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Why no Titration? - Follow up on Wednesday
I have been at this now for over 30 days and I have been reading on nearly all threads that the people involved went through "Titration". I was never given this opportunity.
When I went for my sleep study I only slept for about four hours and the nurse said I would come back for a second night after seeing my sleep doctor. The problem was that my insurance denied a second visit as it was unnecessary. My AHI was 72 and Oxygen < 75%.
They gave me my machine and sent me away. The people on this forum have looked after me since. My CA have continually been over 2/3rds of my total AHI during treatment and despite a few low days it averages over 12.
Can anyone tell me why I never went through Titration? Also, I am going for my first follow up since receiving the machine on Wednesday morning. Is there anything specific that I should be asking?

Our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time.
Thomas A. Edison

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Yes, you need to be sure to tell the doctor how high your CA's are. Bring your SD card, or print a summary of the 30 days from sleepyhead.

It's hard to say why you didn't have a titration. Mabye they had enough information from the four hours you slept.

Be sure to tell him how hour feel. You may need a different type of machine if CA's are that high.
Good luck and keep us posted.
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If you can print out some of your stats, I definitely would take them along to the Doc, whether or not he will even look at them.. I took some when I first started and the Doc said something to the effect> I don't need to see that crap<.. He never got his hand in my wallet again.. Evidently, you had enough sleep time in the lab to satisfy the sleep clinic techs and your insurance.. Don't worry..you'll get all the experienced help you need right here to make you a comfortable and compliant Pap'r... We're with you all the way from the start!!
Yesterday is history; Tomorrow is a mystery; Today is a gift; Thats why its called "The Present".
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Insurance companies are denying 2nd night titration for *OSA* because simple OSA is easy to titrate with an auto-machine. They will pay for titration with Bilevel or ASV when the symptoms indicate necessity - It is up to your Doc to make that case. I think that your data shows that you have a good case for needing an evaluation/titration.
هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه
Tongue Suck Technique for prevention of mouth breathing:
  • Place your tongue behind your front teeth on the roof of your mouth
  • let your tongue fill the space between the upper molars
  • gently suck to form a light vacuum
Practising during the day can help you to keep it at night

هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه
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Thank you very much OR, JM and DV,
At 9.00 am tomorrow I will be in front of the Doctor. He is a really nice guy and sounded like he knows what he is doing so I hope he can help me.
I am going to be armed with lots of SleepyHead information but hopefully not enough to frighten the professionals. I think I have a good case for some further investigation into the reason I am getting such high CA numbers. The OAs are constantly just over three or below - This morning was under 1.0 so I can work on that but with the CAs, nothing seems to work.
I also want to talk to him about masks as I have quite a collection of them to say I have only been at this for 30 plus days. And, it is only going to get bigger as I like the look of the DreamWear and can't wait to see the one that SuperSleeper said is in the pipeline. How many masks do you guys have in the drawer next to the bed?
By he way SuperSleeper can we do the same on chin straps. There has to be a better design. Your chin is either pulled backwards (which has to be counter-productive) or your head is wrapped if fabric (I get terrible chin strap hair)Dielaughing.
Wish me luck.

Our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time.
Thomas A. Edison

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Good luck at the doc! During my home sleep study my AHIs were 45/hr. I had no titration just a script for an APAP with a setting of 4-20. With the help of this forum I took control of my recovery and narrowed my settings with resulting cure while on therapy. I have one mask - the P10s although I will likely try the Dreamwear at some point.
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I just took a look at some of your previous posts and I can see you're having a tough time. An AHI of 72 with SO2 below 75 is really serious so this is no laughing matter. You have a good machine and good mask, but I didn't see that you had posted exactly how your machine is set up. You should go into the Clinician's Menu and tell us what the various options are set to. It's really easy for a clinician to set up even a good machine the wrong way. For instance, my last machine before my current one was a self-titrating Bi-PAP machine (an auto bipap if you will) and it was very easy to program it to be a straight CPAP from the 1970's. That's not the way I had it set up, but an idiot could have done it that way. And frankly, sorry to be blunt, but it doesn't sound like the people who are responsible for your CPAP therapy are a bunch of Einsteins.

BTW, I'm one of those irritable guys who had a sleep study with an AHI in the 40's, and an SO2 in the 70's, and according to Sleepyhead I'm pretty consistently going through the night with no CA's and only a handful of hypopneas. Sleepyhead reports my AHI routinely under .5, and only very rarely over 2.0.

So, my suggestion is to get into the Clinician's menu and post up what the settings are. Then at least we'll know the starting point.

And of course, let us know what Einstein, err I mean your doctor, says tomorrow.
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DonC I can believe you had an AHI of 72 and O2 < 75% and you never had a titration test?? Wow, what's up with that? I would hope you would ask tomorrow about that.
APNEABOARD - A great place to be if you're a hosehead!! Rolleyes

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Thanks Everyone,
I will post a status after the meeting tomorrow but I just wanted to put this on the forum in answer to Cate1898.

The denial from my insurance was worded as such:
We could not approve the next test because......
Your doctor ordered this test because you have a known blockage of the upper airway during sleep that causes pauses in breathing. This test is used to adjust your treatment. This test is needed if you have chronic lung disease or chronic heart failure. We have not been told that you have these problems. For these reasons, this study is not medically necessary for you.

The 16 pages of denial does say that they will consider Titration if there is continued proof that the CPAP is not working after the 30 day test period. It just seems such a waste of time. I have felt worse not better. I don't fully understand but intend to before I leave the doctors tomorrow. I feel a little angry at the moment but want to approach this positively in the morning.

Is it possible that I did not have CAs on the Sleep Study???

SB and TD - I will get back to you with the settings etc.. as soon as I can because I really want your help and advice.


Our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time.
Thomas A. Edison

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Hi Don. It sounds like your insurance company doesn't want to pay for titration tests except in exceptional circumstances. Although this is contrary to what I understand is the American way of doing things, I wouldn't worry about it too much. If you have simple obstructive apnea, your Autoset is capable of giving all the data necessary for a skilled technician (or skilled patient) to home in on an optimum treatment. That's the way many (most?) practitioners work here in Australia.

If you have central, mixed or complex apnea, a CPAP / APAP titration isn't going to tell you a lot anyway unless they also try an ASV machine (unlikely).

Quote:Is it possible that I did not have CAs on the Sleep Study???
Yes, that's possible. Do you have a copy of your sleep test report? If not, ask your doctor. Quite a few people get pressure induced centrals when they start therapy. Sometimes they go away by themselves, or can be controlled by judicious adjustment of maximum pressure and/or EPR settings. If they don't go away then you may need an ASV machine. These are expensive so knowing the cost-cutting attitude of your insurance company you will likely have to jump through hoops to get it.

Good luck with your doc - let us know how it pans out.

Apnea Board Moderator


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