Why do you need a tritation study if you get an auto?

It just seems like an auto is doing the same thing??

Not everyone gets or need a auto. Some people do not respond with a auto. Auto is not for everyone. What is for everyone is a full data capable machine.

Melanndoll wrote:It just seems like an auto is doing the same thing??

Just "titration" or full-blown sleep study?

It all depends.

There are any number of things that can be determined by a full-blown sleep study that may or may not be evident by using an Auto.
But, if a person has the "garden variety" of Obstructive Sleep Apnea.......with no major blood-oxygen desaturations, no Central Apneas, no Restless Leg Syndrome, etc., etc. Then, a person with some degree of "smarts" and deductive reasoning could figure out what effective pressure they need.......with either an Auto or even a straight-pressure, data-capable CPAP.


Den

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It takes a while for the auto machine to find the right pressure. If you leave it "wide open" at 4-20 auto pressure, it will start at 4, and only slowly find the right pressure, so you may have some trouble breathing as you fall asleep. Also, if you, for instance, need 14 cm part of the night, it can be uncomfortable as the pressure changes, and it may cause problems with leaks. If you get the mask to fit at 4, it may leak when you get up to 14.

Also, the machine sometimes doesn't find THE right pressure. A smart person can look at the data and find the best choice.

If you need, for instance, a pressure of 14 on most nights, it might be good to set the APAP to start at a minimum pressure of 10 so that you can get some benefit from the lower pressure and still get 14 when you need it.

I think most people would actually end up better doing this by examining the data that a good APAP machine would collect every night and then tinker a while to find the right pressure, but there are some advantages of a good in-lab titration.

Unfortunately a lot of doctors aren't willing to make the effort to use the very powerful capabilities modern CPAP/APAP machines have to find the correct settings in your home, and get lazy and want to just dump the setup questions into an expensive in-lab titration and then don't bother to follow up properly.

Whether you do an in-lab titration or just look at the data the machine generates at home, it's usually a good idea to not simply run an APAP machine on "wide open" auto. I think most people should be on auto machines set on a somewhat narrower pressure range. If the pressure changes bother the patient, you can always narrow the pressure range or even set the auto machine to manual CPAP.

Good time to remind you folks to see if the other mode (straight cpap or autopap... whatever mode you are not using) is better for you. I'm not sure about the new Resmeds, but the S9 autosets take 11 seconds to respond to an apnea. The delay is for when you roll over, events that you momentarily hold your breath, cough, sneeze, etc... You don't want your machine to chase un-events all night. For myself, I figure, in the autoset mode, I am in an event at least 11 second, not counting the amount of time it takes for the machine to ramp up and treat the apnea. On the straight cpap mode, fixed air is pumped into the windpipe all night, thus, already at the needed pressure to keep my collapsing windpipe open. In my mind, this is why I wear the mask.

That being said, I use autopap several months of the year, but eventually return to straight cpap mode. It's more of a comfort thing. Lots of folks enjoy the benefits of autopap and they feel better using this mode. I'm suggesting you try the other mode for a few weeks to se if you feel better.

We've debated this issue before... but I'm just throwing this out their for the benefit of the "new" newbies.

Sheriff

My insurance company has a policy if the PCP suspects OSA, you go see the pulmonologist (the DR, not a PA). If he suspects "standard" OSA, the insurance specifies you are to have a home sleep study. If OSA is found (as in my case), you are given an APAP set at perhaps 5-20 based on DR's prescription. On follow up visits with a sleep therapist they will tighten the range based on the data from the APAP. I suspect this process will become more common and "real titrations" less common. The quality of the therapy is going to vary with the competence of the therapists and/or if the patient takes an active role.

Sheriff Buford wrote:the S9 autosets take 11 seconds to respond to an apnea

That is simplifying it quite a bit.

It prevents a lot of apneas by responding to inspiratory flow shape and snoring. See http://www.google.com/url?sa=t&rct=j&q= ... XY&cad=rja

Sheriff Buford wrote:I'm not sure about the new Resmeds, but the S9 autosets take 11 seconds to respond to an apnea. The delay is for when you roll over, events that you momentarily hold your breath, cough, sneeze, etc... You don't want your machine to chase un-events all night. For myself, I figure, in the autoset mode, I am in an event at least 11 second, not counting the amount of time it takes for the machine to ramp up and treat the apnea.

no machine does anything about an apnea until it's over, no matter how long the apnea is, because they can't.

depending on how your throat closes, applying more pressure during an apnea would just force it closed more, therefore, the auto machines note that an apnea or hypopnea happened and then take steps to prevent more happening.

also, the modern machines don't pay attention to apneas from moving around, since if you're holding your breath while moving around, it would count as an open airway event, and the machine doesn't respond to those anyway.

Sheriff Buford wrote: On the straight cpap mode, fixed air is pumped into the windpipe all night, thus, already at the needed pressure to keep my collapsing windpipe open. In my mind, this is why I wear the mask.

I'm going to have to channel pugsy for a few minutes here, since she's still working out here computer problems,

it's all well and good to oversimplify the situation as you have, but many people, such as her, have varying needs during the night, most of the night, she'd fine with about 8.5cm, but during her REM sleep, she may need 18cm, now, she's much happier spending the majority of the night at 8.5 and having the machine bump up to 18 when needed, because if she went your way, she'd have to spend the whole night at 18cm... and would be less comfortable because of it.

Sheriff Buford wrote: but I'm just throwing this out their for the benefit of the "new" newbies.

it's good to provide differing viewpoints, but you should try to provide more accurate information to the newbies to avoid more confusing, given how confusing this whole thing is in the first place

Redonthehead wrote:My insurance company has a policy if the PCP suspects OSA, you go see the pulmonologist (the DR, not a PA). If he suspects "standard" OSA, the insurance specifies you are to have a home sleep study. If OSA is found (as in my case), you are given an APAP set at perhaps 5-20 based on DR's prescription. On follow up visits with a sleep therapist they will tighten the range based on the data from the APAP. I suspect this process will become more common and "real titrations" less common. The quality of the therapy is going to vary with the competence of the therapists and/or if the patient takes an active role.

This is how Kaiser operates (except you never see the pulmonologist, it's all done by sleep techs). There are studies validating this method and imho it makes sense because instead of a single night's snapshot under very artificial conditions, you get a long titration under your own real sleeping conditions.

Not Fade wrote:That is simplifying it quite a bit.

Thank You! I aim to please! Keep it simple.... is my motto!

Sheriff

AFAIK, there is NO auto cpap that cannot be alternatively run on straight single pressure.
Two machines in one. What a concept! Small wonder DME's would rather we did not know this.
Having an auto gives us the opportunity to confirm our correct pressure at home, instead of booking a $leep $tudy.

Why is there never any mention of "opti-start". That's a feature with the PR560?

Sheriff Buford wrote: I aim to please!

I had such a bad time with the first sleep study I asked if I could nix the titration study. Thankfully the Dr agreed and I didn't have the titration study and we got the pressure dialed in at my 30 day compliance check up.

The titration study is a critical component of therapy. How else do you expect the owners of sleep labs to pay for their
Mercedes.