Is it strange to not have a titration study?

jrgood27 · Post by **jrgood27** » Wed Jun 07, 2006 2:42 pm

Just saw my sleep specialist (who is also the director of the lab I went to for my initial study) and he prescribed an APAP and said it wasn't necessary to have a titration study. Does this sound right?

I'm thrilled if this is the case b/c my initial sleep study was just awful. But I'm afraid to cancel my appointment for the titration (which my GP made) b/c there is a 2-3 month wait time.

I just have never heard of not having a titration study. Jenny

Linda3032 · Post by **Linda3032** » Wed Jun 07, 2006 2:46 pm

An Auto machine can help titrate your pressure - and more and more doctors are using Autos for that purpose.

Which Auto did he get you? If it's a good one, then software can determine what your 90% pressure is.

If it's a "junker", then you need to insist on a titrating session. Hopefully, the doctor isn't trying to pull a fast one.

GoofyUT · Post by **GoofyUT** » Wed Jun 07, 2006 2:48 pm

Bravo to your sleep doc! There are at least two studies that show that an APAP does at least as good a job of titrating treatment pressures as an attended sleep-titration study does. So, your sleep doc is practicing state of the art sleep medicine, in my humble opinion.

Chuck

P.S. You can consult the ResMed web-site for access to the articles reporting these studies, or I'll be glad to send you the references.

Guest · Post by **Guest** » Wed Jun 07, 2006 2:53 pm

No, it's not strange not to have a titration study. You've already had the PSG and studies have shown an auto adjusting machine is equally as effective at titrating the correct pressure.

Here's a link you can click on to a powerpoint presentation discussing this very issue:

Not Every Patient Needs to Go to the Sleep Lab

Powerpoint presentation by a well respected board certified sleep doctor/pulmonologist, Dr. Barbara Phillips, at a meeting of the American Lung Association of the Central Coast - November 2004

jrgood27 · Post by **jrgood27** » Wed Jun 07, 2006 4:32 pm

I will cancel my titration appointment then. Yippee!

Thanks for the replies and references everyone.

Linda: unfortunately I didn't think to ask the sleep specialist what kind of machine. I was just so happy he recommended an APAP. Actually at first he said the insurance I had wouldn't cover it, but I asked him to confirm this and it turned out he was wrong. They do cover APAP. But ugh, now I wish I asked him what kind.

Jenny

polysomprincess · Post by **polysomprincess** » Thu Jun 08, 2006 1:07 am

wait don't cx that appt! auto's leave many things unattended like central apneas, periodic breathing, central hypopneas, mixed apneas, mixed hypopneas, cheyne stokes, and etc. Not to mention the fact that once your optimal pressure is reached many other sleep disoders maybe discovered, diagnosed and then treated, like PLMS...

Guest · Post by **Guest** » Thu Jun 08, 2006 1:44 am

[quote="polysomprincess"]wait don't cx that appt! auto's leave many things unattended like central apneas, periodic breathing, central hypopneas, mixed apneas, mixed hypopneas, cheyne stokes, and etc. Not to mention the fact that once your optimal pressure is reached many other sleep disoders maybe discovered, diagnosed and then treated, like PLMS...

jrgood27 · Post by **jrgood27** » Thu Jun 08, 2006 4:53 am

wouldn't things like centrals or PLMs be found in my initial study? Jenny

[quote="polysomprincess"]wait don't cx that appt! auto's leave many things unattended like central apneas, periodic breathing, central hypopneas, mixed apneas, mixed hypopneas, cheyne stokes, and etc. Not to mention the fact that once your optimal pressure is reached many other sleep disoders maybe discovered, diagnosed and then treated, like PLMS...

ozij · Post by **ozij** » Thu Jun 08, 2006 7:52 am

wouldn't things like centrals or PLMs be found in my initial study?

Yes, of course they would. Furthemore, some of the other things mentioned by "polysomprincess" - e.g. cheyne-stokes respiration is typical of people with hear failure, not something you wouldn't know about.

I would trust Dr. Barbara Philips, whose credentials and publications you can check.

If your initial sleep study was awful, chance are the titration study would be awful as well. A month at home, with data recorded (and checked!) from an auto will teach your doctor and yourself a lot about your sleep.

A titration study is a one night snap shot of your sleep, and some studies shows it isn't necessarily a good snap shop (can be, but doesn't always have to be). See Standard Diagnostic Test For Sleep Apnea Does Not Detect Condition In Many Patients

I suppose you can always cancel your titration at the last moment, after you've been on the auto for a while.

Yes, it's possible the once you sleep deeply, PLMs will be discovered - but that is rare, and you can cross that bridge when you get to it - i.e. have been sleeping with your APAP for a while. It is also possible that the APAP will show you need very high pressure, and therefore, you might find a bi-pap a better solution. Again, that is a bridge that can be crossed if you get to it. Only a minority of users end up having PLMs or needing very high pressure, and bi-pap.

Enjoy your APAP, come back here to ask about anything you want, take all answers with a grain of salt, search the links you've been given, and cancel the titration study after you've been sleeping with the APAP for a month.

Good luck!

O.

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): Titration, auto, APAP

apneaicinisrael · Post by **apneaicinisrael** » Thu Jun 08, 2006 10:26 am

Also...
Make sure you have a follow up within 1-2 weeks of starting with the APAP. That way the sleep doc or other suitable person can look at your numbers and see if it is doing the job and how the pressures are, etc. You don't want a nice, even great machine, set at the full range of pressures 4 -- 20 and that is that.
I got titrated at home on an APAP, it is great, real sleep in your own environment.

Let us know...
AII

Linda3032 · Post by **Linda3032** » Thu Jun 08, 2006 11:09 am

Jenny,

Is the Auto they are going to have you use going to be yours to keep? Or are they going to switch you to another machine after they get a pressure?

If it's going to be yours, and your insurance is going to pay for it, then don't ask what machine they are going to "sell" you. Tell them what machine you want. You are the customer here. It's easier to get a good machine now then to take an inferior one and try to switch it later.

Many of us use the Remstar Auto with cflex - it's an excellent reliable machine. There are two or three more Autos that are very good too.

Be careful - many times suppliers "tell you things that aren't quite true".

jrgood27 · Post by **jrgood27** » Thu Jun 08, 2006 12:18 pm

Thanks O. and AII for the reassurance. Yeah, the initial study was awful and I only cobbled together 3.5 hours of sleep. Probably my doc thinks it's pointless to do that again.

I'm easily aroused (hm..that doesn't sound quite right, lol). ie. I'm not having any desats - all hypopneas and related arousals. And my doc thinks I may have a tough time adjusting to the mask.

Linda: I have no idea if my insurance will rent or purchase the APAP. As far as I know I'm supposed to wait for someone to call me and schedule an appointment to go get it.

Should I be speaking to them about these details before I go down there?

It's so great to have this forum. It's been a long time to get here - took 10 years since my symptoms started to get a referral for a study b/c I don't fit the damn profile. Now I want to make sure I get the very best tx.

Jenny

Linda3032 · Post by **Linda3032** » Thu Jun 08, 2006 1:20 pm

You don't need to talk with them beforehand, necessarily. Just read this forum and know "your stuff" before you go in. Then it's easier to recognize the Bull S__t if and when it's offered to you.

Everyone has trouble adjust to a mask - not just you. I would start with the ComfortLite 2 - it must be the 2, by Respironics. It's fairly new and comes with 2 mask devices. Get the Nasal Pillows, and the mask - get sizes medium and large (unless you have a tiny face).

Determine what their return/exchange policy is on masks.

Don't let them tell you that you are a "mouth breather". Only time will tell whether you are or not. Full face masks can be difficult to adapt to. And many people who used to breathe through their mouths prior to cpap, don't during cpap.

If your pressure comes out to be really high with the Auto machine, then let this forum know. Because it can then come up with options for BiLevel machines.

Also, if you do turn out to be a mouth breather, then we can offer suggestions there. Or you can simply do a forum search for "best full face mask".

Lots of info here for you to search through. Good Luck.

snoregirl · Post by **snoregirl** » Thu Jun 08, 2006 1:31 pm

You should be speaking with your insurance NOW. Find out if you are required to go somewhere specific or you have choices on where to purchase or rent the machine. Also if the APAP is for good or for a time to get titrated.

Typically there is some network where a doctor's offices makes an order to a DME (of the Dr's choice based on your insurance). In my case Apria. But I found out when I dug deeper that there were 6 options of where I could go. No one told me that. No one will. Just "wait for the call" they say.

Find out what your insurance covers, and whether it is rent or buy or rent to buy. Will they let you keep the APAP as your "normal machine". Is it supposed to be new? Find out how much your copay is and what the total cost they will be charged by the DME. This is the only way to make sure that your copay isn't more than you would pay for an outright purchase from a reputable online source. All this is not easy. I had more insurance people tell me that they didn't know what the contract cost was with Apria for my machine. I asked them, how do they pay the bills if they don't know what they should be charged. Very enlightening conversations.

Look at all the Auto machines on this web site and decide what the differences are and what is important to you.

Easier to make sure your doc orders what you think is best for you the first time, not try to go trade later. Size, features, Cflex or not, humidifier, etc

Read this forum. Lots of threads on different machines and opinions of them.

Get a copy of your prescription to hold. May be useful later even if you go through a DME now.

jrgood27 · Post by **jrgood27** » Thu Jun 08, 2006 5:32 pm

Thanks for the cautions. I did some research and found a document on my insurance web site that APAP is covered ONLY IF CPAP fails. I haven't cancelled my titration appt. yet. Since I'm wondering if I'm going to end up with a CPAP afterall.

I'm kind of afraid to call my insurance at this point because I don't even know if they received the claim yet and I don't want to mess anything up. I guess I'll call my doctor's office and ask the claims person if ordering outright APAP is usually accepted.

Then I'll talk to my insurance and ask if I have a choice of DME. That was nowhere on their website.

Alright, I'm going to have to print all these responses off - my sleep deprived brain can't absorb all this.

Thanks for your help everyone. Jenny

Is it strange to not have a titration study?

Is it strange to not have a titration study?

Insurance

good!

confused

no titration

thanks