How Effective was Your Initial Titration?

rested gal · Post by **rested gal** » Fri Feb 10, 2006 8:15 pm

I didn't choose anything in the poll, as my answer would really have skewed it.

My provider was...me. Message board people, especially one in particular, helped me tweak my autopap to perfection. I had the software to monitor the results.

After two years of great autopap treatment I finally had an opportunity to have a full sleep study done. Three nights, even! One diagnostic, one titration, and the last night all wired up using my autopap.

Outcome: the titration night came up with essentially the same pressure as any of the three different brands of autopaps I've used have found for me. No, I haven't used three different brands because something went wrong -- I just wanted to try different brands to see what the different features were like.

One thing the sleep study turned up that no autopap or any cpap machine can reveal is that I have PLM's (periodic limb movements.) Those can disturb sleep if they cause many arousals. About half caused arousals which apparently are not enough to cause me trouble;
so, I'll not bother to treat them for now.

However, not knowing about the PLM's during the two years of treating myself with autopap... IF I had continued to be sleepy on autopap treatment, I'd have thought autopap was failing me. So, it's good to have a sleep study, to look at many aspects of "sleep" other than just an AHI. If I ever have daytime sleepiness later, despite the good autopap treatment I enjoy, the PLM's would be something to deal with at that time.

P.S. Bellcrest, you're doing the right thing, getting yourself onto autopap! WTG!

NightHawkeye · Post by **NightHawkeye** » Fri Feb 10, 2006 8:38 pm

rested gal wrote:I didn't choose anything in the poll, as my answer would really have skewed it.

My provider was...me.

My answer did skew the poll results (and I'm the one responsible for the poll).

Heck, since I've had two sleep studies, both of which got it wrong and said I didn't have apnea, I kinda think my answer was in line with the spirit of the poll though.

Regards,
Bill

Yoga · Post by **Yoga** » Fri Feb 10, 2006 9:17 pm

I was titrated at 7 using a lousy Comfort Classic mask - air in my eyes all night. I felt that I was not getting enough air so it was upped to 9. I was still not getting enough air but the sleep doc did not want to discuss it. I upped it 1 cm at a time until I felt good at 12 or 13. I purchased an autopap which confirmed 12 was the correct setting.

I then saw a good sleep doc and his titration was right on 12.

That's my saga.

Severeena · Post by **Severeena** » Fri Feb 10, 2006 9:40 pm

I was given the Auto Spirit to titrate my pressure at home. According to the so called 6 days I had the machine, my pressure was between 6 and 7 and up to 10.

I am now using an Auto Spirit I purchased out of pocket and dearly love and I change my pressures at night when I feel I need more or less.

Wulfman · Post by **Wulfman** » Fri Feb 10, 2006 9:48 pm

Ric wrote:
Wulfman wrote:Bottom line is, I believe the DOCTOR got it WRONG!
But more importantly, the DOCTOR got PAID!

(Can YOU say "uvulopalatopharyngeoplasty" fast ten times backwards and forwards while standing in line at the bank and juggling several large unequal size bags filled with money and holding a set of golf clubs on your shoulder??? I'll bet your DOCTOR can!)

Goofproof wrote:Info needed, What kind Vanilla, Oreo. or my favorite Chocolate Chip?
CHOCOLATE CHIP !

Oatmeal Raisin!
Yeah, I know.....that wasn't one of the options listed by Goofproof.....but this is MY post.

Ric, I can't even pronounce or say "uvulopalatopharyngeoplasty" ONCE!

And, the fact that TWO doctors got to bill me (about the same amount) REALLY hacked me off! Especially when I never got to see what one of them had to say about reading my sleep study and the fact that the local sleep doc doesn't know his a** from a hole-in-the-ground.

Take care.

Den

wading thru the muck! · Post by **wading thru the muck!** » Sat Feb 11, 2006 11:32 am

Yoga wrote:I was titrated at 7 using a lousy Comfort Classic mask - air in my eyes all night.

Yoga,

You and I had the EXACT same titration experience... I don't remember seeing you there. LOL!

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CPAPopedia Keywords Contained In This Post (Click For Definition): Titration

rested gal · Post by **rested gal** » Sat Feb 11, 2006 12:12 pm

Ric wrote:(Can YOU say "uvulopalatopharyngeoplasty" fast ten times backwards and forwards while standing in line at the bank and juggling several large unequal size bags filled with money and holding a set of golf clubs on your shoulder??? I'll bet your DOCTOR can!)

OMG, that was funny!!!

Glad I've never had a UPPP or I'd have been spewing even more Pepsi than I did when I read that!

ozij · Post by **ozij** » Sat Feb 11, 2006 12:20 pm

Didn't get much sleep during the titration night, and was give an autopap by the sleep lab for a trial.

After one week, the head techinician or RT decided to put me on a stable pressure of 7.5

It was too high, and I woke up with such a headache that I informed the lab I'm stopping therapy then and there, till I get to talk to the doctor who first interviewed me.

That took about 3 weeks, I was switched to another techinician or ET, this time one who listened to me and said yes, that 7.5 and half was too high, given a 2 week trial on a different APAP, and another mask. The recommended range was 4-8, and after trying it for a while I tried some readjustments. Found out that setting the top higher than 7.5 woke me up too much (machine noise and more central apneas).

I also had to tweak the IFL1 switch on the machine (did this after a few nights of the trial period).

I am now on 5.5-7.5, rarely touch 7.5 and spend most of the time on 5.5 with some nights more time on higher pressure.

Thank God for the forums!
O.

DansCFLEXing · Post by **DansCFLEXing** » Sat Feb 11, 2006 4:55 pm

My sleep study was one night at home with a pulse oximeter, it showed I had an AHI of 10. Then I had a 1 week titration with a Remstar auto. I had a terrible time sleeping with the cpap my first week! My mask, a Profile Lite, was comfortable enough. I just could not fall asleep with the feeling of air being shoved up my nose. My breathing felt very unnatural. The cpap said I used it for 40 hours that week, but I felt like I only slept a few hours out of that 40. Several nights I took the mask off in the middle of the night because I couldn't fall asleep with the air. I was actually more tired and foggy the week of my titration than I had ever been. I figured I would not have enough data for the lab to give me a good titrated pressure when I brought the machine in for the download, and I had serious questions about whether or not I would be able to accept the therapy.

When I went in and had the smartcard downloaded they told me my titrated pressure was 7. The printout they gave me showed that 7 was my 90% pressure, and the highest I got was 10, but only for a few minutes. They were going to give me a Remstar Plus cpap set at 7. I knew from the research I had done online, including this forum, that I wanted to try a machine with C-Flex. I asked if I could get a Remstar Auto with C-flex, and to my surprise they said, "yea sure". They took back the Remstar Plus and brought me out a new Remstar Auto C-flex, no questions asked! They set the low pressure at 5 and the high at 11 because the highest I got during my titration was 10.

What a difference the C-flex made! My breathing felt so much more easy and natural with the C-flex. It was like night and day from the auto without the C-flex. It still takes me a while to fall asleep, but I don't feel like ripping the mask off during the night. Last night I did a little experiment. I'm usually a side sleeper, but I layed on my back and relaxed as much as possible, and allowed myself to obstruct. I felt the apap ramp up a little until my airway felt like it was open. I knew the pressure went up some, but it was still very comfortable to breathe, so I thougth the pressure might be at 6 or 7. To my surprise I got up and looked at the display and it was at 11! I never even got up to 11 with the titration machine, but with the C-Flex, 11 felt totally comfortable. The highest I was ever awake to feel on the titration machine was 8, and that felt like it was blowing my sinuses out of my head.

Since my new apap was set to a max of 11, and I hit 11 just relaxing on my back, I reset the max pressure to 20. I'm SOO glad I knew to ask for the Remstar Auto with C-flex. If I had just taken the basic cpap set at 7, I'd still be struggling to breathe against the pressure, and it probable would not be high enough. A big Thank You to cpaptalk.com for educating me and allowing me to go to my DME knowing what to ask for! I can't wait to get the card reader so I can graph out my pressures now that I am able to wear the mask all night and actually sleep with it. I've had the C-flex machine for two nights and can already feel the difference.

NightHawkeye · Post by **NightHawkeye** » Sat Feb 11, 2006 6:03 pm

Congratulations DansCFLEXing,

I take you just got your machine. Welcome aboard here. I know that others will soon come along and list the reasons for you that you should not set the APAP max pressure all the way up to 20. I'm not that smart yet though, just glad to hear that it's working for you.

Regards,
Bill

rested gal · Post by **rested gal** » Sat Feb 11, 2006 6:41 pm

I'm not a doctor, but personally I think a good reason for not setting an autopap's top pressure "wide open" at 20 is to be sure the machine doesn't "run away" when first using it.

I believe that after checking the overnight data for a few nights and seeing that the machine doesn't ever hit whatever ceiling pressure you've set (14, for example) it's perfectly ok to open up the top pressure if you want to.

If the machine is never going to use more than, say 11 or 12 and never touches the 14 a person had set as the high pressure, there's no reason to think it would hit 20 either. So, it really doesn't matter how high you set the top pressure AFTER you see from the a few nights of data that the machine is behaving itself.

It's the bottom pressure that I think is the more important pressure to consider when thinking about "narrowing the range." Bringing the bottom pressure up to what it takes to keep the throat open most of the time is the key to smooth autopap treatment. Unless that particular "low" pressure is too much to breathe comfortably with, even with C-Flex enabled.

It really is kind of a balancing act to get it all "just right" for each person. Not only is the pressure itself important, but the type of machine is too. C-Flex helps many; is counterproductive for some. It's great if you can try out several types of machines and settings to determine what suits you best.

Sounds like you've gotten a machine that suits you and have dialed in your treatment very well, Dan! Good job!

DansCFLEXing · Post by **DansCFLEXing** » Sat Feb 11, 2006 8:04 pm

The Remstar Auto has a range of 4 to 20. My titrating machine was set to a max of 20, but I only got to 10, and that was only for seven minutes. That's the beauty of the auto, it only goes up when it has to. I asked the woman at the DME to set my minimum pressure to 5 because 4 felt like I wasn't getting quite enough air. She offered then to keep the max at 20, but I said 11 was ok because I only got to 10 when I titrated. Thankfully my DME, Apria, has been very cooperative. Once I slept with the C-flex machine and realized that I might need more than a max of 11, I raised the "ceiling" back up to 20 just in case I needed more. Since the DME offered to keep it at 20 in the first place I figured it couldn't hurt. I think my titrated "sweet spot" of 7 is about right. Once I get my smart card reader and see where my pressure tops out, maybe I'll lower the max, but with the auto I don't think I have to. Thanks for the replies

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CPAPopedia Keywords Contained In This Post (Click For Definition): C-FLEX, DME, auto, Smart Card

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CPAPopedia Keywords Contained In This Post (Click For Definition): C-FLEX, DME, auto, Smart Card

Guest · Post by **Guest** » Sat Feb 11, 2006 11:08 pm

Too bad I didn't see you Wader. We could have gone on the warpath.

I was ready to leave early but they insisted I stay and then had the gall to tell me to hurry and fill out the form as they needed the room.

Darth Vader Look · Post by **Darth Vader Look** » Sun Feb 12, 2006 1:17 am

My sleep study was done on 2 nights, the first night to verify what and if I had OSA and the second night to titrate my pressure level. My prescribed level was 6 to 7 cmH2O and I had them set it to 7 on their choice of machine (a F&P 233). On 3 separate nights I awoke from sleeping on my back and not being able to breathe. When I called the doctor's office and told the receptionist about the inability to breathe she said she could order up to 2 cm increase in pressure without informing the doctor right away. I just returned the unit and booked an appointment with my sleep doctor. The other doctor in the office saw me and when I asked for an APAP she didn't even ask for reasons, just wrote a script for an APAP with C-Flex and heated humidifier. Funny thing was the pressure levels prescribed were for 8 to 9 cm. I questioned her about this and she insisted it was right. The DME gave me the clinicians manual and I set the unit up for a 6 to 10 range with a C-flex of 3. As soon as I get my card reader I will be checking my sleep data results and manage my own pressure levels. So in this poll I chose selection 3.

Barb (Seattle) · Post by **Barb (Seattle)** » Sun Feb 12, 2006 1:20 am

I guess I can't vote *grin* My choice would have been:

"Provider Gave me APAP THEY readjusted it" I was titrated to 8 during the sleep test, and am now on a pressure of 12. How it could be SO diferent is a mystery to me. Did they screw up, or WHAT?

I'm still tired, but hopefully, as I use the Activa mask, I will feel more energetic as time goes on.

How Effective was Your Initial Titration?

How Effective Was Your Initial Titration?

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