How accurate titration studies since most don't sleep good??

jjlady · Post by **jjlady** » Fri Aug 31, 2012 8:49 pm

Since most people don't sleep well during a titration study, how often are they accurate with the initial pressure recommendations? I have to believe that a "normal" night sleep at home requires different pressure than sleep in a clinic especially if it is the first time using a mask, I don't know how they can get any proper pressure settings. Just curious??? I realize having the sensors on you shows a lot, but I would think "normal" sleep looks different than clinic sleep.

avi123 · Post by **avi123** » Fri Aug 31, 2012 9:21 pm

That's why another sleep study should be done before one year is over on the CPAP.

ems · Post by **ems** » Fri Aug 31, 2012 9:41 pm

avi123 wrote:That's why another sleep study should be done before one year is over on the CPAP.

That's a matter of opinion. If you feel good and your data is good, there is no need for another sleep study. That's directly from the sleep specialist I use who is well respected in my area.

Suzjohnson · Post by **Suzjohnson** » Fri Aug 31, 2012 10:02 pm

You have a very good point, jjlady and it makes a positive argument for having a data capable machine, and, if you are fortunate enough to have gotten your hands on an auto adjusting machine, it's much easier to see changing needs in pressure. The value in doing the titration is that it usually gets you in the neighborhood of the correct pressure and with thoughtful evaluation of data and careful, incremental tweeking, you can arrive at an optimal pressure.

Suz

-tim · Post by **-tim** » Fri Aug 31, 2012 11:11 pm

My sleep study was near the intersection of two major roads which have traffic all night. Combine that with trams that run from 5:30 to 3:30 and ambulances it was not a quiet but I used to live about 2 blocks away so I had been used to the noise otherwise it would be a disaster.

That wasn't as bad as another sleep study. One of my professors told me he needed help for a class and volunteered me for a sleep lab in a teaching hospital. They would bring in one group of students who got to hook me up and then watched the process of looking at the equipment and then about an hour later they would disconnect me and do it all over again. The worst part was when one of the students who was in one my classes came in and I had been asking her out. Its hard to try to impress her when your playing the role of a lab rat.

brucifer · Post by **brucifer** » Fri Aug 31, 2012 11:54 pm

Heck, I knew I had OSA before I even had a sleep study. Between my wife elbowing me in the side at night to kickstart my breathing and my daughter recording an apnea event one night, there was no doubt in my mind that I had OSA. I had the sleep study completed in order for my insurance company to pay for my CPAP machine and supplies. I also needed it as a baseline on where to begin on my machine settings.

As for sleeping during my sleep study, I slept for more than 6 hours. I went kayaking earlier that day, so that activity helped. I needed the rest.

zoocrewphoto · Post by **zoocrewphoto** » Sat Sep 01, 2012 2:18 am

I was really surprised to actually sleep pretty well at the sleep study. I woke up about an hour into the diagnosis phase, needing to use the bathroom. After that, I slept okay, and the tech woke me up for the titration phase. I remember a trip to the bathroom again, putting the mask on, and rolling over. According to the sleep study summary. I fell asleep in 4.9 minutes, and I slept for 4.7 hours with the cpap machine. I also felt better the next day. I had a really good sleep study, and my prescription was an apap machine set to 11-17. It has been spot on. Spends most of the time between 11 and 13. Sometimes goes up to the upper 16s, but never more than 4 times in one night. And most nights, not higher than 15. I believe it actually made it up to 17 3 times. I would have to check again. But it is extremely rare. They weren't quite sure how high I needed to go as my apnea was worse on my back, but once I was using the machine, I only slept on my back twice. Unlike the sleep studies of many other people, they did not tell me to sleep on my back on purpose. They told me to sleep any way I wanted. I understand why many studies want you to sleep on your back to get a full study. But I think it helped to have the person more comfortable and natural.

jjlady · Post by **jjlady** » Sat Sep 01, 2012 10:55 am

I change positions alot during my normal home sleep, start on back, go to sides and back and forth. But during my study it was hard to turn on my sides because of all the wires, so I was mostly on my baCK, I did try to turn once but realized it didn't work so went right back to back. But they prescribed a pressure for back but I hear side usually needs less. So I am having another titration tonight from sleep doc because my ahi has been high all along.

chunkyfrog · Post by **chunkyfrog** » Sat Sep 01, 2012 11:31 am

Sleep studies have been done for years, long before patients (at least, us) had access to computerized machines
with full efficacy data, automatic pressure adjustment, and all that other good stuff.
I believe there is a bit of,"This is the way it has always been done, etc." Doctors and insurance gate-keepers
depend on the reports. Often the safety of the patient is an issue--the PSG has been the 'gold standard".
BUT, they really do need to work on it some more.

jnk · Post by **jnk** » Sat Sep 01, 2012 11:57 am

For a lab/center titration PSG, the hope, as I understand it, is that you do sleep, but that your sleep is worst-case scenario, so you can be titrated for that. As long as they see enough supine REM (dream sleep on your back) at treatment-level pressure, to see how you react to that pressure, they have an excellent idea of an effective pressure for you. Some docs even add a cm or so more, just to be sure--to make sure you will have enough pressure to keep you breathing even after running a marathon and then having a heavy meal with a glass of wine or two. Having a human see how you react to pressure can make all the difference, but no test, even a year of home tests every night, can test you for every possible sleep scenario.

It is my belief that PSG titration isn't just the gold standard in effectiveness of testing but that it is also the most cost-effective approach--unless, of course, comparing it to no testing at all. But the most direct answer to your question is that as long as a human sees you reacting to treatment pressure in supine REM, your sleep was more than good enough for a lab/center to do its thing as far as accurate titration and screening for sleep troubles that can get unmasked by PAP.

jjlady · Post by **jjlady** » Sat Sep 01, 2012 12:34 pm

The thing is that I sleep both on back and on side, I hear side needs different pressures than back usually less, so I have a fixed pressure machine and if I need less pressure on side could the higher pressure cause centrals while on side (which I am having)? It really doesn't matter, because I am going for another titration tonight, I will bring this up I would think an auto machine would deal with that but I don't have an auto machine and at this point would have to pay out of pocket for one and doc once commented I have the right machine, so I doubt he will prescribe an auto.

tigrpal · Post by **tigrpal** » Sat Sep 01, 2012 1:00 pm

My diagnostic sleep study showed an AHI of 9.3. I had a separate titration study. It was one of my few really good nights so I had zero events and my pressure never went above 4 cmH20. I feel my titration study was useless. When I met with the pulmanologist, he recommended I go to the ENT to talk about surgery and he never recommended a pressure. I felt he was too quick to recommend surgery and well, I just won't do it, so I never went to the ENT. Since I had gotten a machine right after the diagnostic, I've been self titrating starting at 7. I worked up to 8.5 when I started to get leaks through my mouth and AHI was averaging 3.5. I started working back down and now at 6, no mouth leaks, and AHI under 1.5. My best nights are when I sleep most of the night on my side. The problem is that side sleeping is uncomfortable for me. There is no place to put my lower arm and my shoulder gets sore during the might causing me to sleep restlessly. I sleep best on my back but then AHI goes up.

All of that said, I didn't start to feel better until I started to go to bed early enough to make sure I got 8 hours of sleep every night and I started exercising(walking and jogging) at least a half hour almost every day.

I think doctors making therapy and treatment decisions based on one or even a half night of sleep study is irresponsible. There are too many variables and for some people the severity of apnea changes from night to night. Doctors should use the sleep study as a starting point and teach patients how to use data and how to monitor their feelings in order to self treat much like they do for diabetics. Many doctors do that. Mine was too quick to recommend the knife.

lazer · Post by **lazer** » Tue Sep 04, 2012 9:46 am

avi123 wrote:That's why another sleep study should be done before one year is over on the CPAP.

Even though I'm on your "Foe" list and you likely won't get to see this message. Good luck getting another (at least in-lab) sleep study covered by insurance within 1 year. I've been pretty much told that is not possible and you have to wait a year +. Maybe I have shitty insurance...

BlackSpinner · Post by **BlackSpinner** » Tue Sep 04, 2012 9:50 am

Mine was a home study. In my bed, with my mask.

jjlady · Post by **jjlady** » Tue Sep 04, 2012 10:16 am

Did you have all the wires on? Did you put them on yourself??

BlackSpinner wrote:Mine was a home study. In my bed, with my mask.

How accurate titration studies since most don't sleep good??

How accurate titration studies since most don't sleep good??

Re: How accurate titration studies since most don't sleep good??

Re: How accurate titration studies since most don't sleep good??

Re: How accurate titration studies since most don't sleep good??

Re: How accurate titration studies since most don't sleep good??

Re: How accurate titration studies since most don't sleep good??

Re: How accurate titration studies since most don't sleep good??

Re: How accurate titration studies since most don't sleep good??

Re: How accurate titration studies since most don't sleep good??

Re: How accurate titration studies since most don't sleep good??

Re: How accurate titration studies since most don't sleep good??

Re: How accurate titration studies since most don't sleep good??

Re: How accurate titration studies since most don't sleep good??

Re: How accurate titration studies since most don't sleep good??

Re: How accurate titration studies since most don't sleep good??