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Autoset 90 percentile pressure vs. Titration study pressure
#1
Hello fellow hosers,

Firstly, my thanks goes out to everyone on this board. I’ve been lurking around for the past 8 months trying to absorb all of the great information and advice available here. I’m sure I would not be doing nearly as well without this wonderful resource.

I was diagnosed with severe OSA back in February and started a two week trial with and autoset to determine my optimal pressure setting. After the trial it worked out to a cpap pressure of 13. I tried to maintain this pressure in cpap mode but quickly reverted back to a pressure range (7 to 15) that I found more comfortable. I continued to adjust settings as I got more accustomed to the machine and eventually landed on a range of 10 to 15 that seemed to work well for me. 

Today I finally met with the sleep doc again to review the results of my in lab titration study (8 months later!?!... but I digress). The in lab titration came back with an optimal pressure setting of 10 and the doc questioned why I was using a range of 10 to 15. I explained but was not very impressed with his level of understanding.

Is there a reason that I would see such a difference between my titration study pressure and my autoset results?. When I review my data in sleepyhead I see that I often bump up against the 15 limit, and my average pressures range between 11 and 14.
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#2
Titration studies are a waste of time and money. They only have one night to try and guess at the pressure your going to need. It really takes a week or two to get it right.
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#3
Welcome
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#4
Hi CDNHoser,
WELCOME! to the forum.!
Hang in there for more answers to your question, good luck with CPAP therapy.
trish6hundred
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#5
(10-18-2017, 07:54 PM)CDNHoser Wrote: Hello fellow hosers,

Firstly, my thanks goes out to everyone on this board. I’ve been lurking around for the past 8 months trying to absorb all of the great information and advice available here. I’m sure I would not be doing nearly as well without this wonderful resource.

I was diagnosed with severe OSA back in February and started a two week trial with and autoset to determine my optimal pressure setting. After the trial it worked out to a cpap pressure of 13. I tried to maintain this pressure in cpap mode but quickly reverted back to a pressure range (7 to 15) that I found more comfortable. I continued to adjust settings as I got more accustomed to the machine and eventually landed on a range of 10 to 15 that seemed to work well for me. 

Today I finally met with the sleep doc again to review the results of my in lab titration study (8 months later!?!... but I digress). The in lab titration came back with an optimal pressure setting of 10 and the doc questioned why I was using a range of 10 to 15. I explained but was not very impressed with his level of understanding.

Is there a reason that I would see such a difference between my titration study pressure and my autoset results?. When I review my data in sleepyhead I see that I often bump up against the 15 limit, and my average pressures range between 11 and 14.
Yes.  

Not always but frequently there is a difference between home and clinic.
Additionally your study was 8 months ago.

There are two parts of Optimization, The first is the numbers which we discuss below. Also of great importance is how you feel. This is very subjective. Please do not ignore this aspect of your optimization and ask for help on our forums.
Step 1: Review your sleep Studies Review your initial (or recent) Sleep Study, this is the one done without a xPAP machine. In this study you are wired to measure your sleep stage (EEG) and cardiac function EKG, Are you mouth or nose breathing, and your O2 Saturation levels thru the night. This study determines the proportions and types of Apnea that you experience including the non-obstructive apneas which are more complex to treat. For us here it determines the presence or absence of Central and / or Complex Apneas.
Review your (typically) second study, your titration study. This is where a pressure recommendation is made. This recommendation is a good starting point but it is a single point in time where you are sleeping in an unfamiliar bed in an unfamiliar location with a bunch of wires stuck to your head and various other straps and monitors.
A Caution flag. If you have Complex or Central Apnea (CA) make only small changes and see how they impact your data. Obstructive Apnea is generally treated by increasing pressure. Central Apnea often increases with an increase of pressure. These two treatments (decreasing pressure for Central Apnea and increasing pressure for Obstructive Apnea) often contradict each other. It’s possible one or other of the sleep studies (ie diagnostic and titration) may be skipped. In this case carefully monitor your results to see if you have central apneas. Some machines and software refer to these as clear airway events – a subtle but important distinction.

Download Sleepyhead and post your Sleep Study and your daily charts and we can help you dial it in, or help with talking points for your doctor.

Fred
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#6
CDN, you are about to get outfitted with a "one-size fits all" solution. Many of our Canadian members choose to simply forego the provincial subsidy and buy their own auto machine. A number of good solutions have been discussed including Supplier #2 in the U.S. who sells new, open-box and gently used units, and Supplier #10 who ships internationally. You may pay a bit more than your share under the health plan, but you will be free of the crap they will put you through.
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#7
G'day CDNHoser. Welcome to Apnea Board.

Just to clarify - you already have the autoset machine, and your query is just about pressures and titration?

It seems a lot of sleep doctors and labs still prefer a single set pressure. While some people do indeed find this satisfactory, it doesn't make a lot of sense in the overall scheme of things. As mentioned above the titration study is just a single night in unfamiliar surroundings with probes and wires all over your body - and from that they try to determine a single pressure which will suit you forever? It can't be done - for ordinary obstructive sleep apnea titration studies are just a waste of time and money in my view.

Your auto machine will adjust pressures as required all through the night and over time as your needs change. Some patients are disturbed by the pressure changes and prefer the constant pressure, but for the great majority the autoset allows you to sleep with a lower average pressure, bumping it up as necessary to head off apneas and hypopneas.

From what you've written above I think you're doing everything right. If your pressure frequently bumps up against the maximum, you might want to set the max a bit higher to give it some headroom. At this stage, your main considerations are:

1) Is the AHI consistently low (definitely under five, but preferably as low as possible) and
2) Are you feeling rested and refreshed?
DeepBreathing
Apnea Board Moderator
www.ApneaBoard.com


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#8
In addition to what has been said, it's a gold standard thing based on OLD technology. The same thing happens with care for diabetes. They only tested morning blood glucose so people like my uncle, who had normal blood glucose in the morning, don't discover they have diabetes until 10 years of damage has already occurred. This, despite the fact that A1C test (or even just testing 2 hours after a carb meal) was proved to be far more effective and was in general usage for 6 or 7 years.

A lab test is not useless, but it is not the be all and end all. It does help to rule out some people who have problems that are not caused by sleep apnea. Looking at your raw data will also help you with tweaking because you have a good idea of what actually goes on when you sleep, even though it will change over time. BUT, given what we've seen on here, I think most people could start out with an apap machine and self titrate for a couple of weeks and then use THAT data to figure out best settings. Now, having someone who can read those charts is what you need (thankfully, mine are pretty clear - but I can't figure out most people's charts) and where a doc would also be handy, but most of them won't even look at data brought by a patient. Gotta wonder about that sometimes. Docs make a lot of decisions for diabetics based on their portable blood glucose readers.
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#9
(10-19-2017, 09:34 AM)DeepBreathing Wrote: G'day CDNHoser. Welcome to Apnea Board.

Just to clarify - you already have the autoset machine, and your query is just about pressures and titration?
 
Yes, maybe I should have explained better. There was an eight month span between when I received my diagnosis and initial prescription to when I was able to get the titration study completed and meet with the doc to review results. The whole process has actually been going on for 15 months from the time I requested a referral from my primary HCP to yesterday when I got the titration study results.

Fortunately I ended up with a good DME who actually offered the autoset as a better product and billed it through as a regular CPAP. I received my machine shortly after diagnosis and used it 8 months while waiting for the titration

Was really just wondering which results to put more faith in - I'm leaning towards the results from the APAP and taking the titration study results with a grain of salt.
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#10
(10-19-2017, 07:18 PM)Mosquitobait Wrote: In addition to what has been said, it's a gold standard thing based on OLD technology.  The same thing happens with care for diabetes.  They only tested morning blood glucose so people like my uncle, who had normal blood glucose in the morning, don't discover they have diabetes until 10 years of damage has already occurred.  This, despite the fact that A1C test (or even just testing 2 hours after a carb meal) was proved to be far more effective and was in general usage for 6 or 7 years.

A lab test is not useless, but it is not the be all and end all. It does help to rule out some people who have problems that are not caused by sleep apnea.  Looking at your raw data will also help you with tweaking because you have a good idea of what actually goes on when you sleep, even though it will change over time.  BUT, given what we've seen on here, I think most people could start out with an apap machine and self titrate for a couple of weeks and then use THAT data to figure out best settings.  Now, having someone who can read those charts is what you need (thankfully, mine are pretty clear - but I can't figure out most people's charts) and where a doc would also be handy, but most of them won't even look at data brought by a patient.  Gotta wonder about that sometimes.  Docs make a lot of decisions for diabetics based on their portable blood glucose readers.

Exactly my thoughts. The current technology seems to have gotten way ahead of the established practices, and there's no incentive for them to change
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