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Titatration Preference: In home or lab?
#1
Question 
Hello, Everyone!

I am a 37 year old female. I went for a sleep study on Tuesday night. I don't fully understand or remember all the numbers the doctor rattled off the next morning. I do know I have sleep apnea (mild, I believe) and am on to the titration phase of this journey.

If insurance will approve it, I'll likely have it in the lab. That makes more sense to me, to have a professional monitoring the big picture, rather than relying on a machine to measure a limited amount of data and go back and forth to the doc, while we get the pressure figured out.

On the other hand, I'm not looking forward to having that pokey thing in my nose again! I had a miserable night at the study, in part because I was under allergy attack or a cold and my nose was stuffed up and running all night. I was awake more than I was asleep.

Since the apnea is so minor, I am hoping and praying that losing weight will help, though I'm told my anatomy is the problem (narrow airway, deviated septum). I think a machine y'all talk about that documents everything all night would let me know when maybe I'm ready to wean off the machine? I know I'm probably being a dreamer here, but bear with me, I have to think this way to get through this.

Other info: I am on anti-depressants which contribute to and/or exacorbate restless legs, so I'm now on Requip as well. Its only been a couple weeks, but I feel like I wake up more in the night since I've been on it.

I really don't want to be on all these drugs or the CPAP on one hand. On the other, I know it will save my life. I am also hopefull that the CPAP will get me a better night's sleep, more energy and focus during the day, and maybe I can go off the Celexa and Requip eventually.

I've rattled on a bit here, but my main question is what you recommend/prefer as far as in home/automated titration vs. doing it in the lab.

If I do it at the lab, do I basically come home the next day, CPAP in hand? Or is that when my DME journey begins?

The tech let me try on a nasal pillow mask and a small, over the nose one in case she would have to wake me up to put it on me. I didn't end up needing it that night, but now I'm wishing I'd asked her what happens to those masks? Do they sanitize them for another patient? Throw them away? I'm kindda wishing I'd at least ASKED if I could keep them, just in case.

I can tell already this is a great place for support. You are all a wealth of information.

Thank you.
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#2
I have done sleep studies at home and in lab. I prefer in lab because they gather more info and there is someone monitoring me all night. The key is whether your insurance will cover it. I doubt you'll go home with a machine the following morning. I had to wait a couple of weeks to discuss the results with my doctor and then a few more weeks to get the paperwork through the system to get the machine. YMMV

I have a co-worker that did an at home study and then received an APAP machine without a titration study. His primary care physician submitted the request and he never saw a sleep doctor. Same insurance but his path was much quicker.
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#3
(12-05-2013, 11:08 AM)JohnNJ Wrote: I have done sleep studies at home and in lab. I prefer in lab because they gather more info and there is someone monitoring me all night. The key is whether your insurance will cover it. I doubt you'll go home with a machine the following morning. I had to wait a couple of weeks to discuss the results with my doctor and then a few more weeks to get the paperwork through the system to get the machine. YMMV

I have a co-worker that did an at home study and then received an APAP machine without a titration study. His primary care physician submitted the request and he never saw a sleep doctor. Same insurance but his path was much quicker.

I wouldn't want to get a machine without someone experienced telling what the optimal pressure settings should be. Just my thoughts on this.
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#4
Quote:I wouldn't want to get a machine without someone experienced telling what the optimal pressure settings should be. Just my thoughts on this.

That's how I feel about it too. My sister in law, who's quite an expert in the field, said "the science says the outcome is the same..." but what you're saying makes sense to me, too. I hope I meet the criteria for my insurance to cover it in the lab. I still have to pay 20% of the contracted rate, but that's a heck of a lot better than paying 100% out of pocket!

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#5
My in lab sleep study was almost miserable; far from anything I'd want to do again if I could avoid it. I opted for an at home titration.

I can understand wanting to get observed data to have a solid starting point, but it wasn't anywhere near a real world test for me. And it's only one night; which may be your best or worst as far as the apneas are concerned and may skew results somewhat.

After reading apnea boards for a couple months, doing research, and asking some questions, I felt relatively comfortable going the at home route. I'm pretty comfortable wearing air supplied face masks; I wear one for work. So that wasn't a huge issue for me. I also have a follow-up appointment with the sleep Dr to review data and make changes/adjustments in just a couple weeks.
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#6
An alternate opinion:

I do not sleep the same in the lab as I do at home and it is my understanding that this is the case for most people. The way I see it, a lab-based titration is going to tell you what your ideal pressure is when sleeping in the lab (which is a very unnatural environment). If you want to know what your ideal pressure is for sleeping at home, then you should do the titration at home.

Your sister-in-law is correct--I've read a couple studies that show no difference between groups that were titrated at home vs. in the lab. So really, I don't think it matters. You should obviously do whatever you are most comfortable with.


(12-05-2013, 12:44 PM)simplysara Wrote:
Quote:I wouldn't want to get a machine without someone experienced telling what the optimal pressure settings should be. Just my thoughts on this.

That's how I feel about it too. My sister in law, who's quite an expert in the field, said "the science says the outcome is the same..." but what you're saying makes sense to me, too. I hope I meet the criteria for my insurance to cover it in the lab. I still have to pay 20% of the contracted rate, but that's a heck of a lot better than paying 100% out of pocket!

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#7
(12-05-2013, 02:24 PM)Nozzelnut Wrote: I can understand wanting to get observed data to have a solid starting point, but it wasn't anywhere near a real world test for me. And it's only one night; which may be your best or worst as far as the apneas are concerned and may skew results somewhat.

an in home test, as well as a test in the sleep lab is one night and could be the best or worst for apneas. there has to be a starting point to work with. just my opinion.

yes, my sleep lab tests were not the best situation but it was better than nothing at all and dying b/c I was not being treated.
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#8
My sleep doctor said that there's no point in a titration study if you're getting an APAP machine. The machine determines the correct pressure. The in lab study collect MUCH more data than the at home study ever could and I was happy about that.

As for the in lab study - I slept better during that study that I ever did at home. 1) I had a machine and 2) I was alone in bed. I do sleep better at home now that I have the machine but my wife does wake me up when she gets in or out of bed.
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#9
(12-05-2013, 03:45 PM)JohnNJ Wrote: My sleep doctor said that there's no point in a titration study if you're getting an APAP machine. The machine determines the correct pressure. The in lab study collect MUCH more data than the at home study ever could and I was happy about that.

As for the in lab study - I slept better during that study that I ever did at home. 1) I had a machine and 2) I was alone in bed. I do sleep better at home now that I have the machine but my wife does wake me up when she gets in or out of bed.

I am curious how you got your pressure to set the auto set if you didn't have a titration. Do you look at your data? If so, what does your stats say? If your profile is correct for your pressure, you are just about using a regular CPAP machine.
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#10
(12-05-2013, 05:17 PM)me50 Wrote: I am curious how you got your pressure to set the auto set if you didn't have a titration. Do you look at your data? If so, what does your stats say? If your profile is correct for your pressure, you are just about using a regular CPAP machine.

You misunderstood. I did have an in lab titration study and I would recommend it over a home study.
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