Do it yourself titration!

I came across an article today titled, "Can Patients with Obstructive Sleep Apnea Titrate Their own continuous Positive airway pressure?" and it seems that the answer was yes.

Here is the article: http://ajrccm.atsjournals.org/cgi/conte ... /167/5/716

It went on to say, "Patient Education: A technologist provided 30-minutes of instruction on CPAP treatment for OSA, facial/nasal CPAP appliances, and symptoms that would suggest an incorrect CPAP setting..."

Might anyone on this board know what symptoms it may be talking about?

On the high end, you're going to see aerophagia and pressure induced centrals. On the low end you'll see hypopneas and apneas caused by pressure that's too low. For the high side that means excessive daytime gas/bloating/pain + not feeling as rested, and on the low side that means not feeling as rested.

So essentially the symptoms of mistitration are the symptoms of untreated sleep apnea.

I think the study participants were probably also instructed to have their bed partners let them know if any snoring was noticed. Someone else hearing the person snoring would be a pretty good indication that the pressure needed to be raised until snoring was eliminated.

Get an Autopap and it is easier to perform than manual titration, it will at least identify your 90% pressure where you can fine tune it from there.

Got a question as a new user - is there typically a follow up with someone a few weeks down the road to see if the machine settings are really working for us or are we typically on our own after we get the gear?

I'm sure there are a variety of answers to this question .. I was just wondering what experiences others had. No one has mentioned any follow up to me as I've navigated the sleep medicine waters. I thought about scheduling a follow up visit on my own with the sleep doc - but the DME guy told me none of the docs in my area has the scanner and software to read the smart card from my Resmed S8 Elite (I can't vouch for the accuracy of his statement). All this leads me to believe that at some point - after I have enough time on the machine and have become somewhat educated on all of this - I might be reviewing the user manual (against medical advice) to see which combination of buttons gives me access to the clinical settings on my CPAP.

I think these instructions are for the Vantage (Auto), but should at least get you into the setup menu for the Elite....and maybe they're universal for all of the ResMed machines. Be sure to just scroll through the settings the first time through and write down ALL of the existing screens and settings before trying to change anything.

There are lots of ResMed users on the forum who can give you some advice on the settings (I'm not one of them as I don't have one of those machines).

Den




1. Accessing the Clinical Menu

Turn on the device and wait until the standby (RAMP/SETTLING) screen appears on the LCD.
At this stage you can adjust the ramp/settling time.

Press the DOWN and RIGHT keys simultaneously for 3 seconds to access the clinical menu.


2. Changing Options and Settings.

Press the LEFT (menu) key to access the SETTINGS menu screen.

Use the UP and DOWN keys to scroll through the RESULTS, OPTIONS and SERVICING menu screens.

From a menu screen, use the LEFT (enter) key to access the parameters in that menu.

Use the UP and DOWN keys to scroll through menu parameters.

Use the LEFT key to view or change each parameter setting as required.

Press the RIGHT (exit) key until you return to the standby (RAMP/SETTLING) screen.

Robbie wrote:Got a question as a new user - is there typically a follow up with someone a few weeks down the road to see if the machine settings are really working for us or are we typically on our own after we get the gear?

I'm sure there are a variety of answers to this question .. I was just wondering what experiences others had. No one has mentioned any follow up to me as I've navigated the sleep medicine waters. I thought about scheduling a follow up visit on my own with the sleep doc - but the DME guy told me none of the docs in my area has the scanner and software to read the smart card from my Resmed S8 Elite (I can't vouch for the accuracy of his statement). All this leads me to believe that at some point - after I have enough time on the machine and have become somewhat educated on all of this - I might be reviewing the user manual (against medical advice) to see which combination of buttons gives me access to the clinical settings on my CPAP.

I can only add this to the discussion, based on my own experience. I made such an appointment with my sleep doctor and he was surprised. However, this is the only medical procedure I've had which did not include a doctor SOMEWHERE in the initial stages. This meeting did allow me to get another, better, mask--after only a couple of weeks into my CPAP life.

After taking the advice of a sleep technologist or two, I had another sleep test nearly a year and a half after the first two. This showed that my pressure needed to be raised 4 points. Further, I was not sleeping as well as I might due to PLMD.

With the improved treatment, I am slowly feeling a little bit of improvement. After a year, we should participate in a sleep study again because there are some changes that xPAP treatment causes in our bodies. For example, the treatment has kept my throat tissues from being irritated and has caused a lessening in the swelling. Therefore, a higher pressure is required.

The first study and titration did not diagnose the PLMD because my breathing disturbances were thought to be the cause of my arousals. The apnea was, in effect, hiding the leg movements' effect.

Many of the Forum Folk are quite adept at reading their treatment data because they like to know what is happening with their treatment. IMHO, this is partially because of a lack of good treatment on the part of our sleep professionals.

This is a rapidly expanding field. In a few years, maybe it will adopt some overall standards. Those standards should include a telephone call or two, shouldn't they?

Robbie asked:

Got a question as a new user - is there typically a follow up with someone a few weeks down the road to see if the machine settings are really working for us or are we typically on our own after we get the gear?

Maybe I'm lucky. The representative from my DME called me one day and one week after I first started using my equipment to make sure that everything was going OK, then checked in once again after several weeks. The sleep doctor also scheduled a followup with me for two months after I started (the appointment is tomorrow!).

Jilly