Is a Sleep Lab Titration Necessary?

[Melman]

After a lot of resistance I have finally convinced my wife to get a sleep study. Per my limited understanding it's a good idea to have and overnight sleep lab PSG study to establish the nature of sleep disorder a person may have.  If it's determined, however, that the condition is just "simple" OSA with minimal or no centrals, is there any real value to a subsequent sleep lab titration?  From what I've learned from my personal experience and from this forum, it seems a better and more effective approach is to go straight to therapy using a self-titrating autoset  machine such as the AirSense 10 Autoset and use the data to determine appropriate settings. It seems like most, including me, end up going that route anyway, after being prescribed a pressure that doesn't provide adequate therapy.



Her PCP referred her to a sleep specialist (fortunately not the one I've been going to for 10 yrs) so it may be an uphill battle to avoid the second night in the sleep lab. Then there may be Medicare requirements. Does anyone know if Medicare requires the sleep lab titration?

Is my thinking correct or am I off base?

[TASmart]

In my case a titration study reveled that I am quite sensitive to CA, so I need to limit my pressure to 10. Ultimately I think that saved me a lot of time and effort getting an autoset to discover that over 10 doesn't work for me. On the other hand, that's is a single snapshot in time, so who knows what the future will hold.

[justMongo]

A split night study is a possibility.

[Melman]

A split night study is a possibility.

I didn't think that was done by request but only if the study indicates the need. am I wrong?

[justMongo]

I *think* medicare would require both a PSG for DX plus a titration to show xPAP would benefit the patient.
Why that would require 2 nights seems counter to saving Medicare money.
(Seems to me that MC requirements could be met by a split night study)

[OpalRose]

My doctor is the one who requested a split study.  The first half of the night is done without the mask.  Then second part of the night with the mask to determine titrated pressure.

I'm not sure if a titration is required by Medicare, but it would make sense to be able to determine what type machine you will need.

[Mosquitobait]

Original Medicare requires either a split night or a titration because it is part of the initial diagnosis and treatment. Yes, you have to have a titration of some kind for them to pay. The problem is whether she is bumping up against the protocols. When you barely qualify, they want to continue the original study and not split it because they need more data to qualify you in the first place. The doctor isn't there for the test or some of this nonsense could be avoided. I BARELY qualified since my AHI is 5 (and they fudged that). My RDI, on the other hand was 30 but Medicare doesn't care about RDI. All this occurs only during REM and near REM.

Of course, your wife could avoid the titration and stuff, but then she'd have to pay for her machine and her own supplies. Some people can and do because they can't stand the hassles.

[Sleepster]

You need the titration to determine if she can totolerate CPAP or may require bi-level. The CPAP therapy may induce central apnea, aerophagia, etc. Sure, you could figure all this out by trial and error at home presuming you have the skills to do so. The medical industry is not going to make that assumption. They are not likely to assume, let alone require, that you have a data capable machine.

[Melman]

Thanks for the responses,

If she has sleep apnea it looks like the titration is not just requited for medicare coverage but also worthwhile. Obviously, I'm still learning. Her main problem is going to be able to sleep in the lab. As much as they try to make it like a normal bedroom, we all know it's not.

At least, thanks to this forum, she will go into this knowing more than I did when I was diagnosed. I won't let her get stuck with a brick like I was given originally.

[Mosquitobait]

There are some things that would help. She should visit the sleep lab ahead of time to familiarize herself.  I brought my own pillow.  I also brought my Ipod (which has to be on low so that the machinery can collect data) because white noise is great for me.  Make sure before they start that the temperature of the room is comfortable.  If you are too hot, you are not going to sleep.  I chose not to have any sleep aids, but many sleep docs are fine with it because they need DATA.  Find out what the recommendations are.