Can I skip titration?

If I were to buy something like a Respironics DS650 with full efficacy data couldn't I start at a middle of the road pressure and determine what I need based on the data rather than spending another $ 700 on the sleep test?

Kaiser Permanente sends patients home with an APAP machine for titration all the time. If you have garden variety obstructive apnea it could be a reasonable approach. You mentioned the DS650 which is a bipap machine. You may or may not need bipap but for self-titration you ideally want an auto-adjusting (APAP) machine. In the ResMed line it would be the S9 Autoset (not Escape Auto), and in the Respironics line it would be either the 550 or 560 (integrated heated hose option). All of these have full efficacy data and can be used with free software.

kaiasgram wrote:Kaiser Permanente sends patients home with an APAP machine for titration all the time. If you have garden variety obstructive apnea it could be a reasonable approach. You mentioned the DS650 which is a bipap machine. You may or may not need bipap but for self-titration you ideally want an auto-adjusting (APAP) machine. In the ResMed line it would be the S9 Autoset (not Escape Auto), and in the Respironics line it would be either the 550 or 560 (integrated heated hose option). All of these have full efficacy data and can be used with free software.

I meant 560... i'm dislexic and I didn't catch it on my reread.

No problem. If you go the DIY route, forum member STL Mark is currently selling a zero hour 560 machine. Good deal!

Easy to do if you can check your data. I really didn't want to do another night at the sleep study place for the titration; the first night was horrible. Nothing to do with them; I just didn't "sleep" all that great.

Make sure you start with a high enough pressure so you don't feel like you're suffocating; my DME and I bumped up my starting pressure to 8 when I picked up my machine. I've bumped it up a little and then back down and currently start at 9 (max of 17.) Seems to work the best for me for comfort and therapy. YPMV (your pressure may vary)

CPAP usually isn't rocket science, but it isn't "just buy an APAP and turn it on," either. If you're going to go it on your own, you have to learn a lot of stuff to get it right. I think most apneacs could be diagnosed and treated just fine with a good data capable APAP machine and management via wireless modem and SD card. The trick is finding a doctor willing to work that way, or learning to do it yourself.

The medical mafia loves $leep te$t$, so you may find it hard to get a doctor to work with. Insurance probably won't pay.

In theory, you can't buy CPAP or masks without a prescription. If you're not playing the game with the DME, you probably won't get the support in terms of trying on different masks, exchanging masks, etc.

archangle wrote:In theory, you can't buy CPAP or masks without a prescription. If you're not playing the game with the DME, you probably won't get the support in terms of trying on different masks, exchanging masks, etc.

Depends on the DME. I have been using the same one (selected after fired the first one) for over 5 years for masks and I have never bought a machine from them. They did of course require a RX but not that I purchase a machine from them to be able to buy masks or other supplies.

archangle wrote: If you're going to go it on your own, you have to learn a lot of stuff to get it right.

In that case he would know a lot more than most people who use a sleep doctor and a sleep lab.

Some docs, especially family/primary docs, may be willing to make the Rx without documentation, if you are gonna pay out of pocket, since, in that case, they don't have to worry about what insurance requires in order to be the payers for the medical equipment. And generally speaking, even if you can't afford a titration, treating OSA makes more sense than not treating it.

BUT, PAP titration is one of the most valuable tests out there for a PAP user, arguably even more valuable than a diagnostic test.

The diagnostic test is mostly done to please insurance and to provide a baseline to compare the results of the titration to. So in a sense, you lose part of the value of the diagnostic if you don't get the titration.

The value to the patient in the titration process is mostly what it rules out. It makes sure that other, perhaps related, sleep issues aren't at the root of the sleep problems. Once the obstruction is titrated away, other sleep troubles can be unmasked. Sometimes limb movements or other such issues get uncovered that weren't as clear during a diagnostic when all kinds of breathing issues are hiding the other issues.

And perhaps most important, an in-lab titration documents your reaction to PAP. That can be important if you later need to argue for bilevel, for example.

Everything is a trade-off, so there is no one-size-fits-all answer to the kind of question you ask, I don't think. But it is worth thorough research to answer the question in the light of your personal history and circumstances, in my opinion.

But what do I know--I mostly just play acoustic sixes and twelves. Not fancy-schmantzy, high-falutin Strats.

You can do whatever you wish -- but will it be best? Most likely not ideal. I did that and used a 560 auto machine for a year without a titration. The respiratory therapist at the DME read the chip and made some adjustments based on the data. Went up from 4-20 originally to 7-20. The machine would hit 9-16 during some nights.

But when I later did a titration study, they confirmed what I already suspected, that the pressure wasn't high enough especially when I slept on my back. So after they did so the pressure was re-set at 12. Now I definitely sleep much better. I have to sometimes use the ramp feature because the pressure is high, but at least I am feeling more rested in the morning.

kaiasgram wrote:Kaiser Permanente sends patients home with an APAP machine for titration all the time.

Isn't KP an insurance company? Why do you say they do this? I believe they would get in huge legal trouble practicing medicine without a license.

KP is a HMO - a fully functioning one with paid medical staff. We used to have something like this in my area, but they finally went out of business. KP isn't going anywhere soon, they are HUGE. I don't think I would want to be a part of this type of HMO, had enough of that thru the one I previously had in the late 80's.

Jen

Chevie wrote:

archangle wrote: If you're going to go it on your own, you have to learn a lot of stuff to get it right.

In that case he would know a lot more than most people who use a sleep doctor and a sleep lab.

Heck, you'd have to know a lot more than many "sleep" doctors seem to.

Chevie wrote:

kaiasgram wrote:Kaiser Permanente sends patients home with an APAP machine for titration all the time.

Isn't KP an insurance company? Why do you say they do this? I believe they would get in huge legal trouble practicing medicine without a license.

Even if they weren't an HMO, they can say "we will only pay for CPAP if you do 12 nights in the patient's home with a PRS1 model 560 and titrate with that before switching to a PRS1 SE manual CPAP for long term use." The doctor can refuse to do it the way the insurance says, but then the insurance won't pay. If the doctor has signed up to be an in-network provider, he may not even have the choice to do it differently.

Chevie wrote:

kaiasgram wrote:Kaiser Permanente sends patients home with an APAP machine for titration all the time.

Isn't KP an insurance company? Why do you say they do this? I believe they would get in huge legal trouble practicing medicine without a license.

What jencat said.