Titration Study

Short background, my husband was diagnosed with sleep apnea about 1 1/2 years ago and now has a CPAP machine that he uses most nights. Well, since he got his machine, my snoring has been waking him up and he has also heard me stop breathing on occasion. Since it has been a very long time since I have actually felt rested after sleeping, he finally convinced me to get tested myself.

I went for the first sleep study last month and was diagnosed with a mild obstructive sleep apnea. Last night I went back for the Titration study. It went horrible. I am slightly claustrophobic with things over my face, but I was given the nasal pillows and I had no problems with that. I actually fell asleep pretty quickly.

The problems came during the night. I woke up many, many times. Several of those times I woke gasping and had to force myself not to tear the mask from my face. (I've been having issues with insurance coverage so I didn't want to mess up this test and have to come back again.) At one point it almost felt like an asthma attack. I really struggled with my breathing on and off during the night as he changed the pressure.

When morning came, I was more than happy to get that mask off my face. He could tell I was struggling during the night. To keep it short, he said I was one of the 20% of people that can't tolerate CPAP. It basically changed my mild obstructive to a severe central apnea, which I guess was why I kept waking gasping for breath. He said he was going to talk with the doctor and I think he said something about APAP.

Does anyone have any experience with this? Would an APAP be the best thing for my situation? If the doctor believes an APAP is what I need, would I need any more testing? I've been trying to rush this so I can get everything done by the end of the year.

Thanks in advance for any help.

Not sure about APAP. Did he say bipap or bilevel by chance? APAP is nothing more than cpap with auto adjusting pressures and isn't usually indicated for people with centrals caused by CPAP pressure and actually is contraindicated.

You may have Complex Sleep Apnea..this video might explain things
https://www.youtube.com/watch?v=CU-XTcf ... e=youtu.be
If you developed an alarming number of centrals then eventually you may need the high end bilevel machine in the ASV model line.
Though sometimes insurance requires that a person try the other usual method (plain bilevel machine) first before moving on to the ASV machine because they cost so much more.

The good news it's fixable. The bad news it normally means more hoops to jump through...an perhaps a little longer to get all the stuff done needed to get the machine. You would need another titration study most likely.
That is of course assuming CompSA is what you have. Not hugely common but we have several forum members here with that problem.
I think I read where about 15% of the people who don't normally have centrals that are a problem will develop a problem with the introduction of cpap therapy.
The other good news is that they caught it now and not send you home with a plain cpap machine and you wouldn't be able to tolerate it and not know why or what the problem was...and the machine end up in the closet.

Sometimes CompSA can be resolved with the "plain" bilevel machine like I have...so they might try that first. Mine doesn't function like the ASV bilevel machines. I can't see them giving you APAP machine though...not if the tech already mentioned cpap incapability.

Welcome to the forum BTW.

Thank you for the quick reply!

I thought he said he had tried bipap and it didn't work. But, then again it was 5am and after a restless night sleep I was a little foggy. I am not that well versed in the different terms so I was trying to understand what he was saying. I will watch the video when I get home (blocked at work.) Is central sleep apnea genetic? My dad was diagnosed with sleep apnea years ago, but I don't know what kind and I don't think he ever persued any treatment.

The tech could very well have already tried bipap when he saw the problem start up with continuous pressure and if that is what happened then the next step is a titration with the ASV type of machine.
Maybe he meant auto ASV instead of APAP.
I am short on time...leaving for the holidays but I am going to private message JohnBFisher in just a bit and point him to your thread. He can explain centrals and CompSA and the therapy a whole lot better than I can since he uses one of those machines.
I don't think that the docs know exactly why or what causes CompSA as fair as family history sometimes.
Some people just have it happen and some don't. We used to think high pressures was a cause but it can happen with as little as 6 cm pressure and I used to see 18 to 20 cm when I was using APAP machine and never had more than a random central (a few are normal and no big deal).

Start your reading.
The other good news is that all the ASV machines are full data and the 2 main players are Resmed and Respironics and we can get you fixed up with the software for either if you want it.

Thank you so very much for taking the time to help me. I hope you have a wonderful holiday!

I assumed I had a simple obstructive apnea and a CPAP would take care of it. Of course I have to be difficult. I'll have to educate myself on the different terminology so I know what I might be dealing with. I'm hoping I will hear from the doctor soon. Unfortunately, it took them a week to get my results back to my primary doctor after my initial sleep study. I will update when I do hear back so hopefully I'll make a little more sense.

Thanks!

Ladyflower wrote:I assumed I had a simple obstructive apnea and a CPAP would take care of it.

Hi,

Sometimes, our bodies just don't want to take the simple path. My first titration study went very badly. I was having events all the way up to the max pressure, and I couldn't exhale against pressure. I thought I was doomed since my sleep disorder was disabling (I couldn't drive or work any longer). My second titration was just as bad. The tech gave up after a few hours and they put me on oxygen. After that, my lung doctor set me up with a tech who was highly skilled with BiPAP and ASV. She found a BiPAP setting that worked extremely well, and with the lower exhale pressure, it was easy for me to breathe with it. That woman (the highly skilled tech) saved my life. Net-net, don't give up hope just because one strategy didn't work out. There are smarter machines and smarter technicians out there, but you kind of have to play the game to get access to them.

-john-

Thank you so much for the help. I just spoke with one of the sleep techs and was told I have Complex Sleep Apnea. I'm apparently a good case study because of the problems they had with me. She said I tolerated low pressure CPAP fairly well when sleeping on my side. But, as soon as I rolled over onto my back, I started throwing many central apneas. She said they tried all 4 therapies and I failed them all, but they did not have time (because of the insurance guidelines) to try the AutoSV. She said during the night as the tech increased the pressure, I did worse and worse, throwing a higher number of central apneas. No matter what he did, he couldn't get me into stage 3 sleep. John - does this sound similar to what you experienced?

The doctors are coming into the office this afternoon to discuss my case and decide on what treatment I may need. She said that I may be a good candidate for AutoSV, but because of the insurance, they may want to put me on a low pressure CPAP for 30 days and then re-evaluate. I'm assuming to prove to the insurance that traditional CPAP won't work. She said that I may need to come in for another titration to try the AutoSV. It was a little jarring when she started asking me if I had ever had an EKG or stress test.

Of course all this is at the very end of the year and my insurance will be changing. So, I'm not sure how that's going to be handled.


Thanks,
Angela

I hope it all goes well for you. I wasn't really a believer in the whole sleep apnea thing, but went in for a study having been pressured by my wife, and an anesthesiologist after some mild surgery. He wasn't impressed.

Fortunately I'm not at all claustrophobic and fell asleep in just a few minutes on the first sleep study, and slept until they woke me up a few hours later to put a mask on me. Like you, CPAP was a complete failure. Evidently I had a lot of central apneas even without the cpap going, but they more than doubled my severe apnea to over 102 if the cpap pressure was high enough to take care of the OSA. They wanted to put me on Oxygen right away, but I decided to wait until my next sleep study as I couldn't see how oxygen would be of help if I wasn't breathing.

Second study was with a bipap as per my insurance. I did a fair bit better on that, but not as good as the doctor wanted. I used a bipap for 3 or so months, felt pretty good on it, although not consistently good and adapted quite easily to wearing it. My results still left much to be desired though so I went for a 3rd study, and got placed on an ASV machine. To be honest, months later the machine still tends to be a pain to sleep with as it periodically ramps up to max pressure to get me to breath. I feel consistently good using it though, and am slowly but surely getting much better at sleeping with it.

Hang in there. Dealing with the docs, and insurance can be a pain, but if they get things dialed in right it's almost amazing how much better you feel.

Let us know what the docs decided to do with you next.