newbie - titration study scheduled for 2/15

I had my sleep study about 3 weeks ago and have had a followup referral with my ENT who ruled out any upper airway issues and does not see the need for any surgery (not that I was heading down that road anyway)

My question what can and *should* I expect from the titration study? I have the titration on 2/15 but don't see the sleep doc (a neurologist who is in charge of the sleep clinic) until 3/11

I have read the yellow light bulb wisdom up top and thank everyone who contributed to the posts there. I will be much better informed with my providers and the machine/mask prescription they will be writing for me. I'm not a mouth breather so I am hoping to try out a nasal mask during my titration study since I am mainly a side sleeper - contrary to what the sleep study may have shown (it was tough trying to get comfortable in a bed that is not your own). I have been told they have a selection of masks to try that night.

The pertinent data from my sleep study:

onset latency 11 minutes
total sleep time 345 minutes
efficency 89%
stage I 4.9%
stage II 70.3%
slow-wave 13%
REM 11.9%
REM onset latency 109 minutes

arousal index 13.0
total arousals 75 with 40 related to respiratory events

baseline O2 93%
lowest 84%
8.6% below 90%

9 obstructve apneas
184 hyponeas
5 REPAs

supine position AHI 69.9 (130.5 minutes)
left side 18.2 (82.5 minutes)
right side 7.3 (132 minutes)
"respiratory events were frequent during nonsupine/REM and during supine/REM sleep"

moderate OAS (RDI 34.5)
"respiratory events were primarily associated with supine and stage REM sleep"

Well, its is common or "the norm" for most of our events to occur during REM sleep and when sleeping on our back (supine position) so you fit right in w/the majority of us.

You appear to have educated yourself quite well already. Good on you. Its not to early to call your insurance company to ask them what local DME CPAP suppliers they care contracted with. Hopefully you will have the option of more than one. Do you have an annual deductable you have to meet each year? What is yoour copay if you have any for DME equipment?

You have some time to actually visit those local DME suppliers who are "in network" w/your insurance company and get a "feel" for how they will be to work with, what CPAP manufacturer or manufacturers' devices they prefer to provide. Usually they have a "favorite" from whom they receive a good "bulk price" per unit. That can increase your odds of getting the model you want if you have a manufacturer preference. Whether you would be able to "interview" their RT to determine how comfortable you feel w/him or her and his/her experience and expertise is questionable but maybe you can get some idea of how lenient their mask exchange policy is. It just doesn't hurt to let them know you are investigating and educating yourself now - before being scripted your equipment. It doesn't hurt to feel them about just how experienced they are w/yuor insurance and what your copay % is. Its a good idea to ask both your sleep lab, sleep doctor and local DME supplier if there are any local CPAP/apnea support groups.

Its not unusual for sleep doctors to work w/you in 30 day increments. It takes time to get acclimated to wearing a mask at night and having air blowing into your "face". Most CPAP "failures" and "drop outs" occur during the first 30 days of therapy. If doing fairly well at 30 nights of use its common to be "cut loose" by the sleep doctor for at least 3 months to 6 months and 2 year thereafter. So it is up to YOU to contact your DME supplier's RT and then your sleep doctor as well if you continue to experience problems or new problems crop up. They can't help you w/a problem if they don't know it exists. Most DME suppliers don't even bill insurance for the first 30-60 days.

This is a good time too to ask your sleep lab/doctor for a copy of the full scored data summary reports w/condensed graphs from your sleep evaluation and will also want one from your titration study as well. It sounds like you already have at least the doctor's dictated results. You are also going to want your orignal script so that you can shop your "in network" DME suppliers yourself.

At a minimum, get a fully data capable machine.
An "auto" machine is much more comfortable to breath with, is easier to adapt to, and has other benefits.
While masks are different for everyone, if you can try on a Swift LT, it seems to be very popular.
Check with your doctors office, they might be able to see your sooner if there is a cancellation.
Not knowing what your insurance circumstances are, there a good prices at cpap.com, and cpapauction.com.
Your titration study should be similar to your first night, except you will be fitted with a mask and machine, and they will adjust the pressures to establish a titrated pressure required to manage your sleep events.
You have learned a lot already and are doing great. Plan on sticking around here when you need more advice.

Georgio

Welcome........

You're already way ahead of the curve....and that bodes well for your future success!

I suggest that you quickly start writing a set of specifications for the CPAP equipment that you think you'll need.

By knowing in advance what you want, you'll be able to "write your own prescription"......and not fall into the trap of having to fight your way toward getting equipment that'll really do the job.

Here's what I mean. After I was told that I was "borderline normal" and that I'd have to furnish my own equipment, I contacted CPAP.com and learned what sort of wording they needed on the script.

Once i knew the basic wording, I figured out that a "M" series Auto CPAP with AFLEX and integral humidifier would give me the most options....a machine that could operate in (5) different modes.....a machine that had a smart card....that could be read by a card reader....with software that would allow me to run a a full report....every morning.

Realize that finding "just the right mask" is probably the toughest part......and that you'll probably go through (4) or (5) before you find "the" one.

Gerald

thanks to everyone for your responses. I have been in contact with my insurance to see how they handle it. I was told they rent the equipment for me if I go in network and I got a list of their in network providers. I spoke to a few folks at work and one DME provider stood out and I will be meeting with them next week to for an "informational" visit. I have high hopes for them. My annual OOP deductible is $400 with them covering 90% and I will have no problem meeting that between sleep studies, additional visits and other medical stuff. If I go out of network and want to purchase the equipment they will cover 70%, so I hope the in network impresses me and has their act together like I have heard they do.

I do plan on asking for a machine with heated humidity, auto capabilities and a card reader.

I'm am getting ready for this new "adventure" and plan to be well-informed thanks to places like this forum.

M-E