The question is not whether or not your bypassing the diagnistic process. The question is whether or not for the majority of OSA patients the diagnostic process needs to include a lab sleep study or not. I think not!
Liam, call it what you like, killing you or shortening your life, it's still the same thing.
Can Patients with OSA Titrate their own Pressure
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wading thru the muck!
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Janelle
The issue of how a homestudy with APAP could detect things like Periodic Limb Movements, is very simple. Videotape your sleep night. Or just take a photo of how your bed looks when you wake up in the morning! Have a bed partner testify to your thrashing about during the night, kicking or similar problems.
I never knew how badly I snored until my husband recorded me one night. Everyone I had shared a room with away from home told me I snored very softly. The tape proved different.
Interestingly, I USED to be a mouth breather and had to wear a chin strap for about the first month of APAP treatment. I taped my mouth for two nights because I found the strap very uncomfortable and distracting. When I go to bed now, I automatically position my tongue tip against the backof my lower incisors. This seems to form a block to my throat and even if my mouth does fall open, no air come out from the APAP. I can still cough, talk or whatever without losing pressure. Been sleeping strapless (down boys) for two months now with no problems.
I never knew how badly I snored until my husband recorded me one night. Everyone I had shared a room with away from home told me I snored very softly. The tape proved different.
Interestingly, I USED to be a mouth breather and had to wear a chin strap for about the first month of APAP treatment. I taped my mouth for two nights because I found the strap very uncomfortable and distracting. When I go to bed now, I automatically position my tongue tip against the backof my lower incisors. This seems to form a block to my throat and even if my mouth does fall open, no air come out from the APAP. I can still cough, talk or whatever without losing pressure. Been sleeping strapless (down boys) for two months now with no problems.
I think you might be wrong there.Anonymous wrote:Definitely, straight CPAP wouldn't be a safe means to titrate ones self without extensive involvement of the DME and supporting medical people.
Here is a study that backs up that statement.
Alternative Methods of Titrating Continuous Positive Airway Pressure
A Large Multicenter Study
Juan F. Masa, Antonio Jiménez, Joaquín Durán, Francisco Capote, Carmen Monasterio, Mercedes Mayos, Joaquín Terán, Lourdes Hernández, Ferrán Barbé, Andrés Maimó, Manuela Rubio and José M. Montserrat
San Pedro de Alcántara Hospital, Cáceres; Hospital de Valdecilla, Santander; Txagorritxu Hospital, Vitoria; Virgen del Rocío Hospital, Sevilla; Hospital de Bellvitge, Sant Pau Hospital, and Clinic Hospital, Barcelona; General Yagüe Hospital, Burgos; Son Dureta Hospital, and Joan March Hospital, Palma de Mallorca, Spain
Correspondence and requests for reprints should be addressed to Juan F. Masa, M.D., C/ Rafael Alberti 12, 10005 Caceres, Spain. E-mail: fmasa@separ.es
Standard practice for continuous positive airway pressure (CPAP) treatment in sleep apnea and hypopnea syndrome (SAHS) requires pressure titration during attended laboratory polysomnography. However, polysomnographic titration is expensive and time-consuming. The aim of this study was to ascertain, in a large sample of CPAP-naive patients, whether CPAP titration performed by an unattended domiciliary autoadjusted CPAP device or with a predicted formula was as effective as CPAP titration performed by full polysomnography. The main outcomes were the apnea–hypopnea index and the subjective daytime sleepiness. We included 360 patients with SAHS requiring CPAP treatment. Patients were randomly allocated into three groups: standard, autoadjusted, and predicted formula titration with domiciliary adjustment. The follow-up period was 12 weeks. With CPAP treatment, the improvement in subjective sleepiness and apnea–hypopnea index was very similar in the three groups. There were no differences in the objective compliance of CPAP treatment and in the dropout rate of the three groups at the end of the follow-up. Autoadjusted titration at home and predicted formula titration with domiciliary adjustment can replace standard titration. These procedures could lead to considerable savings in cost and to significant reductions in the waiting list.
Note the second to the last sentence:
Autoadjusted titration at home and predicted formula titration with domiciliary adjustment can replace standard titration.
"predicted formula titration with domiciliary adjustment" = Fancy way to say guess at a pressure and adjust as necessary.
However, I would much rather see APAP than CPAP used this way.