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Permalink Reply by Rock Conner RRT on October 11, 2009 at 6:24pm

Another point in favor of APAP is that in-lab titrations, while certainly more thorough than any APAP algorithm, is a slice of life. Pressure needs can vary hour-to-hour, night-to-night, year-to-year, etc. APAP, while less in-depth, gives response to changing pressure needs.

Judy said:

Yeah, well, Duane, I'm all in favor of an in-lab titration, do NOT misunderstand me!!! But there are times when there are extenuating circumstances. AND not every RPSGT is as good as you. PLUS one night of crappy sleep in a sleep lab sometimes just doesn't give the RPSGT the sleep time to find the right pressure(s) and who can afford repeated in-lab titrations UNTIL some decent sleep time is achieved, whose insurance would pay for them?

My first titration I only slept 42 minutes out of 6 hours bedtime and my second titration I only slept 98 minutes out of six hours bedtime. I was awake and not sleeping at the 6 hour mark both times. How many sleep labs would have allowed me to continue laying there UNTIL I DID put in enough sleep time??? How long would YOU have stayed after waiting for me to HOPEFULLY go back to sleep and sleep long enough to get me titrated to my ideal pressure need??? Would your sleep lab manager have even allowed that?

I didn't go thru one full sleep cycle the first in-lab titration and I'd have to go look at my report to see if I even barely made it thru one full sleep cycle the second time. I rather doubt it but maybe.

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Permalink Reply by Jan on October 11, 2009 at 7:27pm

Hi-- I started this thread (newbie here, and I wonder if I should stop saying that ;-) -- wanting to figure out the fullest featured and most flexible types of machines available. My thought process was that I could turn off features that I didn't want but would have the flexibility of these additional features if I wanted them.

I actually (apparently mistakenly) thought that the automatic feature would just magically vary the "wind" strength based on what my physical needs were at that time. I was never thinking that I would do a titration test on my own. I think that what I am hearing though, is that there IS a downside to using automatic machines in the automatic mode in that they require "failure" ie. apnea events in order to calibrate. However, if you have a fully data capable machine, you might like this feature because you and your doctor can tweak it a bit based on the information/data that you get from the machine on a routine basis. Am I more or less understanding this correctly?

I am also wondering about the levels that are determined during titration (don't have results yet). Would external factors such as allergies during a season, how tired you are one night, how recently you ate, whether you kicked back a few cocktails....do these kinds of things affect the pressure level you need from one night to the other? Or is the level that you need pretty consistent once it is determined for you?

Thanks much,
Jan

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Permalink Reply by Rock Conner RRT on October 12, 2009 at 9:38am

Opinions vary, Jan. That slice of life factor is real, but I still prefer live & capably attended PAP titration, supplemented by APAP where fiscally feasible.

Jan said:

Hi-- I started this thread (newbie here, and I wonder if I should stop saying that ;-) -- wanting to figure out the fullest featured and most flexible types of machines available. My thought process was that I could turn off features that I didn't want but would have the flexibility of these additional features if I wanted them.

I actually (apparently mistakenly) thought that the automatic feature would just magically vary the "wind" strength based on what my physical needs were at that time. I was never thinking that I would do a titration test on my own. I think that what I am hearing though, is that there IS a downside to using automatic machines in the automatic mode in that they require "failure" ie. apnea events in order to calibrate. However, if you have a fully data capable machine, you might like this feature because you and your doctor can tweak it a bit based on the information/data that you get from the machine on a routine basis. Am I more or less understanding this correctly?

I am also wondering about the levels that are determined during titration (don't have results yet). Would external factors such as allergies during a season, how tired you are one night, how recently you ate, whether you kicked back a few cocktails....do these kinds of things affect the pressure level you need from one night to the other? Or is the level that you need pretty consistent once it is determined for you?

Thanks much,
Jan

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Permalink Reply by Duane McDade on October 14, 2009 at 8:57am

Ok your right and I do know that the quaility of sleep labs/ Doctors vari. I just don't think the machines do what they claim to in the books that come with them. I will try to me more understanding.

Judy said:

Yeah, well, Duane, I'm all in favor of an in-lab titration, do NOT misunderstand me!!! But there are times when there are extenuating circumstances. AND not every RPSGT is as good as you. PLUS one night of crappy sleep in a sleep lab sometimes just doesn't give the RPSGT the sleep time to find the right pressure(s) and who can afford repeated in-lab titrations UNTIL some decent sleep time is achieved, whose insurance would pay for them?

My first titration I only slept 42 minutes out of 6 hours bedtime and my second titration I only slept 98 minutes out of six hours bedtime. I was awake and not sleeping at the 6 hour mark both times. How many sleep labs would have allowed me to continue laying there UNTIL I DID put in enough sleep time??? How long would YOU have stayed after waiting for me to HOPEFULLY go back to sleep and sleep long enough to get me titrated to my ideal pressure need??? Would your sleep lab manager have even allowed that?

I didn't go thru one full sleep cycle the first in-lab titration and I'd have to go look at my report to see if I even barely made it thru one full sleep cycle the second time. I rather doubt it but maybe.

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Permalink Reply by RockRpsgt on October 14, 2009 at 9:36am

No you won't! LMAO

Duane McDade said:

Ok your right and I do know that the quaility of sleep labs/ Doctors vari. I just don't think the machines do what they claim to in the books that come with them. I will try to me more understanding.

Judy said:

Yeah, well, Duane, I'm all in favor of an in-lab titration, do NOT misunderstand me!!! But there are times when there are extenuating circumstances. AND not every RPSGT is as good as you. PLUS one night of crappy sleep in a sleep lab sometimes just doesn't give the RPSGT the sleep time to find the right pressure(s) and who can afford repeated in-lab titrations UNTIL some decent sleep time is achieved, whose insurance would pay for them?

My first titration I only slept 42 minutes out of 6 hours bedtime and my second titration I only slept 98 minutes out of six hours bedtime. I was awake and not sleeping at the 6 hour mark both times. How many sleep labs would have allowed me to continue laying there UNTIL I DID put in enough sleep time??? How long would YOU have stayed after waiting for me to HOPEFULLY go back to sleep and sleep long enough to get me titrated to my ideal pressure need??? Would your sleep lab manager have even allowed that?

I didn't go thru one full sleep cycle the first in-lab titration and I'd have to go look at my report to see if I even barely made it thru one full sleep cycle the second time. I rather doubt it but maybe.

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Permalink Reply by Judy on October 14, 2009 at 9:45am

Why, Duane McDade?? They are your opinions and I value them even when I don't agree. Actually I guess I only half disagreed w/you. Give me a good sleep tech anytime! But you heroes are too expensive to be used just willy-nilly. And I'm not jesting when I say heroes. My mind hasn't changed - the real heroes of the sleep profession are the very ones we have least access to - our PSGT!!!!

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Permalink Reply by Renee on October 15, 2009 at 12:26pm

Hello Judy,

Thanks so much for this info! I have just been diagnosed with severe OSA and will be getting CPAP next week. I have been reading this forum religiously and am so very glad because, although I felt lost, the more I am learning with SG, the more I am realizing how truly lost I would be without SG. Also I have been reviewing ResMed's website but didn't know what to require of my DME regarding a CPAP model. You have set everything out so well here that it all makes such good sense. But besides making sense, it is very generous of you to have taken such time and care in sharing this info.

Thank you and wishing you restful sleep,
Renee

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Permalink Reply by Judy on October 15, 2009 at 6:33pm

Duane McDade, as jnk says repeatedly, APAPs are good for "trending", to see which way the wind is blowing from time to time and making minor adjustments based on a data trend..

Renee, I'm biased. I would recommend the Resmed S8 Elite II w/EPR or if you are feeling adventurous try for the Resmed S8 AutoSet II. REFUSE any Respironics brand that has Plus in its name. Be leery of any brand other than Resmed or Respironics for the time being.

Covidien (Puritan Bennett) has come out w/the Sandman Info - REFUSE the Sandman Intro. I forget now - whether it is DeVilbiss or Fisher & Paykel that have come out w/the IntelliPAP ..... we just don't see that many of these brands. They make GOOD devices and they've come out w/fully data capable CPAPs but I'm afraid I may be getting the model names confused between brands as well w/in brands which are fully data capable and which are compliance data only clunkers.. I THINK I posted a list of fully data capable CPAPs in the Article section here several months ago.

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Permalink Reply by Jan on October 15, 2009 at 6:37pm

whats up with the respironics that have the word PLUS in the title.

Judy said:

Duane McDade, as jnk says repeatedly, APAPs are good for "trending", to see which way the wind is blowing from time to time and making minor adjustments based on a data trend..

Renee, I'm biased. I would recommend the Resmed S8 Elite II w/EPR or if you are feeling adventurous try for the Resmed S8 AutoSet II. REFUSE any Respironics brand that has Plus in its name. Be leery of any brand other than Resmed or Respironics for the time being.

Covidien (Puritan Bennett) has come out w/the Sandman Info - REFUSE the Sandman Intro. I forget now - whether it is DeVilbiss or Fisher & Paykel that have come out w/the IntelliPAP ..... we just don't see that many of these brands. They make GOOD devices and they've come out w/fully data capable CPAPs but I'm afraid I may be getting the model names confused between brands as well w/in brands which are fully data capable and which are compliance data only clunkers.. I THINK I posted a list of fully data capable CPAPs in the Article section here several months ago.

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Permalink Reply by Judy on October 15, 2009 at 9:15pm

None of the Respironics Plus models are fully data capable.

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