Titration study questions

Since I'm doing so poorly with my sleep apnea, my dr wants me to do a titration study and have all the wires hooked up to me and such.

They're trying to get insurance pre-auth and then will contact the hospital and have them call me to schedule it.

Also they're sending me a booklet of info in the mail, which I'll review when it arrives.

To be honest there are a bunch of reasons why I don't want to do this test, in particular the cost / financial hit, but also concerns such as getting COVID, being unable to sleep due to being uncomfortable with the room/equipment/mattress etc, trying masks to wear at the study and not being able to make any of them work, wondering if they can work around my night owl sleep schedule or if they force you to go to bed at a certain time, and the list goes on. I will contact the hospital about some of my concerns if the insurance approves the test. There are some questions that probably only they can answer, that may differ depending on where the test is done.

Just wanted to post this and see if you have any advice, tips, or other info to share regarding a titration study, or any sleep study in a hospital for that matter, such as:
- specific questions that I should ask or info I should get before I schedule or before the day of the test (questions for the hospital, the dr, or the insurance, etc)
- tips for making the stay more comfortable or go more smoothly (things to ask the hospital or technicians, things to do before or while I'm there, etc)
- advice about the cost / financial aspect...is there a way to save money on this kind of test somehow? are there extra costs they add in for things that aren't really necessary, that could be cut out if I tell them not to do them? I'll certainly not be asking for room service

I bet you all have knowledge and experience that could save me a lot of trouble and make the experience go better.

Thank you, as always

A better attitude would be a good start.

Often the titration can be avoided by using an Autoset machine with close monitoring of nightly data.

wannasmile wrote: ↑

Tue Oct 06, 2020 11:49 pm

Just wanted to post this and see if you have any advice, tips, or other info to share regarding a titration study

Forget the titration study. Learn to use OSCAR and let forum members help you self-titrate. One night in the sleep lab usually doesn't make an optimal therapy. You end up needing to do it yourself.

You do have several options available. Granny is right that in most cases you will end up using Oscar to fine tune your settings. This does require time, patience and is a steep learning curve (lots of reading and keeping notes) but that will be helpful no matter which way you go. There is also an at home sleep study your doc can order. If you go in lab be sure to let them know about your work/sleep schedule.

You should check with your insurance to find out what your share will be for at home, in lab studies, and how it works when they pay for the cpap.

While an in lab study is the gold standard and should give you the best starting point for your treatment, I will say that it took me a good year and several equipment changes before I got my therapy right. It took about a month to be able to sleep thru the night with a mask on my face. That was with daily notes and reading online and way before Oscar.

You have been a member for 3 yrs? and have not yet completed any part of this?

Of course you do know you can do all of this on your own if you choose to buy a cpap from Craigslist, right?

Get the manual, dearie, and set your own machine.
Unless you really want to be a cash cow for your "providers".
After 3 years, I would expect more of you.

Hello, wannasmile. I looked back at your recent thread and see that your average pressure is up at 18 -- do I have that right? Could you tell us what results you are getting -- AHI and breakdown into obstructive apneas, central apneas, and hypopneas?

I'm asking these questions because I'm trying to think through the possible reasons for the titration study. I'm wondering whether the plan is to try you on a different kind of machine, perhaps a bi-level machine or (if you have a lot of central apneas), an adaptive servo-ventilation machine.

If that's the plan, the titration might be necessary if your insurance is to cover the costs of the different kind of machine. You should ask about this!

I would suggest that you try to turn your schedule around as much as you can before the titration study, because they will probably not have the flexibility to schedule the study for your usual asleep time. You should also ask your doctor whether you can take a sleeping pill before lights-out. If yes, get a prescription. Take your own pillow, if that is allowed.

I understand the worry about COVID, but I imagine they do a good job of sanitizing surfaces, masking the technicians, etc. But it would be completely reasonable for you to ask what their protocols are.

The assumption is that he has undergone a diagnostic study.

I have had an APAP machine since May of this year (2017).
Within a few days of starting it, I noticed definite improvements over not having a machine.

Yes, I assume there was a diagnostic study too. In the years since, though, there may have emerged reasons to consider a different kind of machine. Or not! So I hope the OP can answer the questions.

Thanks for the replies and help.

Yes, I had the in-home sleep study originally (a few years back) so the insurance could see I had severe apnea, and cover the equipment.

I do already know how to adjust my machine and have been tweaking the pressure and such over time.

And I have been paying attention to the basic info shown on my dreamstation regarding the AHI and whatnot...

Essentially what is happening is that I have an APAP machine and my avg pressure has risen over time and is now close to the limit of 20 for the machine - the 30 day avg is over 19 now

My AHI 30 day avg is close to 15.

That's the only data I can get off it via the display, but if you want I can get the memory card data. Not sure if I can send that data to someone here? I tried installing OSCAR the other day but had some problems with my computer.

The doctor's reasoning for the titration study was indeed that I might do better with a BIPAP machine, so I'm assuming the study is required to figure out the specifics and determine if that is the case, and then I would assume, as someone else here mentioned, that the insurance would use the results to determine if they would cover a new machine.

The dr told me that the BIPAP goes to a higher pressure, which would probably help me, and then on the breath out it reduces pressure. The lower pressure on the breath out sounds like a nice feature to have at higher pressures. My APAP has a flex setting but it's probably not as dramatic as the BIPAP would be.

I may as well also note that I've been dealing with some unexplained medical issues and symptoms over the past 4 months, that I've been trying hard to figure out. Some neurological symptoms such as all kinds of pain across my entire body, muscle twitches, dramatically increased fatigue, etc. I've seen about 10 doctors with various areas of expertise. I just got an MRI last week per a neurologist and today's follow up indicated no major problems there. Anyway I was thinking maybe the sleep apnea and the other issues are somehow tied together (maybe the apnea / lack of oxygen is damaging my nervous system, or conversely maybe the apnea is worsening due to something wrong with my nervous system controlling my body. Obviously I'm just spitballing here as a layman.)

I think I covered all of the questions or things you mentioned, but let me know if I missed something.

wannasmile wrote: ↑

Wed Oct 07, 2020 7:38 pm

Essentially what is happening is that I have an APAP machine and my avg pressure has risen over time and is now close to the limit of 20 for the machine - the 30 day avg is over 19 now

The doctor's reasoning for the titration study was indeed that I might do better with a BIPAP machine, so I'm assuming the study is required to figure out the specifics and determine if that is the case, and then I would assume, as someone else here mentioned, that the insurance would use the results to determine if they would cover a new machine.

Now, those are good reasons to undergo an in-lab titration study.

Be sure to talk to your insurance company in advance to see if the sleep lab is in network and what your costs are. Also, ask that what will be your costs for a BiLevel machine (insurance code E0470).

As far as the night of the study, your job is just to relax and sleep. You might ask your doc if he wants to prescribe one sleeping pill to be used only if you cannot fall asleep or stay asleep.

ChicagoGranny wrote: ↑

Thu Oct 08, 2020 11:13 am

wannasmile wrote: ↑

Wed Oct 07, 2020 7:38 pm

Essentially what is happening is that I have an APAP machine and my avg pressure has risen over time and is now close to the limit of 20 for the machine - the 30 day avg is over 19 now

The doctor's reasoning for the titration study was indeed that I might do better with a BIPAP machine, so I'm assuming the study is required to figure out the specifics and determine if that is the case, and then I would assume, as someone else here mentioned, that the insurance would use the results to determine if they would cover a new machine.

Now, those are good reasons to undergo an in-lab titration study.

Be sure to talk to your insurance company in advance to see if the sleep lab is in network and what your costs are. Also, ask that what will be your costs for a BiLevel machine (insurance code E0470).

As far as the night of the study, your job is just to relax and sleep. You might ask your doc if he wants to prescribe one sleeping pill to be used only if you cannot fall asleep or stay asleep.

Excellent, thank you! I will check into these things as you advise.

Yes, as ChicagoGranny says, this all makes sense. But I'd really like to know the breakdown of your events. Can you describe the problem you ran into while trying to install Oscar?

The reason I'm pursuing this is that I've known forum members whose doctors thought increased pressure or pressure support would address central apneas, when really the patient needed an ASV machine.

Miss Emerita wrote: ↑

Fri Oct 09, 2020 10:32 am

Yes, as ChicagoGranny says, this all makes sense. But I'd really like to know the breakdown of your events. Can you describe the problem you ran into while trying to install Oscar?

The reason I'm pursuing this is that I've known forum members whose doctors thought increased pressure or pressure support would address central apneas, when really the patient needed an ASV machine.

Thank you.

What is the difference between an ASV machine and the one I have that is an APAP which automatically adjusts pressure? They sound similar.

The Oscar issue was that my computer kept constantly throwing security warnings during installation and set up, and some of them seemed like things I didn't want the program to do so I just decided not to continue.