Anyone NOT been titrated?

If they put a mask on you, the odds are you were titrated. It may have also been to stop you asking questions

It is possible to be titrated at home. Kaiser HMO does this regularly. They send you home with a fully data capable machine for a week to determine the settings and whether or not you will be compliant. Once that week is over you return the machine and they order a machine for you.

With the capability of many machines to "phone home" nowadays, it's even easier to be titrated at home by a clinic that can do so and you may not even be aware of their adjustments unless you know how to look.

Janknitz wrote: ↑

Sun Apr 08, 2018 7:24 pm

It is possible to be titrated at home. Kaiser HMO does this regularly. They send you home with a fully data capable machine for a week to determine the settings and whether or not you will be compliant. Once that week is over you return the machine and they order a machine for you.

With the capability of many machines to "phone home" nowadays, it's even easier to be titrated at home by a clinic that can do so and you may not even be aware of their adjustments unless you know how to look.

Was this the case ten years ago in the U.K, U.S., or anywhere else? I suspect not.

I was not titrated, I only did the at home test but doc was not far with what he started me on.

Hi Chalkie,

You ask: "Is the NHS happy to treat you now you have bought your own machine?"

As far as I know, yes - although I do note you say "the NHS" and not "the sleep medicine department that I have been referred to and which I attend".

Meaning: your local sleep medicine department may have a policy that sez not to - but providing your safety is considered, I don't see why they should run such a policy.

I have my own bought-and-paid-for machine. I had it when I was first referred to the sleep medicine department here in Gloucestershire. (How that happened I'll save for another time.)

I can assure you that my sleep medicine department are more than happy to:

- see me at annual follow up,
- check on my progress and confirm that in writing to my GP,
- issue me with replaceable mask parts and/or new designs of mask as they became available (I've got four now ), and
- confirm my compliance and my continuing fitness to drive to the DVLA.

And if that isn't proof enough (that they're happy to treat me), the chief sleep physiologist herself filled in the prescription form for my PR 561 when the blower in my PR 551 began to sound rough after five years.

Which PR 561 I bought direct from Philips Respironics UK.

And which buying direct and brand new I did because - if the staff at the sleep medicine department do have concerns, one of them must be that 'duty of care' thing again.

If they have been properly trained, the thought should cross the minds of any NHS staff treating you that they are at legal risk if they accept you for treatment using a machine that they don't know the history and provenance of.

So if you did turn up with a second-hand machine, they might ask that their technical and service department get a chance to look at it, to give it the ok. Just to cover themselves. And also protect you.

Alternatively, you can ask either Philips Respironics UK or ResMed UK to inspect any of their machines that you own and give you a written report. From memory, the fee for an inspection by PR is £57. I imagine that an inspection by ResMed costs something of the same order.

You could then show that report to anyone with concerns, and say: my machine is as safe and effective as any that the NHS issues patients with.

To put it another way, provided I show the staff at my sleep medicine department that I'm aware of their concerns, and provided I act to support them, they don't have a prejudice about my privately-owned machine.

There seems to be a trend of prescribing APAP and leaving the range wide-open (4 to 20).

This is acceptable, as long as the data are analyzed and the settings are then revised. These are not good permanent settings, at least not for most.

BTW, for many (such as myself), there's no reason to lower the max even if you never get near it.

Note that this procedure is akin to "titration," where you call it titration or not.

D.H. wrote: ↑

Sun Apr 08, 2018 7:28 pm

Janknitz wrote: ↑

Sun Apr 08, 2018 7:24 pm

It is possible to be titrated at home. Kaiser HMO does this regularly. They send you home with a fully data capable machine for a week to determine the settings and whether or not you will be compliant. Once that week is over you return the machine and they order a machine for you.

With the capability of many machines to "phone home" nowadays, it's even easier to be titrated at home by a clinic that can do so and you may not even be aware of their adjustments unless you know how to look.

Was this the case ten years ago in the U.K, U.S., or anywhere else? I suspect not.

Yes, I believe Kaiser has been doing Home titration longer than 10 years. They published papers on it. I’m on my phone ATM so can’t look them up but if you search you may find the studies.

I had the home titration initially from Kaiser in December 2012, but they didn't like how my numbers were during the titration, so then they sent me out to a contractor to have an overnight sleep study combined with a titration in January 2013

I am not sure this is germaine to the topic. I had 3 overnight sleep studies and they were never able to titrate me -- for whatever that is worth.

gwc2795 wrote: ↑

Fri Apr 13, 2018 5:49 am

I am not sure this is germaine to the topic. I had 3 overnight sleep studies and they were never able to titrate me -- for whatever that is worth.

How did you determine your pressure settings?

The sleep Dr. ordered a bipap and set the pressure at 20/16.

I'm scheduled for a titration next week...the 18th. When they gave me my sleep study result and diagnosis, they mentioned that I may need a high pressure due to my high AHI and really low O2 levels....so they may try me out on a bilevel machine.

Good luck

D.H. wrote: ↑

Fri Apr 13, 2018 6:41 am

gwc2795 wrote: ↑

Fri Apr 13, 2018 5:49 am

I am not sure this is germaine to the topic. I had 3 overnight sleep studies and they were never able to titrate me -- for whatever that is worth.

How did you determine your pressure settings?

I suspect they guessed based on the untitrated sleep data.

One night, 2 1/2 hours sleep, 450 events. I suspect they guessed based on the untitrated sleep data. The Doctor pulled the number out of his hat, his Magic 8 Ball was broken, it fell on the floor when his previous patient was playing with it.

His guess was with-in one cm, of what I needed, from there I got the Software (Encore Pro) and finished the job, told him what I had done, he agreed the change was good. Still after 13 years and gaining 100 pounds, still ising the same pressure, AHI under 2.0 usually 1.2 avg. Jim