Can Patients with OSA Titrate their own Pressure

This will really get GUEST going...

Many factors affect CPAP compliance, but education and support, rather than in-laboratory CPAP titration, appear to be pivotal. Self-adjustment of CPAP at home will provide equal or superior efficacy in the treatment of obstructive sleep apnea (OSA) as compared with in-laboratory titration. A randomized, single-blind, two-period crossover trial of CPAP treatment at the in-laboratory–determined optimal pressure versus at-home self-adjustment of CPAP (starting pressure based on prediction equation). Eighteen CPAP-naive patients (16 males, 50 ± 15 years old, apnea hypopnea index 40 ± 20) with a new diagnosis of OSA were tested. Testing was performed before and after CPAP treatment in each of two 5-week study limbs. CPAP, compliance with CPAP treatment, the Sleep Apnea Quality of Life Index, the Functional Outcomes of Sleep Questionnaire score, the Epworth sleepiness scale score, sleep architecture, sleep apnea severity, and maintenance of wakefulness tests were performed. Both modes of CPAP treatment significantly improved objective and subjective measures of OSA, but they did not differ in efficacy. Home self-titration of CPAP is as effective as in-laboratory manual titration in the management of patients with OSA.

Link Here

Mike! you're dangerous!


...the answer to your question is YES!

Hey, I backed that up with a true scientific study. (ok it was done in Canada, but so what?)

I don't know about that study in Canada. They speak French in some parts don't they ?

Chris

My opinion... I have no problem with someone tweaking pressure once they have a baseline # from a sleep study.

But IMHO Self Titration without a study is wreckless. What if the person has Central Apnea's? What about Narcolepsy? There are people out there that snore like a chainsaw and do not have Apnea. What about overtitration which has been shown to induce central apnea? What about Blood Oxygen levels....There are some that need suplemental oxygen with their therapy. Also there is the question of threshold. I know some flolks with severe OSA that really "Think" they don't sleep bad at all and the only reason they went for a sleep study is they got tire of there wife jabbing them in the ribs. What you may think feels like titration, may be inadequate!

I know many of you love your APAP.....but for goodness sake....determine wheather OSA is your problem before you buy a machine and turn your bedroom into a home sleep lab.

What about those that have OSA . They know they have OSA. But they don't have the $$ to go thru the gauntlet of sleep docs and sleep clinics to be diagnosed.

They just go untreated thats what.

Or they could do this.

http://www.sleepreviewmag.com/Articles. ... d=S0311F03

Cheers,

Chris

I guess the question is how safe it is when you get a larger patient base. But my (admittedly limited) understanding of the standard range of 4 -20 cm is that the risks are either lack of resolution from too little pressure or lack of comfort from too much. Can a pressure of 20 cm or less ever cause physical damage? If self titration does become a reality, a lot more people will get treated. In my case, I spent one night at the lab getting a diagnosis, one night at the lab getting titrated and five nights on a wide open APAP at home on an APAP titration study and now I have an APAP with a fairly wide range. First, thousands were spent to diagnose and advise treatment, then hundreds more to do roughly the same thing and finally I am using an APAP set in a range it would likely stay in even if it were wide open. So in the end, hooking up a wide open APAP right out of the box would probably be every bit as effective.

I am not advocating going around the system, but rather changing the system if it makes sense. A huge number of people are getting care that is tantamount to denial of service because the way it is traditionally done is very expensive and inconvenient. People aren't falling through cracks in the system. It's more like canyons. It would be one thing if data supported the system, but it doesn't seem to.

Joe A wrote:My opinion... I have no problem with someone tweaking pressure once they have a baseline # from a sleep study.

But IMHO Self Titration without a study is wreckless. What if the person has Central Apnea's? What about Narcolepsy? There are people out there that snore like a chainsaw and do not have Apnea. What about overtitration which has been shown to induce central apnea? What about Blood Oxygen levels....There are some that need suplemental oxygen with their therapy. Also there is the question of threshold. I know some flolks with severe OSA that really "Think" they don't sleep bad at all and the only reason they went for a sleep study is they got tire of there wife jabbing them in the ribs. What you may think feels like titration, may be inadequate!

I know many of you love your APAP.....but for goodness sake....determine wheather OSA is your problem before you buy a machine and turn your bedroom into a home sleep lab.

Joe, if someone has narcolepsy and not SA, the AUTO will not respond, if they have the pressure set too high on the upper limit, the newer auto's will not respond when central apnea's occur. The biggest problem is that the risks from getting unneeeded therapy is much less harmful than untreated sleep apnea. Read the powerpoint presentation Here

It's people like Joe A, claiming that trying out an apap without a $2500 lab study is wreckless, that are killing people by leaving them untreated.

Mike, as one of you previous links stated "It's illogical to spend more on the diagnosis than on the treatment."

wading thru the muck! wrote:Mike, as one of you previous links stated "It's illogical to spend more on the diagnosis than on the treatment."

This quote, I disagree with. There are lots of things that can be diagnosed or ruled out with really costly tests that don't cost so much to TREAT, but we need to know before we can treat them.

For example, MS. I've had two different MRIs of my brain trying to determine if I have MS (doesn't look like I do). The treatments for MS aren't particularly expensive, compared to the cost of the MRIs, but it's important to find out, the treatment isn't good for someone who DOESN'T have MS.

In fact, the diagnosis is LIKELY (for a lot of conditions) to cost more than the treatment, because there are relatively few of the diagnosing machines built, where as the treatment, you have to have separate treatments sold for each patient diagnosed.

(Now, I don't think it makes sense to spend that much if you don't have to, certainly. But just the fact that the diagnosis of something might cost more than the treatment is not particularly illogical, to me.)

Liam, who could probably just have let this one slide.

I think that was taking a bit out of context. The idea is that if a) The cost of the study is more than the treatment and b) no treatment could be detrimental to your health, c) treatment when not needed is not harmful. (according to Dr. Phillips)

Liam,

Your argument makes no sense (sorry). MS is a digenerative disease that is fatal. There is no treatment. Only measures to temporarily minimize the effects. OSA is an illness that for most people can be treated with little or no continued symptoms and is certainly not fatal when treated, but can be fatal if not treated.

A person with MS, will die from MS whether they get treated or not, A person with OSA can die from it only if they don't get treated. In the case of MS the treatment does not effect the outcome. With OSA the treatment is crucial to affecting the outcome. In both illnesses the diagnosis has no effect on the outcome.

wading thru the muck! wrote:A person with MS, will die from MS whether they get treated or not

Common misconception. MS does not, as a rule, kill you. It MAY shorten your life, if you don't take precautions (such as not driving when you feel the symptoms of an attack) and it definitely reduces your QUALITY of life.

But having done a LOT of research into it when I thought I had it, with proper precautions, you don't die of MS...

In the specific case of OSA, it might not make sense to spend more on diagnosis than on treatment, but in general making a blanket statement like the one you quoted is (IMO) ludicrous.

Diagnosis costing more than treatment is only illogical in cases where:

o the treatment is entirely benign to non-sufferers
o use of the treatment unambiguously tells you whether it is helping you.

Neither of these is necessarily true for OSA. The first... if I didn't have to use the mask and machine, I'd DEFINITELY be better off without it. And as you can see, I'm awake at odd hours again, because wearing the mask doesn't let me sleep properly.

I think it's DEFINITELY useful to me to know the specifics of my disease, to know which aspects I have and which I do not so that I can make an adequate choice as to whether to continue treatment or not, and have adequate motivation to try to make it through the pain of treatment.

Liam, wide awake and grumpy.

Liam,

No treatment is entirely benign. But, what Dr. Phillips is saying is that there are much greater risks from no treatment, than from treatment that isn't necessary.

I agree it is not prudent to self treat OSA. By that I mean bypass the diagnostic process entirely. A definitive diagnosis is necessary, but the problem is how the many without insurance or the funds to pay for one deals with it.

I would hope the improvement in a home diagnostic model will continue to the point it is reliable and accurate. Then a pcp can prescribe an appropriate PAP. This could be done for a small fraction of the costs of a sleep lab.

The problem here is that the sleep industry will defend their turf and livelihood. The lawyers will sue any trivial complaint and we are back to square one.

It is not exactly a Hobsons choice. There should be a compromise that respects those who cannot affort a sleep study.

Not sure if this is the study cited, but it is one done in Canada.:
http://www.sleep-solutions.com/clinical ... n_CPAP.pdf

Keep in mind that ignorance and apathy is very much alive in the sleep community. We could do much better if the interest of the patient was the overriding concern.
Over at sleepnet, Sandman does not allow ANY mention of self titration or self adjusting of machines. I think the subject should be discussed.

I could be wrong
Tomjax
I could be wrong.