Titration study

[Ron Poelstra]

I have had a sleep study and a titration some months ago.  The doc originally put me on a cpap an air curve 10.  Therapy did not go well and I was switched to a bilevel machine and Airsense 10 vauto.  Therapy is very hit or miss.  I wanted to get switched to the only machine that will work for complex and central apnea.  The doc wants another titration.  I have two questions: 1.  Why good will titration do if I have one gof my good nights?  2.  Is there any way to get around another titration?  BTW, I am on medicare and Humana.

Thanks

[Crimson Nape]

You are mixing the series names with their purpose.  This makes your question a little hard to follow.  The standard CPAP (most  common) is the AirSense series.  Within this model line is the CPAP, Elite, and Autoset(2 flavors).   The AirCurve is the more advanced model series and includes the S, VAuto, ASV, ST, and ST-A models.   If you have any one of the auto models, you can perform your own titration study.  Just set the minimum pressure to the machine's lowest and the maximum pressure to its highest.  If you have an AirCurve VAuto, set the PS to 0 (zero).  One night at this setting, inputting the data into OSCAR should provide enough information to point you in the correct treatment direction.

I forgot to ask; Do you have a copy of your Sleep study?

[SarcasticDave94]

I'm thinking what has been discussed in another thread was that there's Central Apnea needing the ResMed AirCurve 10 ASV. To convince insurance to approve paying and for doc to script, a Titration with ASV will benefit.

[Ron Poelstra]

Sorry about that mix up.  It is the Aircurve vauto.  I will try the settings tonight.

[Ron Poelstra]

Yes, I have copies, already redacted.  Here they are.


  sleep_study.docx (Size: 145.79 KB / Downloads: 10)

  titration.docx (Size: 181.2 KB / Downloads: 10)

[Crimson Nape]

Before I forget, please keep all your posts in one thread. This will help in providing the reader a historical context.

Looking at your reports showing a predominance of CAs would suggest an ASV. Seeing a recommended setting of a min of 7 and a max of 14 probably will be more comfortable, but still won't address your CAs.

My knowledge in this area is minimal, at best. I would recommend that you wait for more input.

[Geer1]

Ok, I looked at your sleep studies and previous thread for some OSCAR data.

Your original sleep study indicates central apnea is the issue. It shouldn't be a surprise to doctor that APAP/Bilevel is failing as these machines are rarely capable of treating central apnea and your central apnea is not treatment emergent and likely to go away.

Your titration study shows a significant central apnea issue at all settings except for the final 14 cm. Normally I would say a titration like that was a failure but in your case the results did seem to stabilize and you were at the 14 cm setting for over 2 hours. This could be because that pressure actually helped you or because you just had a moment of good apnea free sleep. The biggest issue I see right now is that you have never tried the settings determined in this titration study... Your machine is set to a range of 4-13 cm (Nov 27 OSCAR data posted) which fails to reach the pressure determined to be required...

You should try the titration study settings to see if they do in fact work so you can use that as evidence with doctor. Since it is a higher pressure I would use a fixed pressure range by limiting the machine. I would set min EPAP to 14. It is worth noting you are using PS of 2 whereas titration study did not use PS. If you want to match settings exactly should use 0 PS and set max IPAP to 14. If you want to continue with PS of 2 then will have to set max IPAP to 16. You should try these settings for at least a few days to see what happens.

Central apnea is often inconsistent as I am sure you have noted in your data (occurring at random times) and the higher pressures determined by titration may not be sufficient every night. After trying these settings for a few nights you can document the results and AHI at those settings (using OSCAR data) and if AHI is still high use that as proof for your doctor that the titrated pressures do not treat your central apnea. Then the doctor can either prescribe you ASV since APAP/bilevel has failed to treat or send you for an ASV titration study to prove it will resolve breathing issues. ASV is the correct machine to treat central apnea and almost everything points to it being required.

[SarcasticDave94]

Our OP has a history of CA trainwrecks at times. He lives at about 7400 foot elevation.

What was the elevation at the site of this Titration? If it's not similar to home, it will skew home results IMO.

http://www.apneaboard.com/forums/Thread-...d-to-masks

[Sleeprider]

It is extremely common for a doctor to request a titration study to demonstrate efficacy with the ASV, however it is completely unnecessary. The Resmed Aircurve 10 ASV is so smart that it will quickly provide the correct pressures automatically.  In fact during titration the technician only adjusts EPAP and the machine provides the adaptive pressure support.  With the machine in ASVauto mode, EPAP is automatic.  To save over $3000, your doctor should just prescribe the ASV and set it to the default ASVauto values, then follow-up in 30 days.  The test is as expensive as the machine and does absolutely nothing beneficial that does not happen anyway with the automatic machine control.  There is Resmeds Titration Protocol.

[Sleeprider]

For more complete information on the ASV and other machines in the Resmed lineup, read this Sleep Lab Titration Guide. You can even borrow information from this to guide your doctor to the right decision, which is to simply prescribe the machine and follow-up after 30 days.

https://document.resmed.com/en-us/docume...er_eng.pdf