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Modifying the titration procedure
#1
After being diagnosed with mild sleep apnea and because there were some heart issues I've been on an APAP for the last 3 months. The APAP was chosen because the titration test was unsatisfactory. They manipulated the APAP settings but I'm still running an average AHI of 6 with some good nights around 3-5 and some not so good in the 6-10 range. The sleep specialist thought I should have another titration thinking I might need a BiPAP. I assumed that the guidelines for this titration would designed around the 3 months of data and the possible objective of switching to a BiPAP. All the providers involved are part of the same large health clinic so I was surprised to find when I got to the sleep study that all they had was the report of the failed titration test and were simply going to try it again. The day after the test my sleep specialist seemed a little annoyed when I asked him if the titration should have been designed around my particular situation. Was I wrong to believe they might have modified the standard titration procedure?
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#2
Ideally, one would think the procedure would be tailored to the person.
It just doesn't work that way. Generally a PSG technician conducts the test according to standard protocols. There is no doctor present to make decisions to vary the protocol in real-time.

The protocols have branch points the PSG tech will take -- example:
If Oxygen saturation falls below a certain number, they are to administer Oxygen.

Bilevel is often used when a person requires higher pressures. The greater expiratory relief makes it easier.

They, the medicos, usually want a PSG titration on a bilevel machine to prove effectiveness and find optimum settings. It can be a maddening merry-go-round.

Some doctors just see questions as an offense to their ego.
I try to avoid such doctors. A good doctor can take questions, even criticism, and keep their cool. Healthcare is a two-way street; and a "my way or the highway" doctor will get little feedback from those he's charged with caring for.
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