regardless of the A-Flex settings I choose. The Ramp feature is disabled, and because it's an autopap, it starts out at a pressure of 4, and doesn't increase unless I need it. I feel like I need it right off the bat and have no way to control the pressure.

Tuesday is my CPAP titration. If I can't sleep with it by then, what is the point of going to the sleep clinic? Would be a waste of my time, money, and sleep. I hate that the APAP machine was thrown at me seemingly without exploring other options. Stress/anxiety runs in my family, and I feel like the CPAP therapy is a lost cause for treating any kind of hypopnea (mild hypopnea at that) until something can be done about my stress--not to mention that the main cause of my hypopnea may very well be a problem with my nasal airway. I don't see how I can be expected to sleep with this mask when I can barely fall asleep in a room that's too quiet, too noisy, too hot, too cold, too bright, etc.

If I had my machines set up that way, I'd want to quit, too.

I suppose you have your humidifier setting cranked up there, too.

That's a setup for failure.

But, I'm confused....... Is that Auto/APAP something that they gave you temporarily until the titration, or what? How is it that you have a machine before the titration? And, then they have a regular titration study for you to do? Usually, it's one or the other. Are you supposed to take that APAP machine back or is it yours to keep?


Den

[KC5cychris]

I don't think that you should cancel, because the titration is where the Rt and/ or Sleep technician will be using their equipment to determine what your pressure should be . By them sending you home with little to guidence is only setting you up for failure. so I would hang inthere go to your appointment despite the cost an see where it goes from there. I had my titration last tuesday night and I will say I was still groggy on Wensday but I h ad more energy over all through out the whole of the day I was up almost 20hrs as I work the afternoon shift so I go home around 12AM so I feel it was worthe the extra effort involed to give this a go it will help if you give it a chance.
I am a newbie but want to encourge you just as I know those that have been here a while will as well

Good Luck
Chris

[jules]

Den

There are labs and HMO's that do send patient a machine prior to titration to get acclimated. It isn't a true APAP trial. I assumed this was such a case.

[Needsleep75]

Just a quick question on something I have noticed. Why do so many people opt for a full face mask right off the bat.. I can understand the full face mask if you can't keep your mouth closed or it opens alot when you fall asleep, or if your preasure is so high that you cannot get a really good seal with the other masks.. I was just kind of curious as the nasal pillows or other mask would probably be alot more comfortable and easier to get used to.

[BlackSpinner]

Just a quick question on something I have noticed. Why do so many people opt for a full face mask right off the bat.. I can understand the full face mask if you can't keep your mouth closed or it opens alot when you fall asleep, or if your preasure is so high that you cannot get a really good seal with the other masks.. I was just kind of curious as the nasal pillows or other mask would probably be alot more comfortable and easier to get used to.

Because many people sleep with their mouth open - why assume that you will keep your mouth closed when you are asleep? Since we can't watch ourselfs while we sleep, assuming you can keep your lips buttoned up is kind is stupid when your therapy will be totally dependent on this.

[Needsleep75]

I was not intending to come off rude so I appolagize if it came off that way. When I went for my sleep study they started me off with a nasal mask so figured they would tell me if I needed a full face mask or chin strap during the study. Also my DME sugested the nasal pillows to start off with. I know my dme is giving me 30 days to switch masks if I don't like the first one they set me up with. Was just trying to be helpfull and sugest maybe something perhaps a little easier to tolerate.

[StephenP]

I suppose you have your humidifier setting cranked up there, too.

That's a setup for failure.

But, I'm confused....... Is that Auto/APAP something that they gave you temporarily until the titration, or what? How is it that you have a machine before the titration? And, then they have a regular titration study for you to do? Usually, it's one or the other. Are you supposed to take that APAP machine back or is it yours to keep?


Den

They gave me the autopap to get used to it prior to the study. I already paid for it, and they will set it to "CPAP mode" after my titration, and I will keep the machine, unless I end up needing bipap. That's what stresses me out. I feel like I have a week to get used to it and that if I can't sleep during the titration, it's a wasted night.

As for the humidifier, I don't know why I was prescribed one. I live in Louisiana. There's quite enough humidity in the air, and I'd much rather cool air than a feeling of suffocating in the jungle. I have it all the way to 0, but that doesn't help the claustrophobic feeling.

I have a nasal mask too. I initially took the full face on the first night. They had me down for a nasal (why did nobody notice I sleep with my mouth open?), but I told the Apria guy it wouldn't work. After the claustrophobic feeling, I decided to try a nasal mask as well. It's better, but it's nearly impossible to sleep on my side with it. It's either so tight that it presses on my upper lip and nose bridge, making it difficult to breathe, or it's loose, open, and leaky. And I can feel myself wanting to open my mouth when I relax. I'm considering the taping method, but I don't know if that will help. I mean, it's my tongue blocking the mouth airway, not my lips. I can open my mouth without breathing through it.

[BlackSpinner]

I was not intending to come off rude so I appolagize if it came off that way. When I went for my sleep study they started me off with a nasal mask so figured they would tell me if I needed a full face mask or chin strap during the study. Also my DME sugested the nasal pillows to start off with. I know my dme is giving me 30 days to switch masks if I don't like the first one they set me up with. Was just trying to be helpfull and sugest maybe something perhaps a little easier to tolerate.

Personally I hated the feel of things on/in my nose. I use a hybrid and it works well after I accepted that there were things touching my nose. I would have totally stuck with the quatro if I could easily get the supplies for it here.
As far a DME recommendations - I got fitted from across the desk and from 6 feet away she could totally tell that there were no possible leaks. - It is really too big but I was basically told -too bad we don't have the size you want, live with it. So my thought is basically they didn't have your size and couldn't care less if you were a mouth breather anyway because they probably make more money off this mask.

[Muse-Inc]

Do the titration...lotta valuable data collected...GET A COPY!!! The data will help you optimize therapy. With an initial pressure of 4, most of would feel we're suffocating! Most of us need to start at 6 or 7 to avoid that feeling. You have my sympathy they set the machine to start at that low pressure; it should quickly increase pressure to abort events (practice some relaxation techniques before maskup so your breathing slows down). You might need to use a mask like the one I wear (quite a few of us here sleep with it too) to avoid the claustrophobia reaction:

[fiberfan]

The Ramp feature is disabled, and because it's an autopap, it starts out at a pressure of 4, and doesn't increase unless I need it. I feel like I need it right off the bat and have no way to control the pressure.

I feel almost like I am suffocating at a pressure of 4. I did some cpap practice while working late the night after I picked up my cpap machine. My machine had the default ramp start of 4. I tried a ramp time of 5 minutes but that ramped up too fast for me. Luckily someone had pm'd me with the location of a clinical manual so I upped the starting ramp rate to 5 and it made such a difference.

Just a thought that perhaps when you have a pressure that is a bit higher it might be easier to use. The sleep center used a pressure of 5 for my mask fitting and started my titration study at 5 so I didn't know how bad 4 felt until I had my own machine.

[Needsleep75]

The Ramp feature is disabled, and because it's an autopap, it starts out at a pressure of 4, and doesn't increase unless I need it. I feel like I need it right off the bat and have no way to control the pressure.

I feel almost like I am suffocating at a pressure of 4. I did some cpap practice while working late the night after I picked up my cpap machine. My machine had the default ramp start of 4. I tried a ramp time of 5 minutes but that ramped up too fast for me. Luckily someone had pm'd me with the location of a clinical manual so I upped the starting ramp rate to 5 and it made such a difference.

Just a thought that perhaps when you have a pressure that is a bit higher it might be easier to use. The sleep center used a pressure of 5 for my mask fitting and started my titration study at 5 so I didn't know how bad 4 felt until I had my own machine.

I used the ramp feature all of 1 day and just start off at my full preasure now and I have only been on it a week. I am at a preassure of 8 and it takes me about a minute to get used to it starting off then I don't even notice it.

[GumbyCT]

YES, do the titration - it will save you more troubles ahead. Ask your doc for a sleep aid if you think you will need it. No point going if you can't/don't sleep. But the lab may require a prescription for them to provide the sleep aid.

Having the machine at home is actually brilliant however comma it IS setup wrong if it starts at 4cm. 4 needs NO ramp period. It would be better starting at 7-8 with the ramp staring at 4cm. Cuz ramp won't start unless YOU press the button.

This gives you the chance to get used to wearing the mask and work out any bugs. Imagine, on a split-nite, when the tech comes in, wakes you and just slaps a mask on your face - THEN you try to sleep - Imagine.

Request a copy of your sleep study, titration, AND prescription - in writing if needed.

Following the titration either ask the tech to correctly setup your machine or use the instruction from this forum to fix it yourself. An auto machine should be set to start 1 or 2cm below your titrated pressure, there-by avoiding many of the events that would be required to increase the pressure.

A straight CPAP machine is set to just one pressure. You are better off using the auto feature IF it is set correctly and you can tolerate it.

HTH - go and be sure to let us know how it went for you

Good Luck

[StephenP]

Another bad night now... I just panic every single time. I don't know why. I just feel like I need to do a lot of stress and sleep-hygiene adjustments before I have any hope of being okay with having this on me...

I just don't feel like I was evaluated properly the first time. No monitoring of mouth breathing, no acknowledgment that that particular night of sleep was absolutely nowhere close to how I normally sleep... hell, I didn't even see the doctor after my first PSG. I saw her nurse, who simply told me about CPAP machines because of my 14 hypopnea events per hour.

I kind of wish they'd do a second regular PSG... Which leads me to a couple of hypothetical questions:

1. Worst-case scenario, is my CPAP machine returnable, or am I stuck with it? (note: I got it from Apria, and I had to pay for it because I hadn't met my deductible.)

2. Is it rare that insurance companies would cover a second PSG (non-titration, just regular sleep)?

I know you all think I should go to the titration, but I don't feel like I'm getting the proper attention. There are too many people involved in this; they are all trying to make their money, and nobody is paying attention to my individual needs. I haven't seen an actual doctor since February.