[Pressure] Is Titration Recommended?

[Remember2Breathe]

I'm new to the Forum.  Also new to CPAP.  As you can see, I have not yet gotten my equipment for my Mild to Moderate Sleep Apnea.  However I have put my intentions in profile.

I've had 2 Home Sleep Tests, a little over a month apart (Watchpat and Res Med).  Was considering MAD since already use a bite guard for bruxism; but have concluded that CPAP will be more therapeutic.
I thought that my bite guard might worsen mouth breathing and AHI; however with one test wearing the bite guard and one without, the results were almost identical.
Mild OSA with an AHI of 10.3 and 10.8.  However on both tests my lowest oxygen saturation was not good at 75 and 78%.  With mean saturation at 91 and 92%.

One doctor recommends getting a titration study at a sleep lab.  Other doctors suggest just getting Auto CPAP.

From reading on this website that pressure needs change constantly, it seems that getting a Titration study at a lab might be an unnecessary hassle (especially w/Covid levels) and that pressure needs might be better assessed by going with the recommended pressure of 6-14 on Auto CPAP machine, and monitoring with software (OSCAR and ResScan).

Do you agree or is there some reason that Titration might be helpful?

[Sleeprider]

With some exceptions, a titration test is generally a waste of time and money. The method used in a titration amounts to nothing more than trial and error, with pressure generally starting briefly at 5.0 cm and increasing pressure until events are resolved. This snapshot of your sleep while using CPAP pressure is usually translated into a fixed pressure prescription that rarely works in the long-term. Most of us on the forum strongly favor self-titration, particularly when an individual is motivated and equipped with software like you have. The Airsense 10 Autoset is responsive enough to move you into an effective range of pressure that prevents most events. By evaluating the results of a single night, it is usually possible to optimize the pressure range to ensure the minimum pressure is high enough, that large pressure changes are unnecessary and your sleep is less disrupted. We can also identify issues such as obstruction caused by positional issues.

Clearly, if there is a problem with self-titration or complications with things like central or mixed apnea, then the option to request a titration evaluation can better identify those issues and recommend a modification in the therapeutic approach. What we have found is that an initial titration rarely identifies these problems and often ends up with a very inappropriate pressure recommendation when the test results are non-linear for events in relation to pressure. In other words, the test is usually a waste of time for someone that has good equipment and an ability to analyze the results of using Auto CPAP. You will be much more empowered and less frustrated if you control your therapy, rather than have others tell you what to do, then ignore when that doesn't work.

[SarcasticDave94]

Go easy to harder as in Auto machine no titration unless the sleep study indicates need for it by not having vanilla Apnea.

[Dormeo]

You've selected an excellent machine; I strongly encourage you not to accept a substitute, unless it is a different type of machine altogether (e.g., a bilevel machine).

Your apnea may be "mild" but your mean O2 levels suggest your long-term health will benefit a lot from PAP treatment. And even without that, your sleep is being repeatedly disrupted, probably interfering with your ability to get adequate REM and deep sleep, which you need for both short-term and long-term health.

Keep us posted, would you? When the machine is on the way, we can give you some advice about how to launch your therapy.

[Remember2Breathe]

Thank you so much for your information and support, Sleeprider, Dave, and Dormeo!!  

Now I have to go to work on getting a descent DME.  So far, they remind me of car salesmen, anxious to make a sale.  Love the guidance on this site for that task.
And of course, choose the nasal pillow mask to try with my  small head.

One question, if when I get my machine, they set it to say 6-14, do I have to stick with that setting until I've made my compliance hours?  

Will the sleep police somehow nail me and cancel out compliance if I change any settings before "fully compliant"?

[staceyburke]

No compliance is just showing at least 4 hours of use per night. The settings do not matter.

[Sleeprider]

If you get initial settings of 6-14, consider it an improvement over 4-20 that we see a lot. You can optimize, and we can help you understand why you might want a change that narrows the pressure changes. If you look at charts by the experienced and optimized members of this forum, you might be surprised at how little their pressure actually changes through the night. In my opinion, that is what optimized auto-pressure therapy looks like. It is effective, not disruptive to sleep and just works quietly. We do this for a lifetime of comfortable better sleep, not just to stop apnea events. We are here to help you be empowered to get the best therapy possible. That is another way of saying, almost no one here is using the pressures they were prescribed, but what works best for both efficacy and comfort. If you want to read the more rebellious purpose of this forum, Supersleeper discusses it in the CPAP Setup Manuals https://www.apneaboard.com/adjust-cpap-p...tup-manual

[SarcasticDave94]

We've a wiki on DME selection, good info and not just because I'm quoted.

[Remember2Breathe]

Thanks, Stacey!

[Remember2Breathe]

Thanks, Sleeprider and Dave, such good info here!