Question for you??

My husband's doing great with his autoPAP, Pressures set I think in the 5-15 range. He did NOT have a titration study because the dr. he went thru did not believe in them. I notice frequently at night he has bouts of snoring. I'm wondering if I should try to up his pressure a little to see if that would take care of it? His AHI and HI's aren't too bad and range in the 3-5 range. I know I bumped my pressure up above my titrated pressure and really began to feel better. any ideas would be helpful thanks.

I think most of us here would consider your plan to be very logical and reasonable.


Den

For me, 5 cm ain't enough to part my nose hairs.

jnk wrote:For me, 5 cm ain't enough to part my nose hairs.

Same here.

Den

Take a look at the nightly data to see where the machine sits most of the time. The 'average lower end' of that pressure range is a good minimal pressure to set the machine to.

5 CMs sure seems a low starting point.

Good luck

DSM

karessamom wrote:I notice frequently at night he has bouts of snoring. I'm wondering if I should try to up his pressure a little to see if that would take care of it? His AHI and HI's aren't too bad and range in the 3-5 range. I know I bumped my pressure up above my titrated pressure and really began to feel better. any ideas would be helpful thanks.

I'd definitely raise the minimum pressure some more. I'd raise the minimum to at least 7 and as much as 10, if it were me.

He did NOT have a titration study because the dr. he went thru did not believe in them.

I'd be curious about the doctor's explanation of this... does he intend to review the data from the machine to adjust the titration range after a month or so? If so, that may be a legitimate philosophy (save the health care expense of a sleep study when the machine at home can give you good enough data). If not, I'd question this doctor's credentials... how else is he to know if the therapy will be effective?

Interesting. I, like karessamom's husband did not have a titration sleep study done. My autopap is set to 5 to 20 until I see my MD in February, although he did say I could fax him the print-out of the data after a month. I wonder if the very low minimal pressure contributed to my failed attempt at a nose mask, as I felt that I was not getting enough air when I used it. But it was my first mask ever after being diagnosed (started APAP Nov 18,2009). I automatically assumed that it was because I was a mouth breather and switched to a full face mask within a few days. Humm, maybe I will give the nose mask or nasal pillows another try after some adjusting to my machine.

karessamom wrote:He did NOT have a titration study because the dr. he went thru did not believe in them.

The more I think about what you said the doctor said, the more bizarre that doctor's notion seems to me.

Now if the doctor were part of an insurance plan that discourages sleep lab titration studies and wants people put on autopap right after the diagnosis, to save money, that would be one thing. Or even if a doctor wants to put someone on autopap while waiting for a sleep lab titration, I could understand that. But to "not believe in" doing a PSG titration...how odd.

The more info the better, imho, and even if I'd personally want to use autopap at least for awhile to get more info before or after a PSG titration, I'd DEFINITELY want to have a full night PSG titration if at all possible. A LOT more info can be revealed in a PSG titration than through any amount of info from an autopap machine at home.

It's funny... what we usually hear on the message board is people saying a doctor told them he doesn't believe in autopaps. How funny to hear about a doctor who "doesn't believe in " titration sleep studies in the sleep lab.

Some docs may take the "auto-titrating" of APAP a little to literally. To me, the titration study is part of the diagnostic process in many ways--seeing what titrating away the obstructions uncovers is just part of the full gig. To my way of thinking, it would make more sense to skip the diagnostic than to skip the titration, although I don't really like the idea of skipping either one without a REALLY good reason.

jnk wrote:Some docs may take the "auto-titrating" of APAP a little to literally. To me, the titration study is part of the diagnostic process in many ways--seeing what titrating away the obstructions uncovers is just part of the full gig. To my way of thinking, it would make more sense to skip the diagnostic than to skip the titration, although I don't really like the idea of skipping either one without a REALLY good reason.

Well we'll see if my insurance company agrees with you. In Quebec cpap equipment is not covered by government health care plan but by private insurance. I have yet to send in my claim for my apap equipment. I paid for it and should get 80% back. In addition to the MD's prescription, sleep study and letter describing my sleep apnea, I think they might need the results of a titration study. But I never had a titration study. My MD seems to think that the print-out from the machine will be enough. We shall see. I hope I will not have any problems getting refunded.

jnk wrote:For me, 5 cm ain't enough to part my nose hairs.

lmao. That was awesome.

rested gal wrote:

karessamom wrote:He did NOT have a titration study because the dr. he went thru did not believe in them.

The more I think about what you said the doctor said, the more bizarre that doctor's notion seems to me.

Now if the doctor were part of an insurance plan that discourages sleep lab titration studies and wants people put on autopap right after the diagnosis, to save money, that would be one thing. Or even if a doctor wants to put someone on autopap while waiting for a sleep lab titration, I could understand that. But to "not believe in" doing a PSG titration...how odd.

The more info the better, imho, and even if I'd personally want to use autopap at least for awhile to get more info before or after a PSG titration, I'd DEFINITELY want to have a full night PSG titration if at all possible. A LOT more info can be revealed in a PSG titration than through any amount of info from an autopap machine at home.

It's funny... what we usually hear on the message board is people saying a doctor told them he doesn't believe in autopaps. How funny to hear about a doctor who "doesn't believe in " titration sleep studies in the sleep lab.

I think the dr. was looking at it from a money savings thing. I really like our ENT (the one that dxed my husband and put him on the AUTo. His reasoning was that the autopap should take care of the pressure settings automatically. and because he felt so good right after he started, we never questioned it. infact my husband was a little pissed that they did a titration on me instead of putting me on an auto. but i went thru a different dr. and knowing what i know i'm glad I had the titration done. As far as the data readings go--i don't have a card reader but every time i check the machine, It always shows that it was at the 15cm setting from what I can tell--the machine will show the AHI's etc and then the pressure setting. as a side note--why would the machine just stop in the middle of the night?? out of the blue??? apparently last night it just shut itself off

His reasoning was that the autopap should take care of the pressure settings automatically.

This is true, but when the pressure starts so low, the machine has a long way to go to get to the right titration level. It only adjusts in small increments at a time until it successfully stops all events. In the meantime, he has probably had quite a number of events... especially if the machine eventually settles on a pressure of 15. Ideally, the lower limit should only be a few cm below the maximum it needs to get to in order to control the apnea events.

karessamom wrote:

rested gal wrote:

karessamom wrote:He did NOT have a titration study because the dr. he went thru did not believe in them.

The more I think about what you said the doctor said, the more bizarre that doctor's notion seems to me.

... The more info the better, imho, and even if I'd personally want to use autopap at least for awhile to get more info before or after a PSG titration, I'd DEFINITELY want to have a full night PSG titration if at all possible. A LOT more info can be revealed in a PSG titration than through any amount of info from an autopap machine at home. ...

I think the dr. was looking at it from a money savings thing. ... His reasoning was that the autopap should take care of the pressure settings automatically ... as a side note--why would the machine just stop in the middle of the night?? out of the blue??? apparently last night it just shut itself off

This is exactly why board certified sleep specialists worry about self titration.

IF your husband's ENT knew enough about your husbands physical status, it might have been OK to go without a sleep study. HOWEVER, if there was some underlying health issue where the increased pressure adversely impacted your husband, you would not have known it until you struggled through it ... or worse. No, I am not being an alarmist. I've done a LOT of research that clearly shows that the pulmonary and cardiovascular systems are closely linked. Tinkering with one can adversely interfere with the other.

The sleep study reveals SO much more than the pressure required. It is important to have that as a baseline.

And, karessamom, with your "Oh, By The Way..." you just proved my point. I knew I was having SERIOUS problems when my BiPAP would start to turn itself off during the night. In my case, it was an indication of serious central apneas during sleep.

I do not know if your system has an Auto Off feature (it will turn off after one minute or so, if you no longer have the mask on). If it does it could indicate you had an apnea that lasted a minute or so. Reviewing the manual for your unit, I did not see a feature like that. But you might want to call the supplier of the unit to see if it does have such a feature ... Or just turn it on without wearing the mask and see what happens after a minute or so. If there is no Auto Off, then you may have just briefly lost power to your power outlet last night.