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AASM Guidelines for Titration
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me50 Offline

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Post: #1
AASM Guidelines for Titration
Recommendation 4.3.1.1 in the AASM Manual Titration guidelines states:

4.3.1.1 If the patient is uncomfortable or intolerant of high pressures on CPAP, the patient may be tried on BPAP. If there are continued obstructive respiratory events at 15 cm H2O of CPAP during the titration study, the patient may be switched to BPAP (Consensus).

Therefore, it is up to the clinician’s judgment whether the patient is switched to BPAP when:

a) The patient is uncomfortable or intolerant of high pressures on CPAP or

b) The patient has continued obstructive respiratory events at 15 cm H2O of CPAP during the titration study

I have included my latest titration study. One would think that I would have been tried on BIPAP. Any thoughts? Thanks.
11-11-2013 03:01 PM
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robysue Online
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Post: #2
RE: AASM Guidelines for Titration
I think it is worth bringing up the question of why BiPAP wasn't tried during the titration with your sleep doctor.
11-11-2013 03:11 PM
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me50 Offline

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Post: #3
RE: AASM Guidelines for Titration
(11-11-2013 03:11 PM)robysue Wrote:  I think it is worth bringing up the question of why BiPAP wasn't tried during the titration with your sleep doctor.

I did that with no concrete answer. This is why I am now looking for another doctor. Just not sure whether to go with a pulmonologist or what.

If I understand the titration info I was given, 15 was definitely not a good number and 16 was only used for approx. 30 minutes so who knows if that was good or not.

Thanks.
11-11-2013 03:31 PM
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justMongo Offline

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Post: #4
RE: AASM Guidelines for Titration
If I am reading your titration correctly, it looked acceptable at 13 cm-H2O CPAP.
What pressure did they settle on?

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
11-11-2013 03:42 PM
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me50 Offline

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Post: #5
RE: AASM Guidelines for Titration
(11-11-2013 03:42 PM)justMongo Wrote:  If I am reading your titration correctly, it looked acceptable at 13 cm-H2O CPAP.
What pressure did they settle on?

16
(This post was last modified: 11-11-2013 04:01 PM by me50.)
11-11-2013 03:46 PM
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zonk Offline

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Post: #6
RE: AASM Guidelines for Titration
I assume its not specified by the doctor or/and insurance requirement, CPAP have to be tried/failed before bi-level machine prescribed

Bi-level machine might be more comfortable as pressure support can set higher than 3 cmH2O but if not mistaken, EPAP has to be the same as your prescribed CPAP pressure ... not lower
11-11-2013 04:10 PM
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me50 Offline

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Post: #7
RE: AASM Guidelines for Titration
(11-11-2013 04:10 PM)zonk Wrote:  I assume its not specified by the doctor or/and insurance requirement, CPAP have to be tried/failed before bi-level machine prescribed

Bi-level machine might be more comfortable as pressure support can set higher than 3 cmH2O but if not mistaken, EPAP has to be the same as your prescribed CPAP pressure ... not lower

yea, this is why I had the 2nd sleep study because I was waking up throughout the night; was still sleepy/tired and most often take a nap and the pressure was butted up against the max capability of my machine (and nightmares too). Since I was having issues the doc said he would have them test me on BIPAP if my pressure was at 15 but when he wrote the order he said if pressure is 16 according to the sleep center. Well, AASM guidelines state that it is beneficial to try BIPAP at 15. I dunno. :-(
11-11-2013 04:19 PM
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justMongo Offline

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Post: #8
RE: AASM Guidelines for Titration
(11-11-2013 03:46 PM)me50 Wrote:  
(11-11-2013 03:42 PM)justMongo Wrote:  If I am reading your titration correctly, it looked acceptable at 13 cm-H2O CPAP.
What pressure did they settle on?

16

But your SPO2 desaturated more at the higher pressure.
I see your machine is an Auto.

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
11-11-2013 06:39 PM
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me50 Offline

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Post: #9
RE: AASM Guidelines for Titration
(11-11-2013 06:39 PM)justMongo Wrote:  
(11-11-2013 03:46 PM)me50 Wrote:  
(11-11-2013 03:42 PM)justMongo Wrote:  If I am reading your titration correctly, it looked acceptable at 13 cm-H2O CPAP.
What pressure did they settle on?

16

But your SPO2 desaturated more at the higher pressure.
I see your machine is an Auto.

Exactly my point!! Not only that, the tech did not put the belts on me so I just wonder how much she did not get due to leaving the belts off of me.

This is why I have more faith in this forum and the members here than I do with my doctor(s)
(This post was last modified: 11-11-2013 08:31 PM by me50.)
11-11-2013 08:30 PM
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me50 Offline

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Post: #10
RE: AASM Guidelines for Titration
November 10 data shows mostly Centrals. During my last titration study, at pressure 15, I had a lot of centrals if I am reading the study correctly along with O2 desat (see above attachments in intitial post) I also noticed on some of the centrals that my pressure did not go up so that bothers me. Any thoughts or suggestions that I can tell the new doctor?

[attachment=547]

November 11 data shows when I used my new Amara Gel mask. The first part is using a medium cushion and the 2nd part is using a small cushion.

[attachment=548]

Both times I kept waking up because of the leaks and I have tightened the head gear as much as I can without it hurting. I heard that Amara Gel isn't good for higher pressures (after the fact of ordering the mask...Respironics said it should be able to handle higher pressures without causing leaks).

I just changed my EPR to 2 but not sure that will help at all.

Not sure a pulmonologist will be able to help with that but guess I should try it and see.
(This post was last modified: 11-12-2013 02:24 AM by me50.)
11-12-2013 02:22 AM
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