Self Titration - Scientific Study Confirms Apnea Board Approach

[SuperSleeper]

Having no sleep study was a disaster for me.

I didn't sleep during the study, because it was held at night, and I sleep during the day.

Eight hours of lying awake on a bed with a full face mask on (and strapped tight) was a charming introduction to sleep medicine.

Regardless, the very credentialed sleep lab doc said: "No problem! (switching to a mexican accent) Sleep study? We don't need no stinkin' sleep study!"

He prescribed a Respironics M Series Auto CPAP Machine with C-Flex. Full face mask. Default limits on pressure (4 to 20?).

................

The first day I woke up gasping because I couldn't exhale.

Called the sleep doc, he said: "No problem!" I had to visit them so they could set the C-Flex (which was off) to 3.

The next day, same result. Recently, I've had an apnea that lasted 24 seconds and it didn't wake me, so I can only guess how long I was without oxygen during those two events.

Two wake-ups like that was enough for me. I returned the unit. My sleep doc looked very hurt.


-------------------

Went to another sleep lab, titrated to 10.4

Used a ResMed CPAP the next day, and 10.4 was fantastic.

I'm on ResMed auto-pap now, but 10.4 was an important floor to establish. Gradually increased the upper to limit to 14.5

--------------------

Finding the right mask was another long and frustrating story, for another thread.


But if you have the insurance, I'd always recommend a sleep study.

[SuperSleeper]

Does Home Sleep Testing Impair CPAP Adherence in Patients with Obstructive Sleep Apnea?
http://chestjournal.chestpubs.org/conten...st.10-1060
Abstract
Background: The increasing recognition of obstructive sleep apnea and demand for polysomnography has created a need for home sleep testing (HST) utilizing unattended diagnostic and titration studies. While these studies increase access to care and reduce cost, the limited interaction with sleep laboratories may negatively affect positive airway pressure (PAP) adherence. We sought to determine the difference in PAP use between HST and traditional in-lab studies.

Methods: Observational cohort study of 210 OSA patients classified into three equal groups. Following pre-established guidelines, group 1 underwent unattended, type III home diagnostic and unattended home auto-adjustable positive airway pressure (APAP) titrations; Group 2 underwent in-laboratory, type I diagnostic and CPAP titration studies; Group 3 underwent type I diagnostic and APAP titration studies. Group 1 was primarily managed and educated in a primary-care clinic, while groups 2 and 3 received extensive education in an academic Sleep Medicine Center. Objective measures of PAP use during the first 4-6 weeks of therapy were compared between groups.

Results: Type of study and location of care did not affect PAP adherence. PAP was used for 70%, 73%, and 72% of nights in Groups 1, 2 and 3, respectively (p=0.94). Mean hours of nightly use (4.4±2.0, 4.7±1.5, and 4.6±1.5, hours, p=0.98) was also similar. Regular use was observed in 54%, 51%, and 50% of subjects (p=0.84). Discontinuation rates were similar between groups.

Conclusions: PAP usage did not differ between those undergoing HST versus in-lab studies. HST offers a more accessible and cost-effective alternative without compromising therapeutic adherence.

[leo]

If have read that 95% is 5.7 and ReSmed S8 elite II is set 5.0 to 7.0. Could I reduce (7.0 the high one) to 6.0 ? Thanks.

[Dreamcatcher]

If have read that 95% is 5.7 and ReSmed S8 elite II is set 5.0 to 7.0. Could I reduce (7.0 the high one) to 6.0 ? Thanks.

You could but your not leaving much room for you to breath. A window that tight is ok if your well on top of your readings and you know that you wont go out of this range, the problems will start if you have a bad night and need a little more.

[leo]

If have read that 95% is 5.7 and ReSmed S8 elite II is set 5.0 to 7.0. Could I reduce (7.0 the high one) to 6.0 ? Thanks.

You could but your not leaving much room for you to breath. A window that tight is ok if your well on top of your readings and you know that you wont go out of this range, the problems will start if you have a bad night and need a little more.

I have decrease to 6.8(max) and the 95% decrease to 5.5.

[Dreamcatcher]

Going back to the original post, it maybe ok for America but over hear its frown upon. Just reading your results will get the clinics over here hoping mad. Ive been warned several times by top Doctors and also been told that one day someone will be killed by listning to the advise on forums. Of course when I was first told this I was shocked, I just dont say anything anymore. I probably know more than them. The only way to go on your own in the UK is to buy everything yourself.

[SuperSleeper]

Going back to the original post, it maybe ok for America but over hear its frown upon. Just reading your results will get the clinics over here hoping mad. Ive been warned several times by top Doctors and also been told that one day someone will be killed by listning to the advise on forums. Of course when I was first told this I was shocked, I just dont say anything anymore. I probably know more than them. The only way to go on your own in the UK is to buy everything yourself.

Gazby, you can always escape from behind the iron curtain and come over here where they don't think it's a crime to change one's own CPAP pressure. Of course, the way our "Nanny State" is headed here, it won't be long until we're behind a similar iron curtain of "Big Brother" healthcare laws as well.

The folks who claim we're killing people by offering this "secret" knowledge of how to change pressures need to read this topic thread. Still haven't read one obituary that attributed the cause of of death to "CPAP Self Titration"... or even listed it as a contributing factor to anyone's death. I think I'll be waiting quite a long while before I see that.

Good to see you here, Gazby! I tip my teacup to you from across the Big Wavy Pond.

[Dreamcatcher]

Going back to the original post, it maybe ok for America but over hear its frown upon. Just reading your results will get the clinics over here hoping mad. Ive been warned several times by top Doctors and also been told that one day someone will be killed by listning to the advise on forums. Of course when I was first told this I was shocked, I just dont say anything anymore. I probably know more than them. The only way to go on your own in the UK is to buy everything yourself.

Gazby, you can always escape from behind the iron curtain and come over here where they don't think it's a crime to change one's own CPAP pressure. Of course, the way our "Nanny State" is headed here, it won't be long until we're behind a similar iron curtain of "Big Brother" healthcare laws as well.

The folks who claim we're killing people by offering this "secret" knowledge of how to change pressures need to read this topic thread. Still haven't read one obituary that attributed the cause of of death to "CPAP Self Titration"... or even listed it as a contributing factor to anyone's death. I think I'll be waiting quite a long while before I see that.

Good to see you here, Gazby! I tip my teacup to you from across the Big Wavy Pond.

Good Morning, Good Afternoon and Goodnight, you now have a window into the future as that is where I am 6 hours in front I think. I dont really care what the doc tells me as he sees me every 18 months, I know how I feel and will change things to make me better. I will not don my mask and lay back and think of england so to speak. Its great being here and thanks for the welcome

[Dreamcatcher]

If have read that 95% is 5.7 and ReSmed S8 elite II is set 5.0 to 7.0. Could I reduce (7.0 the high one) to 6.0 ? Thanks.

You could but your not leaving much room for you to breath. A window that tight is ok if your well on top of your readings and you know that you wont go out of this range, the problems will start if you have a bad night and need a little more.

I have decrease to 6.8(max) and the 95% decrease to 5.5.

My AHI can vary as much as 3-4cm your leaving yourself a margin of 1.3cm thats very tight. Mine is set at 10-18cm just in case I have a bad night and need a bit more. Just make sure you check your readings

[mjbearit]

This is some very interesting information. I do find it interesting that I can be trusted by a pain management doc to set a narcotic schedule, trusted by a diabetic team to take blood tests, know when to take urine tests, and if necessary even inject insulin where the patient decides how much to take and is trusted to use a sliding scale. I'm trusted to self medicate my bronchial tubes when and as much as is necessary. There of course are other examples as well, but providing me the ability to be able to self adjust this other form of "medication" is a big no-no! It just does not make sense to me. But one of the first things I did when I got my machine years ago was to seek out and find the method for setting the pressure. Over a period of several months I found a pressure that worked for me because the one they sent me home with, while close, just wasn't getting the job done! Guess I should toddle off to the local constabulary now and turn myself in!
Mike