Self-Titration w/ APAP
Hey folks, hoping to get some knowledgeable opinions here. My insurance company declined a lab titration and I was given an APAP machine.
What is the best way to self-titrate using OSCAR data? My APAP machine was originally set with a range of 5 - 15 but I quickly changed it to 7 - 15 because I couldn't breathe at the lower pressure. My AHI is consistently between 3 - 5 but I feel it could be lower. Per OSCAR, my 95% pressure is between 10.6 and 11.4. My 99.5% pressure is between 11.5 to 12.5.
Last night I changed my range from 7 - 15 to 9 - 14 and the result was an AHI of 2. 95% pressure 11.2, 99.5% pressure 11.8. Truth is while I kind of understand the data I'm not nearly confident enough to continue messing with the pressure range and was hoping some more knowledgeable people could assist.
Thank you!
RE: Self-Titration w/ APAP
Hi corgan115! -
We really need to see a screenshot of your OSCAR Daily screen. Please use the
F12, or
Fn+F12 for a Mac, to take the screenshot. My signature has links to instructions on how to post images here.
-
Red
RE: Self-Titration w/ APAP
Sure thing! I attached a few days. 1 of my more normal days with my default pressure of 7 - 15 and AHI ~3, one particularly rough night where the AHI was 4, and then last night where I had modified my settings to 9 - 14 and had an AHI of 2.
Thanks!
RE: Self-Titration w/ APAP
Your titration has progressed in the right direction since your earliest chart on 11/21 with 7.0-15.0 pressure EPR 3. to the current 9.0-14.0 EPR 3. Your Autoset is actually a limited bilevel machine, so I'm going to refer to your settings in bilevel terms where your current minimum pressure is 9.0/6.0 PS 3 and ranges up to 14.0/11.0 PS 3. When dealing with obstructive apnea, the EPAP or exhale pressure is what maintains a patent airway and prevents obstruction. Your 90th percentile EPAP is 8.24 cm pressure and I think your titration will eventually reach a minimum pressure of 11.0/8.0 EPR 3 with a maximum pressure of around 14.0. Your therapy looks good otherwise with low flow limitation and leaks, and a healthy group of respiratory statistics. Your early charts had clusters of obstructive apnea which looked like positional issues, but those have resolved with the higher pressure. You have done an excellent job of self-titration and I think your are getting close to your optimized pressure of minimum 11.0, Maximum 14.0 EPR 3. Keep up the good work.
RE: Self-Titration w/ APAP
Everything is looking pretty good. Since you just started therapy, you need a little time for your body to adjust.
One thing I might suggest is to set your View back to the Standard view. "Advanced" refers to the type of CPAP, such as an ASV or ST model. At this point, your Flow Rate is more important than Mask Pressure. Also, by default, the graphs are organized in the order of importance for displaying here.
- Red
RE: Self-Titration w/ APAP
Thank you both for your help!
Looking closer at my OA events I notice that it tends to happen frequently when my pressure is below 10 and rarely when below 11. I don't seem to see any once the pressure is at 11 and per the 95% stats it seems that's around the pressure my machine likes to be at anyways. 11 seems to be my "sweet spot" and coincides with Sleeprider's comments as well.
Would a good plan going forward be to continue to bump the lower-end of my pressure range up slowly towards 11 and continue to monitor? Since I seem to never have apnea's at a pressure of 11 it seems that would be where I would want my minimum to be. But that almost sounds too easy for someone so new to this like myself.
RE: Self-Titration w/ APAP
Your conclusions are bang-on. Obstructive sleep apnea is pretty easy to solve when other complications like aerophagia, comfort or central apnea are not present. The airway responds to pressure by opening and making the soft tissues less likely to collapse. The optimum number for you is pretty obvious after your trial at minimum pressure of 9.0 and comparing that to previous trials at 7.0. Provided you are comfortable with the therapy, the progression to a higher pressure is an easy decision, and as I said, it does not appear you will need to increase that above 11.0.
RE: Self-Titration w/ APAP
Hey folks, me again!
I am so thankful to the helpful people on this board. I'm hoping I could have another round of intelligent eyes.
I've been bumping the lower end of my range slowly up and currently I'm exactly where I thought I would be. A range of 11 - 14. I can't seem to get my AHI under 2. I'm not sure if I'm just being picky but I know a lot of people who have AHI's of < 1.
I've attached the last few days and I'm curious if you all think I should continue to bump the lower end of the pressure range of just accept my AHI of 2 and call it a day.
Thanks!!
RE: Self-Titration w/ APAP
When increased pressure does not result in improvement of "the numbers", the question becomes, what is the quality of sleep? Too many people think this is a game of the lowest AHI, but it is actually, what makes me feel best and delivers the best sleep. If you kept notes on how you feel after a night of sleep at lower or higher pressure, what would you conclude?
RE: Self-Titration w/ APAP
Good point. Upping the lowest pressure from 7 to 9 definitely made me feel better in the morning. The gradual bumps from 9 up to 11 don't seem to have made much of a difference, both in AHI and in how I feel in the morning. The only thing I have noticed is higher leaks and higher average pressure due to the change in range.
