How Often Are You "Re-Tritrated"?

kidknits · Post by **kidknits** » Thu Oct 12, 2006 10:34 am

For the veterans out there....

There's been a lot of "talk" on the board about adjusting pressure, apap machines, etc.... which made me wonder- how often do you have sleep studies after you have been diagnosed and are on cpap? It seems like the pressure should be reevaluated every so often, once the patient has consistently used the same mask/machine....

Snoredog · Post by **Snoredog** » Thu Oct 12, 2006 10:40 am

I haven't had the need for one since getting an autopap. But they say about every 2 years is the norm.

rested gal · Post by **rested gal** » Thu Oct 12, 2006 10:53 am

Using autopap with software, I haven't seen the need for it either.

If a person had been diagnosed with other sleep disorders though, like PLMD (periodic limb movements) and a person was still feeling tired or beginning to feel tired again despite good AHI's on the software data, another PSG study (perhaps while using one's own autopap) wouldn't be a bad idea.

arthuranxious · Post by **arthuranxious** » Thu Oct 12, 2006 11:12 am

they say that losing 10 lbs or gaining 10 lbs is a reason to be retitrated, as are symptoms of inadeqaute CPAP. I think auto-PAP makes it less frequent, however supposing my auto_pap was showing that it pushed to the top end of the range of pressures set every single night (lets say previous titration study suggested 11, AutoPAP set for 9- 14, and hits 14 every single night much of the night) and not feeling well rested.... would be reason to retitrate.

Wulfman · Post by **Wulfman** » Thu Oct 12, 2006 1:02 pm

My opinion:
Purchasing a machine that has the sleep detail recording capabilities and the software to monitor and tweak your therapy would be far less expensive than having to go through additional doctor's visits and sleep studies.

I wouldn't even consider going through that "experience" again. Once was plenty.

It's YOUR therapy.

Den

Guest · Post by **Guest** » Thu Oct 12, 2006 1:21 pm

My doc told me basically whenever I feel it's needed.

Otherwise, she feels it's needed only if there is significant change in my lifestyle or health or if I feel like I'm not responding to treatment.

Right now I plan to do it about every 18 months or so.

snoregirl · Post by **snoregirl** » Thu Oct 12, 2006 1:33 pm

I agree with Wulfman.

On the "whenever I feel it is needed"/18 months Gee I wonder what is driving our health insurance costs. Autopap is so much cheaper.

rested gal · Post by **rested gal** » Thu Oct 12, 2006 2:43 pm

arthuranxious wrote:supposing my auto_pap was showing that it pushed to the top end of the range of pressures set every single night (lets say previous titration study suggested 11, AutoPAP set for 9- 14, and hits 14 every single night much of the night) and not feeling well rested.... would be reason to retitrate.

I think in that scenario, I'd first try make sure mouth air leaks were not the culprit. Only after I was sure those were no problem or had taken care of the problem, then I'd try just raising the upper pressure to 16 for a few nights and see how that made me feel.

If not better, I'd try some single straight pressures.

But, back to the autopap again, if I kept hitting the raised pressure in a range of pressures, I'd dig farther into the message board to see if other factors could be involved.

Things like:

If using a 420E autopap, I'd try IFL1 off for a few nights.

If I kept hitting top pressure with other machines, or if IFL 1 turned off on a 420E didn't make a difference, I'd be thinking seriously about the possibility of acid reflux swelling the throat tissues so that continuous positive air pressure in general was not able to to push rigid tissue aside very well. VCD (vocal cord dysfunction) would be a possibility too.

If sinus problems were a known factor, I'd suspect that might be interfering with cpap treatment. Allergies, also.

We think of pressure (right pressure, titrated pressure, more pressure, less, different range, etc.) as always being the answer, but sometimes other physical conditions or factors can interfere with getting good "cpap" treatment. Another sleep study titration isn't necessarily going to provide the answer. Not that it's a bad idea at all.

dsm · Post by **dsm** » Thu Oct 12, 2006 3:59 pm

My own experience re this is that my sleep doc this week requested another sleep study for me in Feb 2007 - that will be 20 months approx from the previous one (done 2nd qtr 2005).

Based on how comfortable I am at the moment with my own monitoring & adjusting, I don't really believe this 2nd study is needed but it won't cost me anything so I have agreed to do it.

He specifically wantes to do a split study with me using first a UMFF mask then with me using an Adams Circuit (I may substitute a CL2).

I also agree with the others who have said that using their own Autos and monitoring the data, they are comfortable with their own diagnosis. I am not sure this would work for everyone but if someone is that interested & does lots of homework, it seems probable they can self titrate.

DSM

Offerocker · Post by **Offerocker** » Thu Oct 12, 2006 4:42 pm

dsm wrote:He specifically wantes to do a split study with me using first a UMFF mask then with me using an Adams Circuit (I may substitute a CL2).

DSM

DSM,
Did your doctor tell you WHY he wanted to use those two masks? I'm asking especially since you have been compliant.
Thank you

Guest · Post by **Guest** » Thu Oct 12, 2006 4:43 pm

snoregirl wrote:I agree with Wulfman.

On the "whenever I feel it is needed"/18 months Gee I wonder what is driving our health insurance costs. Autopap is so much cheaper.

Ditto.
An apap and the software can do the same job. There was a study done--maybe someone here can find it and supply the link-- where it was shown successful self-titration with an auto required only 30 minutes of education to learn how to read the software and adjust the machine. The APAP is an infinitely simpler, infinitely cheaper, equally accurate method of titration.

dsm · Post by **dsm** » Thu Oct 12, 2006 5:24 pm

Offerocker wrote:
dsm wrote:He specifically wantes to do a split study with me using first a UMFF mask then with me using an Adams Circuit (I may substitute a CL2).

DSM
DSM,
Did your doctor tell you WHY he wanted to use those two masks? I'm asking especially since you have been compliant.
Thank you

My sleep physician only suggested the split study when I told him I used both a UMFF mask and an Adams Circuit Mask. I like both these masks for different reasons (but I am never able to stay long on the Adams Circuit or any other nasal pillows mask, sooner or later mouth leaks will occur).

He agreed with me when I said that I ran the masks at different cms settings (I always drop the CMS by 1-2 cms when using the nasal pillows).

He said that there was an accepted study that showed that due to the varying deadspace in the many types of masks, that each mask required evaluation and its own titration setting. I know there was a lot of discussion here on this issue so it has been a hot topic in the past.

For those of us who are true lab rats, being able to monitor what happens and having access to a lot of practical and useful data such as can be got here (most of the time), is essential to anyone who wants to 'cut their own path' in their therapy.

I recommend Autos to anyone willing to experiment as long as they keep getting feedback on any deviations or challenges they experience but mostly if they monitor their own data.

My biggest concern with Autos is when DME / RTs send people out the door with them set to min 4 max 20. That to me, shows an appalling lack of understanding of the use of the machine.

DSM

tooly125 · Post by **tooly125** » Thu Oct 12, 2006 6:13 pm

I have an auto and see no need to have another study done.
I'm sure my Dr will want to get a newer car soon so when she tells me it's time for another study I might just bring laptop down there and teach her about my sleep!

rested gal · Post by **rested gal** » Thu Oct 12, 2006 8:53 pm

Guest wrote:There was a study done--maybe someone here can find it and supply the link-- where it was shown successful self-titration with an auto required only 30 minutes of education to learn how to read the software and adjust the machine.

Actually the people in the study were using just plain cpap machines with no software to do their own titration at home.

You're right, Guest, the study found that a short amount of instruction on what to do demonstrated that many people could titrate themselves quite successfully with cpap. Much the same way many diabetics can manage monitoring their blood sugar levels and handling their own insulin injections at home.

Can Patients with Obstructive Sleep Apnea Titrate Their Own Continuous Positive Airway Pressure?

Excerpt from the study:
In summary, this study demonstrates that self-titration of CPAP in patients with OSA is as efficacious as manual titration in a sleep laboratory, with similar subjective and objective outcomes. Clearly, for this strategy to be successful, the patient must understand when and how to change the CPAP. Although the patient population studied did include a wide age range, this strategy would not be feasible for intellectually disadvantaged patients and those with physical handicaps that would severely limit vision and/or manual dexterity. Nonetheless, the findings from this study imply that routine overnight polysomnography is unnecessary for the purpose of CPAP titration in many patients with OSA, provided that the patient is given some basic education and support.

kidknits · Post by **kidknits** » Thu Oct 12, 2006 9:10 pm

Wow- you are all so amazingly helpful! Thanks for your answers. My f/u appt is in December- depending on how everything is going, perhaps I'll ask for an apap. Sleep studies are NO fun!