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How can I perform a sleep titration study, on myself?
#1
How can I perform a sleep titration study, on myself?
Due to covid19, sleep clinics in Israel have either shut down, or offer only HSATs. I was recommended a titration study since my stupid hands keep taking off the mask during nighttime.

I can't keep being this sleepy until covid19 passes, if it ever does in any reasonable time. Sounds crazy, but, how much of a titration study could be performed at home? Cause if its just changing pressure settings while I am asleep, I am sure I could write a script that does it.
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#2
RE: How can I perform a sleep titration study, on myself?
If you can borrow, safely, an Autoset, and try it on perhaps four successive nights, but with two different modes, you can come away with an approximation of what your real AHI is.  You'll need a mask that fits reasonably well and that you can tolerate well.  Could be a challenge finding out which it will be.

First two nights, set it for a low of 4 cmH2O and a high of about 6.  Third and fourth nights, set it to 5 and fully open (20 cm).  Count the events, and note the types in each case.  Also note where the machine feels it can level off on a working top pressure that keeps your airway inflated.  It could be anywhere.

IF....IF...you have treatable apnea and/or detectable flow limitations, they will be noted heavily in the first instances, and they should be treated in the second instance.  

Mask fit might be the thorn here.  If you get a good fit for the first two nights, anything over 12 cm might want to push the mask away from contact sufficiently that you get a lot of leakage, and that might disrupt your sleep sufficiently that you don't get a good indication of what the machine found and what it 'cleaned up'. 

You are likely to get another couple of opinions/suggestions if you can wait a bit.   Please do.
Serial Tapist
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#3
RE: How can I perform a sleep titration study, on myself?
A titration involves a process of changing machines pressures, and comparing against data of the impact on your breathing.

Normally for people on this forum, a Resmed CPAP machine + OSCAR is sufficient to do that, but I have no idea how one would do that with your machine.

What kind of data can you get off it?

Per mesenteria, any chance you could get a ahold of a Resmed Autoset, even just temporarily?
Caveats: I'm just a patient, with no medical training. And my first experience with xPAP was fairly recent. So I'm somewhere along the path of a steep learning curve.
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#4
RE: How can I perform a sleep titration study, on myself?
(08-24-2020, 03:41 AM)mesenteria Wrote: If you can borrow, safely, an Autoset, and try it on perhaps four successive nights, but with two different modes, you can come away with an approximation of what your real AHI is.  You'll need a mask that fits reasonably well and that you can tolerate well.  Could be a challenge finding out which it will be.

First two nights, set it for a low of 4 cmH2O and a high of about 6.  Third and fourth nights, set it to 5 and fully open (20 cm).  Count the events, and note the types in each case.  Also note where the machine feels it can level off on a working top pressure that keeps your airway inflated.  It could be anywhere.

IF....IF...you have treatable apnea and/or detectable flow limitations, they will be noted heavily in the first instances, and they should be treated in the second instance.  

Mask fit might be the thorn here.  If you get a good fit for the first two nights, anything over 12 cm might want to push the mask away from contact sufficiently that you get a lot of leakage, and that might disrupt your sleep sufficiently that you don't get a good indication of what the machine found and what it 'cleaned up'. 

You are likely to get another couple of opinions/suggestions if you can wait a bit.   Please do.

My reason for being referred to a titration study is my inability to stay with the mask on. When I go to sleep, I take it off (unconsicously). So I don't think I will be able to get the data needed since my bottleneck is not AHI but compliance. 

Like, how could I "Debug" this compliance issue? I am thinking of trying different pressure each night, but besides that have no clue.

(08-24-2020, 06:07 AM)slowriter Wrote: A titration involves a process of changing machines pressures, and comparing against data of the impact on your breathing.

Normally for people on this forum, a Resmed CPAP machine + OSCAR is sufficient to do that, but I have no idea how one would do that with your machine.

What kind of data can you get off it?

Per mesenteria, any chance you could get a ahold of a Resmed Autoset, even just temporarily?

Would a dreamstation be sufficient? What it is about the Autoset that makes it apropriate to study ones own sleep?
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#5
RE: How can I perform a sleep titration study, on myself?
(08-24-2020, 06:51 AM)NoddingHacker Wrote: Would a dreamstation be sufficient? What it is about the Autoset that makes it apropriate to study ones own sleep?

Yes. I was just going on your profile.

Both are supported in OSCAR, and so you get access to a full range of data off the machine, which has flow rate sensors and such.
Caveats: I'm just a patient, with no medical training. And my first experience with xPAP was fairly recent. So I'm somewhere along the path of a steep learning curve.
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#6
RE: How can I perform a sleep titration study, on myself?
(08-24-2020, 06:51 AM)NoddingHacker Wrote:
(08-24-2020, 03:41 AM)mesenteria Wrote: If you can borrow, safely, an Autoset, and try it on perhaps four successive nights, but with two different modes, you can come away with an approximation of what your real AHI is.  You'll need a mask that fits reasonably well and that you can tolerate well.  Could be a challenge finding out which it will be.

First two nights, set it for a low of 4 cmH2O and a high of about 6.  Third and fourth nights, set it to 5 and fully open (20 cm).  Count the events, and note the types in each case.  Also note where the machine feels it can level off on a working top pressure that keeps your airway inflated.  It could be anywhere.

IF....IF...you have treatable apnea and/or detectable flow limitations, they will be noted heavily in the first instances, and they should be treated in the second instance.  

Mask fit might be the thorn here.  If you get a good fit for the first two nights, anything over 12 cm might want to push the mask away from contact sufficiently that you get a lot of leakage, and that might disrupt your sleep sufficiently that you don't get a good indication of what the machine found and what it 'cleaned up'. 

You are likely to get another couple of opinions/suggestions if you can wait a bit.   Please do.

My reason for being referred to a titration study is my inability to stay with the mask on. When I go to sleep, I take it off (unconsicously). So I don't think I will be able to get the data needed since my bottleneck is not AHI but compliance. 

Like, how could I "Debug" this compliance issue? I am thinking of trying different pressure each night, but besides that have no clue.

(08-24-2020, 06:07 AM)slowriter Wrote: A titration involves a process of changing machines pressures, and comparing against data of the impact on your breathing.

Normally for people on this forum, a Resmed CPAP machine + OSCAR is sufficient to do that, but I have no idea how one would do that with your machine.

What kind of data can you get off it?

Per mesenteria, any chance you could get a ahold of a Resmed Autoset, even just temporarily?

Would a dreamstation be sufficient? What it is about the Autoset that makes it apropriate to study ones own sleep?

I live in Ontario Canada. I have a cpap. I'm on a path to get an autoset machine so I can make my cpap treatment more comfortable.

I've done this a long time.  Over 35 years.  I started at 7, and now have a prescription for 13. Threre's a world of difference.  Masks leak more at high pressure, if they don't fit well. I have a friend whose prescription is for 20....

I've taken my mask off at night too.  

Remedy? First I want a mask that doesn't block my view.  I want a mask that fits well. I'm using a nasal mask.  It's a ResMed N20.  I find that they work really well for me when they're new.  By 6 months I'm ready for a new mask, because my mask has developed leaks. So my concern for you is, how old is your mask? Does it fit well?

I used a heated hose. I *think* that makes treatment more comfortable.  And I use a humidifier.  That way my nose isn't dried out.

I believe the secret to compliance and better treatment is to have a comfortable mask, fit it right, and keep the seals clean.



I found my DME by asking everyone who they went to and if they were happy with their service.
DaveL
Compliant for about 30 Canadian years

I'm just a cpap user like you. I don't give medical advice. I hope to learn from you, and share my experiences with you. 
Seek the advice of a physician before seeking treatment for medical conditions including sleep apnea. Sleep-well

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#7
RE: How can I perform a sleep titration study, on myself?
It's kind of bizarre that a titration test would be used to resolve a behavior problem like mask removal in your sleep. If we had OSCAR data from any machine, we could identify the antecedent conditions that result in mask removal, but that is not titration. You want titration to resolve mask removal, then yes you can do it yourself. Your profile shows a pressure of 4.0. Start increasing pressure by 1 until you stop removing the mask and get what feels like effective therapy. If you current pressure is higher, start there and titrate upward. If I was using a ridiculously low pressure I would rip off my mask too. Increase pressure to the point you feel better, and if the pressure becomes intolerable, back off to where it feels good again...that is titration. If you need another aid to make mask removal more difficult, you might want to make something like the Knightsbridge chin strap from Supplier #37. They don't do much international shipping, but the concept would keep most people from removing a mask.
Sleeprider
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www.ApneaBoard.com

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#8
RE: How can I perform a sleep titration study, on myself?
Lab Titrations are typically performed with fixed pressure and gererally mean that at some point of the night the recommended worked for you. Fixed pressures translate well across different brands. Optimization requires using the same brand, the same algorithm that you use at home.

They are counting on the tech helping with the mask.

Many users have videoed there night's sleep. That could ID the mask removal.

Don't use ramp. Very few of us here do.,

Put it back on as soon as you remove it, at least as soon as you know it's off

Use a chin strap over the mask. This is a temp tool to make the mask more difficult to remove.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
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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.
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