Home Titration

[milkman55]

i had a in lab baseline study done in July that was diagnosed as moderate sleep apnea. My Dr had request a split study, but the tech for some reason did not do the titration. Blue Cross pre-approved the in Kabul study, but now says the titration must be done in home? I called all the local providers including who did the baseline and none offer in home titration?

Anybody had in home titration? BTW my baseline was an average of 10 events per hour.

[Krelvin]

Call your insurance to find out where it can be done.

[milkman55]

Talked to Blue Cross and they gave me three name, all of whom offer in lab and not in home. Will call them again.

Has anyone had an in home titration? The labs I called acted like it was just not done. Baseline was offered by all three in home, but no titration.

[LSAT]

Talked to Blue Cross and they gave me three name, all of whom offer in lab and not in home. Will call them again.

Has anyone had an in home titration? The labs I called acted like it was just not done. Baseline was offered by all three in home, but no titration.

Call Blue Cross and tell them that all 3 names do not offer home titration....they should approve in lab titration in that situation.

[Wulfman...]

i had a in lab baseline study done in July that was diagnosed as moderate sleep apnea. My Dr had request a split study, but the tech for some reason did not do the titration. Blue Cross pre-approved the in Kabul study, but now says the titration must be done in home? I called all the local providers including who did the baseline and none offer in home titration?

Anybody had in home titration? BTW my baseline was an average of 10 events per hour.

Did they charge your insurance for a split-night study? It seems to me that they OWE you the other half of that study.

But, "at-home" titrations have been done for decades. That's actually how the APAPs came to be in the first place. They were called "Auto-titrating" CPAPs to begin with for people who, for whatever reasons, couldn't make it through an in-lab sleep study. But over time they began to be used by normal nightly use and became known as "Auto-adjusting" CPAPs.


Den

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[palerider]

Talked to Blue Cross and they gave me three name, all of whom offer in lab and not in home. Will call them again.

Has anyone had an in home titration? The labs I called acted like it was just not done. Baseline was offered by all three in home, but no titration.

generally, "in home titration" as Den says, involves sending you home with an auto adjusting machine, either to keep, or temporarily, and letting you get some real world numbers on what you need, instead of artificial ones in a strange environment for a very few hours.

though it's possible, I have never heard of ANY place that wags their equipment out and sets up a temp sleep lab in your home....

[Janknitz]

Kaiser requires in home titration. They set you up with a loaner auto machine set wide open 4-20 with no humidifier. After a week they read your card and decide on tge settings and whether you are getting an auto or CPAP. It works because instead of a snapshot of one night in an unfamiliar setting, you get 7 nights of data in your own bed. Not fun, but it works.

Any DME can set you up with a rented auto but you need a doctor to read the data and determine your prescription.

[Guest]

Thanks for the feedback. At this point I just would like to get the S9 and A10 nasal pillow and just let the auto settings give me the feedback. I don't think I will ever get what I want through insurance, so easier to just buy out of pocket.

Just need to figure out how to get a script with only my baseline report and no titration results.

Going to call some area DME suppliers tomorrow and see what they know.

[palerider]

S9 and A10 nasal pillow

when calling around, it might save you problems if you get the terminology right.

there are 14 different s9 machines... avoid any that say 'escape' in the name.

there is no 'a10 nasal pillow' there are the
f10 full face mask.
n10 nasal mask.
p10 pillows mask.

the f and n come in various sizes, the p comes in pink and blue, with the pink being a bit smaller.

[MarylandCPAPer]

When calling around about machines, you may also want to ask about the Airsense 10 (A10), which is an update from the s9, and also comes in numerous models (including A10 Autoset, Autoset For Her, Elite, and CPAP.). You will have the most flexibility in your therapy with an Autoset model. The "For Her" version has an additional auto-titration mode and measures RERAs.

The Airfit P10 nasal pillows mask comes in a standard and "For Her" model. The differences between the two are the sizes of nasal pillows included when you get the full Airfit P10 mask kit. It is possible, based on recent discussions here, that the "For Her" model headgear may be 5/8" to 1" smaller than the standard P10 headgear, or they may be exactly the same size. These discussions are based on forum members' comparisons of the headgear they received. I just ordered a replacement set of P10 mask equipment in the "For Her" version and was told by the DME that the headgear sizes are exactly the same.

In any case, it is best to meet in person with a DME if possible and try on masks. Finding the right mask FOR YOU is often the hardest part of starting treatment, but there are many different masks out there, so don't give up if the first one you try doesn't seem to be right for you. Ask about the return/exchange policy. Some DMEs will exchange a mask within 30 days if you find that it doesn't work out for you.

Also, you will need a dr.'s prescription for the machine, mask (preferably "of patient's choice") and pressure settings.

I would ask the sleep lab why they did not do a titration when your dr. ordered a split night study. It would seem to me that they owe you the titration, especially if they billed your insurance for a split-night study.

Without a knowledgeable doctor reviewing your sleep study results, you will not be able to get a machine unless you buy used. If you do, you may end up with the wrong type of machine (I.e. Autoset or CPAP) when your sleep study results (with a titration) may indicate you need a Bi-Level or ASV machine. You need to know the type of machine that will treat the particular sleep apnea problems that you have. I would follow up with the sleep lab and your dr. to get a titration done before buying equipment, and I would not give up on getting part of the equipment paid for by insurance.

[Janknitz]

If you are planning to sidestep insurance and buy your own desired machine there are ways, but don't expect much help from the dme's

First, they cannot by law sell you a machine without a prescription and you can't get a prescription without a titration. Catch 22. Btw, there are some online companies who can set you up for home titration if the insurance will approve.

Secondly, if you get a prescription and choose to pay out of pocket, anyway, a DME is your worst bet. They may charge you 2 or 3 times the retail price without an insurer negotiating the price for you ($2500 is not uncommon for what you can buy from our hosts for $600 to $900!). Or they may be legally barred from selling directly to you at all if your insurance is a Medicare supplement policy or if they have some contractual agreement with your insurer.

Repeat after me: "The DME is not my friend." They are not there to help you, they are there to take as much of your money as they can. If you walk into a DME and ask them to make you a deal they are going to make them a deal. The odds of beating the house are far worse than any table in a Vegas casino.

You can obtain a machine and titrate yourself--there are ways that do not involve DMEs. At an ahi of 10 your apnea should not be complicated to deal with. But your worst nightmare is going to be to try to get assistance from a DME without insurance at least holding them to some financial responsibility. Fair warning!

[rachelp]

I have severe sleep apnea and didn't even do a titration. They gave me an apap prescription and sent me on my way. I guess it's working because my AHI are typically below 1 now. Are titrations even necessary if it's not a complicated case?

[Wulfman...]

I have severe sleep apnea and didn't even do a titration. They gave me an apap prescription and sent me on my way. I guess it's working because my AHI are typically below 1 now. Are titrations even necessary if it's not a complicated case?

Yes, no, maybe......
Typically and historically, a "titration" is performed to find an ideal therapeutic (single) pressure.

Some doctors believe that a wide-open range on an APAP is supposed to work and write prescriptions accordingly. Reality and the experiences of many on this forum does not necessarily bear that out. A pressure too low is not going to be optimal if the machine doesn't have enough events to trigger pressure increases.......and, it can take too long for the pressure to get to where it needs to be. Or, pressures too high or the pressure changes can be disruptive to some users' sleep.

So, it works for some and not for others. We're all different. And, an algorithm on one brand of machine may not work as well as an algorithm of another brand.


Den

.

[rachelp]

I have severe sleep apnea and didn't even do a titration. They gave me an apap prescription and sent me on my way. I guess it's working because my AHI are typically below 1 now. Are titrations even necessary if it's not a complicated case?

Yes, no, maybe......
Typically and historically, a "titration" is performed to find an ideal therapeutic (single) pressure.

Some doctors believe that a wide-open range on an APAP is supposed to work and write prescriptions accordingly. Reality and the experiences of many on this forum does not necessarily bear that out. A pressure too low is not going to be optimal if the machine doesn't have enough events to trigger pressure increases.......and, it can take too long for the pressure to get to where it needs to be. Or, pressures too high or the pressure changes can be disruptive to some users' sleep.

So, it works for some and not for others. We're all different. And, an algorithm on one brand of machine may not work as well as an algorithm of another brand.


Den

.

Thanks for your insight!