Replies to This Discussion

Permalink Reply by RockRpsgt on March 30, 2009 at 3:42am

no because not being able to breathe, and not getting the signal are 2 different situaions. During an OSA the lungs are trying to do the job they were made to do, but do to the blockage in the throat they can't. OSA usually will have a desat though.

Mike said:

not to get off topic, but if centrals without desaturation of O2 aren't a problem, shouldn't the same be true of obstructive events without O2 desaturation?

j n k said:

A nice explanation in harmony with Rock Hinkle's mention of CO2 in the bloodstream: http://www.apneos.com/csa.html

'The brain continuously monitors the body's status and continuously decides the proper rate and depth of breathing to command. In particular, the brain continuously monitors how much carbon dioxide is contained in the bloodstream.

'Breathing is normally controlled by a simple cycle of events:

'1. When the level of carbon dioxide gets too high, the brain sends a "breathe now" command to the breathing muscles.

'2. The act of breathing lowers the level of carbon dioxide in the blood.

'3. There is no stimulus to breathe until the level of carbon dioxide rises again to the "too high" level.

'4. Since the body continuously produces carbon dioxide, the "too high" level is reached again in a few seconds. The cycle starts again at step 1. '

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Permalink Reply by Judy on March 30, 2009 at 10:35am

No need to defer to my suggestion of 10 cms, jnk. He only spent some 25-30 minutes of the night sleeping at that pressure. It just looked, to me, like a good pressure to start and spend some time at for a thorough evaluation at that pressure. Remember, a half hour is not normally even a full sleep cycle.

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Permalink Reply by RockRpsgt on March 30, 2009 at 11:37am

I would hire her!

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Permalink Reply by Mike on March 30, 2009 at 2:41pm

funny that Judy said try 10. i think he was at 10 for awhile, and was doing better than he is now. . . making real progress. then we thought that if we raised the pressure more, that we would zero out the remaining apneas and do even better. maybe it was a case of pigs getting slaughtered...

... fascinating information about the central vs. obstructive, and how obstructives can actually be far more damaging than centrals. intuitively, centrals sound scarier because it makes you think something is terribly wrong here with the brain and we have no idea how to fix it... at least with obstructives, you can make sense of it all and it seems like something that can be easily dealt with by upping the positive airway pressure. your last post makes me rethink all of that.

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Permalink Reply by RockRpsgt on March 30, 2009 at 4:05pm

When you say "we" do you mean that the 2 of you raised the pressure on your own?

Mike said:

funny that Judy said try 10. i think he was at 10 for awhile, and was doing better than he is now. . . making real progress. then we thought that if we raised the pressure more, that we would zero out the remaining apneas and do even better. maybe it was a case of pigs getting slaughtered...

... fascinating information about the central vs. obstructive, and how obstructives can actually be far more damaging than centrals. intuitively, centrals sound scarier because it makes you think something is terribly wrong here with the brain and we have no idea how to fix it... at least with obstructives, you can make sense of it all and it seems like something that can be easily dealt with by upping the positive airway pressure. your last post makes me rethink all of that.

• ▶ Reply

Permalink Reply by Mike on March 30, 2009 at 4:09pm

guilty as charged. yes, he changed it on his own. is that something you feel strongly about?

Rock Hinkle said:

When you say "we" do you mean that the 2 of you raised the pressure on your own?

Mike said:

funny that Judy said try 10. i think he was at 10 for awhile, and was doing better than he is now. . . making real progress. then we thought that if we raised the pressure more, that we would zero out the remaining apneas and do even better. maybe it was a case of pigs getting slaughtered...

... fascinating information about the central vs. obstructive, and how obstructives can actually be far more damaging than centrals. intuitively, centrals sound scarier because it makes you think something is terribly wrong here with the brain and we have no idea how to fix it... at least with obstructives, you can make sense of it all and it seems like something that can be easily dealt with by upping the positive airway pressure. your last post makes me rethink all of that.

• ▶ Reply

Permalink Reply by RockRpsgt on March 30, 2009 at 5:07pm

I do understand the need and the want to control a persons own treatment. Some of you might even have become quite the experts on it. That does not change the fact that these studies are done in a lab setting for a reason. Alot of things can go wrong when you are messing with the gas exchange in your bodies. What if by chance your friend's centrals was underlying complex apnea brought on by a heart condition? You raise his pressure thus messing with the gas exchanges in his body causing a chain reaction. 1st his co2 levels go crazy in his lungs, causing him to hyper/hypoventilate, causing a panic attack, causing increased heart rate and unwanted stress on an already sick heart, causing him to go into cardiac arrest. In a lab setting we are trained to deal with these things as they happen. In a hospital setting they have a team seconds away to treat the pt. WE MONITOR THE HEART! I am not saying that this is what is going to happen but it could. There are reasons that so many things are monitored during the study. Some for better treatment of your sleep, and some to make sure that you don't die during the process. Yes for some people that have gone a long time without treating their apnea, death is a possibility. Generally it is not the sweet death of just going to sleep and not waking up. Untreated or improperly treated apneic pts go out with massive heart attacks, strokes, or siezures. or worse yet a slow health declining death do to a lack of o2 in the blood stream. mike I don't know what you do, and i mean you no disrespect, but are you trained to handle anyone of these situations? I am. Not only am I trained, but I(we) practice to perfection exactly what to do. As a trained sleep specialist I am evaluted on how I perform these drills, and my job is dependent on my evaluation. What would you do if you punctured a lung due to high titration? Collapsed a lung? Collapsed an airway. Could you, or any of you perform a tracheotemy if you had to on the fly? Could you live with the fact that your titration advice killed someone. The answer to your question is yes I feel strongly about this subject. I am also a little upset about this post. Mike you lead me to believe that this might be a bad titration done by a tech, in a lab setting. I went to my peers and instructors for advice for you and your friend. I spent hours researching this subject looking for answers! When in fact it is a bad titration done by you/or your friend. By all means people experiment with your machine, change your mask, your straps, your humidity! Try mouth pieces and surgery, positional therapy. Remember one thing changing your pap pressure is changing a prescription, and now matter what way you look at it, it can and eventually will lead to a dangerous side effect. Maybe I am being a little dramatic, but these are the worries that have been beatin into me as I have gone through my training. I personally have had to blow life back into a pt. I have seen people turn blue. I hope that no one here ever has too. I have to go through 2 years of training just to be able to perform a psg or CPaP study, yet this still does not entitle me to be able to determine a persons PaP pressure. This is a Dr.s' job. If you are not satisfied with what oyur Dr. tells you or how you are diagnosed. I am sure that there is another Dr. right next door, down the street that would be happy to reevaluate you.

Mike said:

guilty as charged. yes, he changed it on his own. is that something you feel strongly about?

Rock Hinkle said:

When you say "we" do you mean that the 2 of you raised the pressure on your own?

Mike said:

funny that Judy said try 10. i think he was at 10 for awhile, and was doing better than he is now. . . making real progress. then we thought that if we raised the pressure more, that we would zero out the remaining apneas and do even better. maybe it was a case of pigs getting slaughtered...

... fascinating information about the central vs. obstructive, and how obstructives can actually be far more damaging than centrals. intuitively, centrals sound scarier because it makes you think something is terribly wrong here with the brain and we have no idea how to fix it... at least with obstructives, you can make sense of it all and it seems like something that can be easily dealt with by upping the positive airway pressure. your last post makes me rethink all of that.

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Permalink Reply by Mike on March 30, 2009 at 5:28pm

i understand your point of view and respect it. i can tell you that if we had just left the treatment up to him and his doctor, we'd be nowhere now -- his doctor refused to even look at the data, and would only ask him subjectively how he felt. if he said he felt better than when not using the CPAP, even if he still felt lousy, his doctor declared victory/treatment success. He is working to find a way through this maze, yes, sometimes taking matters in his own hands, but also under the supervision of doctors. We'd of course rather all this happen under the close supervision of doctors, but the realities are such that nothing would ever get done if we solely relied on them, and not on ourselves as well.

i know this is a touchy subject, and i don't mean to diminish anything you've said or done. he has an appointment tomorrow with a very prominent sleep specialist, and armed with all the research that you and others on this forum have done, he'll be able to have an intelligent conversation with the doctor about what to do next. i hope you will not be discouraged by our actions and leave us. most of us will not adjust our own pressures, but for those who would, they should hear about the risks from folks like you... then make their own decisions. anyhow, your professional/trained viewpoint is much needed here. we just want to do what's right.

Rock Hinkle said:

I do understand the need and the want to control a persons own treatment. Some of you might even have become quite the experts on it. That does not change the fact that these studies are done in a lab setting for a reason. Alot of things can go wrong when you are messing with the gas exchange in your bodies. What if by chance your friend's centrals was underlying complex apnea brought on by a heart condition? You raise his pressure thus messing with the gas exchanges in his body causing a chain reaction. 1st his co2 levels go crazy in his lungs, causing him to hyper/hypoventilate, causing a panic attack, causing increased heart rate and unwanted stress on an already sick heart, causing him to go into cardiac arrest. In a lab setting we are trained to deal with these things as they happen. In a hospital setting they have a team seconds away to treat the pt. WE MONITOR THE HEART! I am not saying that this is what is going to happen but it could. There are reasons that so many things are monitored during the study. Some for better treatment of your sleep, and some to make sure that you don't die during the process. Yes for some people that have gone a long time without treating their apnea, death is a possibility. Generally it is not the sweet death of just going to sleep and not waking up. Untreated or improperly treated apneic pts go out with massive heart attacks, strokes, or siezures. or worse yet a slow health declining death do to a lack of o2 in the blood stream. mike I don't know what you do, and i mean you no disrespect, but are you trained to handle anyone of these situations? I am. Not only am I trained, but I(we) practice to perfection exactly what to do. As a trained sleep specialist I am evaluted on how I perform these drills, and my job is dependent on my evaluation. What would you do if you punctured a lung due to high titration? Collapsed a lung? Collapsed an airway. Could you, or any of you perform a tracheotemy if you had to on the fly? Could you live with the fact that your titration advice killed someone. The answer to your question is yes I feel strongly about this subject. I am also a little upset about this post. Mike you lead me to believe that this might be a bad titration done by a tech, in a lab setting. I went to my peers and instructors for advice for you and your friend. I spent hours researching this subject looking for answers! When in fact it is a bad titration done by you/or your friend. By all means people experiment with your machine, change your mask, your straps, your humidity! Try mouth pieces and surgery, positional therapy. Remember one thing changing your pap pressure is changing a prescription, and now matter what way you look at it, it can and eventually will lead to a dangerous side effect. Maybe I am being a little dramatic, but these are the worries that have been beatin into me as I have gone through my training. I personally have had to blow life back into a pt. I have seen people turn blue. I hope that no one here ever has too. I have to go through 2 years of training just to be able to perform a psg or CPaP study, yet this still does not entitle me to be able to determine a persons PaP pressure. This is a Dr.s' job. If you are not satisfied with what oyur Dr. tells you or how you are diagnosed. I am sure that there is another Dr. right next door, down the street that would be happy to reevaluate you.

Mike said:

guilty as charged. yes, he changed it on his own. is that something you feel strongly about?

Rock Hinkle said:

When you say "we" do you mean that the 2 of you raised the pressure on your own?

Mike said:

funny that Judy said try 10. i think he was at 10 for awhile, and was doing better than he is now. . . making real progress. then we thought that if we raised the pressure more, that we would zero out the remaining apneas and do even better. maybe it was a case of pigs getting slaughtered...

... fascinating information about the central vs. obstructive, and how obstructives can actually be far more damaging than centrals. intuitively, centrals sound scarier because it makes you think something is terribly wrong here with the brain and we have no idea how to fix it... at least with obstructives, you can make sense of it all and it seems like something that can be easily dealt with by upping the positive airway pressure. your last post makes me rethink all of that.

• ▶ Reply

Permalink Reply by RockRpsgt on March 30, 2009 at 5:51pm

I am not going anywhere. I like this site. It is only one of 2 that I have not and probably won't give up on. Just next time be honest with me. I DO UNDERSTAND that this is not an easy process for everyone. At least if you do change the pressures, have someone sit with you during the process. JUST IN CASE! I have learned alot from this post as well. I am sure that this will not be the first time I disagree with someone on this site. God forbid that would be boring! I do apologise for the post. We don't know each other personally, but I have come to enjoy talking to and listening to quite a few of you. I would not want to see anyone seriously injured, or worse due to a bad titration. Besides it's just one man's opinion.

Mike said:

i understand your point of view and respect it. i can tell you that if we had just left the treatment up to him and his doctor, we'd be nowhere now -- his doctor refused to even look at the data, and would only ask him subjectively how he felt. if he said he felt better than when not using the CPAP, even if he still felt lousy, his doctor declared victory/treatment success. He is working to find a way through this maze, yes, sometimes taking matters in his own hands, but also under the supervision of doctors. We'd of course rather all this happen under the close supervision of doctors, but the realities are such that nothing would ever get done if we solely relied on them, and not on ourselves as well.

i know this is a touchy subject, and i don't mean to diminish anything you've said or done. he has an appointment tomorrow with a very prominent sleep specialist, and armed with all the research that you and others on this forum have done, he'll be able to have an intelligent conversation with the doctor about what to do next. i hope you will not be discouraged by our actions and leave us. most of us will not adjust our own pressures, but for those who would, they should hear about the risks from folks like you... then make their own decisions. anyhow, your professional/trained viewpoint is much needed here. we just want to do what's right.

Rock Hinkle said:

I do understand the need and the want to control a persons own treatment. Some of you might even have become quite the experts on it. That does not change the fact that these studies are done in a lab setting for a reason. Alot of things can go wrong when you are messing with the gas exchange in your bodies. What if by chance your friend's centrals was underlying complex apnea brought on by a heart condition? You raise his pressure thus messing with the gas exchanges in his body causing a chain reaction. 1st his co2 levels go crazy in his lungs, causing him to hyper/hypoventilate, causing a panic attack, causing increased heart rate and unwanted stress on an already sick heart, causing him to go into cardiac arrest. In a lab setting we are trained to deal with these things as they happen. In a hospital setting they have a team seconds away to treat the pt. WE MONITOR THE HEART! I am not saying that this is what is going to happen but it could. There are reasons that so many things are monitored during the study. Some for better treatment of your sleep, and some to make sure that you don't die during the process. Yes for some people that have gone a long time without treating their apnea, death is a possibility. Generally it is not the sweet death of just going to sleep and not waking up. Untreated or improperly treated apneic pts go out with massive heart attacks, strokes, or siezures. or worse yet a slow health declining death do to a lack of o2 in the blood stream. mike I don't know what you do, and i mean you no disrespect, but are you trained to handle anyone of these situations? I am. Not only am I trained, but I(we) practice to perfection exactly what to do. As a trained sleep specialist I am evaluted on how I perform these drills, and my job is dependent on my evaluation. What would you do if you punctured a lung due to high titration? Collapsed a lung? Collapsed an airway. Could you, or any of you perform a tracheotemy if you had to on the fly? Could you live with the fact that your titration advice killed someone. The answer to your question is yes I feel strongly about this subject. I am also a little upset about this post. Mike you lead me to believe that this might be a bad titration done by a tech, in a lab setting. I went to my peers and instructors for advice for you and your friend. I spent hours researching this subject looking for answers! When in fact it is a bad titration done by you/or your friend. By all means people experiment with your machine, change your mask, your straps, your humidity! Try mouth pieces and surgery, positional therapy. Remember one thing changing your pap pressure is changing a prescription, and now matter what way you look at it, it can and eventually will lead to a dangerous side effect. Maybe I am being a little dramatic, but these are the worries that have been beatin into me as I have gone through my training. I personally have had to blow life back into a pt. I have seen people turn blue. I hope that no one here ever has too. I have to go through 2 years of training just to be able to perform a psg or CPaP study, yet this still does not entitle me to be able to determine a persons PaP pressure. This is a Dr.s' job. If you are not satisfied with what oyur Dr. tells you or how you are diagnosed. I am sure that there is another Dr. right next door, down the street that would be happy to reevaluate you.

Mike said:

guilty as charged. yes, he changed it on his own. is that something you feel strongly about?

Rock Hinkle said:

When you say "we" do you mean that the 2 of you raised the pressure on your own?

Mike said:

funny that Judy said try 10. i think he was at 10 for awhile, and was doing better than he is now. . . making real progress. then we thought that if we raised the pressure more, that we would zero out the remaining apneas and do even better. maybe it was a case of pigs getting slaughtered...

... fascinating information about the central vs. obstructive, and how obstructives can actually be far more damaging than centrals. intuitively, centrals sound scarier because it makes you think something is terribly wrong here with the brain and we have no idea how to fix it... at least with obstructives, you can make sense of it all and it seems like something that can be easily dealt with by upping the positive airway pressure. your last post makes me rethink all of that.

• ▶ Reply

Permalink Reply by Mike on March 30, 2009 at 5:58pm

Sounds good, Rock. I have come to value and trust your opinions on these things, so i'm glad you're not going to be out of here when someone decides to self-titrate. This is an uncensored forum where all viewpoints will be aired, and where some people will feel strongly pro self-titration, and others strongly against self-titration. my goal is to get everyone talking to one another so that we can all make the best/safest decisions for our health situations.

with respect to being honest with you, i thought that i was being upfront with you all along. perhaps there was miscommunication along the way, but i never intended to mislead you, and it upsets me if you think that i did.

in any case, all water under the bridge. i am glad you have a thick enough skin to deal with people who disagree... there will be many of them, just as there will be many who totally agree with you. the important thing is to get it all "out there" so people can make informed decisions.

Rock Hinkle said:

I am not going anywhere. I like this site. It is only one of 2 that I have not and probably won't give up on. Just next time be honest with me. I DO UNDERSTAND that this is not an easy process for everyone. At least if you do change the pressures, have someone sit with you during the process. JUST IN CASE! I have learned alot from this post as well. I am sure that this will not be the first time I disagree with someone on this site. God forbid that would be boring! I do apologise for the post. We don't know each other personally, but I have come to enjoy talking to and listening to quite a few of you. I would not want to see anyone seriously injured, or worse due to a bad titration. Besides it's just one man's opinion.

Mike said:

i understand your point of view and respect it. i can tell you that if we had just left the treatment up to him and his doctor, we'd be nowhere now -- his doctor refused to even look at the data, and would only ask him subjectively how he felt. if he said he felt better than when not using the CPAP, even if he still felt lousy, his doctor declared victory/treatment success. He is working to find a way through this maze, yes, sometimes taking matters in his own hands, but also under the supervision of doctors. We'd of course rather all this happen under the close supervision of doctors, but the realities are such that nothing would ever get done if we solely relied on them, and not on ourselves as well.

i know this is a touchy subject, and i don't mean to diminish anything you've said or done. he has an appointment tomorrow with a very prominent sleep specialist, and armed with all the research that you and others on this forum have done, he'll be able to have an intelligent conversation with the doctor about what to do next. i hope you will not be discouraged by our actions and leave us. most of us will not adjust our own pressures, but for those who would, they should hear about the risks from folks like you... then make their own decisions. anyhow, your professional/trained viewpoint is much needed here. we just want to do what's right.

Rock Hinkle said:

I do understand the need and the want to control a persons own treatment. Some of you might even have become quite the experts on it. That does not change the fact that these studies are done in a lab setting for a reason. Alot of things can go wrong when you are messing with the gas exchange in your bodies. What if by chance your friend's centrals was underlying complex apnea brought on by a heart condition? You raise his pressure thus messing with the gas exchanges in his body causing a chain reaction. 1st his co2 levels go crazy in his lungs, causing him to hyper/hypoventilate, causing a panic attack, causing increased heart rate and unwanted stress on an already sick heart, causing him to go into cardiac arrest. In a lab setting we are trained to deal with these things as they happen. In a hospital setting they have a team seconds away to treat the pt. WE MONITOR THE HEART! I am not saying that this is what is going to happen but it could. There are reasons that so many things are monitored during the study. Some for better treatment of your sleep, and some to make sure that you don't die during the process. Yes for some people that have gone a long time without treating their apnea, death is a possibility. Generally it is not the sweet death of just going to sleep and not waking up. Untreated or improperly treated apneic pts go out with massive heart attacks, strokes, or siezures. or worse yet a slow health declining death do to a lack of o2 in the blood stream. mike I don't know what you do, and i mean you no disrespect, but are you trained to handle anyone of these situations? I am. Not only am I trained, but I(we) practice to perfection exactly what to do. As a trained sleep specialist I am evaluted on how I perform these drills, and my job is dependent on my evaluation. What would you do if you punctured a lung due to high titration? Collapsed a lung? Collapsed an airway. Could you, or any of you perform a tracheotemy if you had to on the fly? Could you live with the fact that your titration advice killed someone. The answer to your question is yes I feel strongly about this subject. I am also a little upset about this post. Mike you lead me to believe that this might be a bad titration done by a tech, in a lab setting. I went to my peers and instructors for advice for you and your friend. I spent hours researching this subject looking for answers! When in fact it is a bad titration done by you/or your friend. By all means people experiment with your machine, change your mask, your straps, your humidity! Try mouth pieces and surgery, positional therapy. Remember one thing changing your pap pressure is changing a prescription, and now matter what way you look at it, it can and eventually will lead to a dangerous side effect. Maybe I am being a little dramatic, but these are the worries that have been beatin into me as I have gone through my training. I personally have had to blow life back into a pt. I have seen people turn blue. I hope that no one here ever has too. I have to go through 2 years of training just to be able to perform a psg or CPaP study, yet this still does not entitle me to be able to determine a persons PaP pressure. This is a Dr.s' job. If you are not satisfied with what oyur Dr. tells you or how you are diagnosed. I am sure that there is another Dr. right next door, down the street that would be happy to reevaluate you.

Mike said:

guilty as charged. yes, he changed it on his own. is that something you feel strongly about?

Rock Hinkle said:

When you say "we" do you mean that the 2 of you raised the pressure on your own?

Mike said:

funny that Judy said try 10. i think he was at 10 for awhile, and was doing better than he is now. . . making real progress. then we thought that if we raised the pressure more, that we would zero out the remaining apneas and do even better. maybe it was a case of pigs getting slaughtered...

... fascinating information about the central vs. obstructive, and how obstructives can actually be far more damaging than centrals. intuitively, centrals sound scarier because it makes you think something is terribly wrong here with the brain and we have no idea how to fix it... at least with obstructives, you can make sense of it all and it seems like something that can be easily dealt with by upping the positive airway pressure. your last post makes me rethink all of that.

• ▶ Reply

Permalink Reply by sleepycarol on March 30, 2009 at 5:59pm

I too realize this is a touchy subject with many professionals in the sleep field. Yet, for many of us that are thrown to the wolves -- with no support, no follow-ups, no anything -- we do the next best thing.

I make informed choices in my life. I do not take things lightly and ask anyone that knows me and they will tell you it takes me forever to make decisions that I have to live with. Picking out my car (when we purchased it new) was a very difficult decision for me to make. When we have purchased new furniture. I go look at all the new up to date styles. A week or so later I am back in the store to relook. Give me another week or so and I have narrowed the choices down. Back to the stores I go. I think you get the idea by now. I have a college education with over 190 college credits under my belt. So I am not exactly a simpleton that goes off on tangents.

When I asked my primary care physician for a sleep study -- she scheduled it. I thought for sure I would meet with the sleep doctor at some point. Nope, never did. We are a small community with only one sleep doctor for approximately 75 mile radius. It takes over a month or more for appointments. My primary doctor scheduled it. I went to the lab as instructed, given the sleep study, and no one told me anything, no appointment with the sleep doctor was given, zip -- nada -- nothing. Okay next step, is my primary care doctor calls and says that the sleep doctor has faxed her a request that I come back for a titration. No one had even explained that the results were positive and I would have to go back. I set up the return visit for the titration. When I went for it the nurse that was doing the study was surprised that I knew absolutely nothing about my results. Told her I had not spoken to the doctors. She explained how busy he was and it was difficult to get an appointment, etc. etc.

When the sleep doctor faxed the stuff to my primary care doctor she called and told me to pick up the paper work and go get my cpap. No explanations, no anything. Took the paper work to the DME that set it up and was headed out the door.

AND I want to leave my treatment up to THEM? Don't think so!! I will take my chances and monitor my own therapy with the software and if pressure changes are needed I will make them. My primary care doctor is fully aware of me changing my pressure and I have her blessings. Says she doesn't know much about sleep apnea or machines and I know more than she does.

Don't mean to sound critical of those in the field of sleep medicine. If you are here helping you are in the minority. Many just shove their patients out the door with little or no information. That is why forums like this are invaluable so that users can get the support needed to make informed choices.

If I had a sleep doctor that took the time to help his patients and a DME that was helpful and knowledgeable I wouldn't have to take my therapy in my own hands. I would allow them to do their job.

• ▶ Reply

Permalink Reply by RockRpsgt on March 30, 2009 at 6:15pm

Thanks for the artical JNK. Got any other good info for an up and coming tech?

I do agree that it is probably where the industry is going. If you have the Doc's permission that is one thing. Then it becomes a part of your prescription. Along with the right and knowledge to do this comes a certain responsibility. a responsibility to yourself if your are the one raising/ or changing the prescription. Your right everyone on this site is probably smarter than the auto algirithm. That however does not give anyone the right to do it before they know what the side effects could be. Most of the people are here because of the bad experience they had with their sleep professionals. Just because a Dr. says he can trust a patient to raise the pressure does not mean that they are armed with the whys and hows. I think you should have to take an apne/titration test first to demonstrate that you understand the complexity of apnea/hypopnea syndrome and the titration there of. At the very least to know not to raise for CSA. Then let them go and do what ever they want. At least by doing this we would know without a doubt that the Dr. gave, and the pt got, an education on sleep related breathing disorders and the use of a xPaP machine( excluding Judy whom has proven that she is far more educated than me on the subject.)
j n k said:

Personally, I advocate getting diagnostic sleep studies done. It is my opinion that it is good to screen patients for other conditions when the patient can afford to get that done. I also advocate getting a professional initial titration. PLMs and centrals can be unmasked during that process, and they may turn out to be serious enough to address in some cases. But once a patient is diagnosed plain vanilla OSA and a sleep doc thinks that patient can be trusted with an autotitrating machine, that is a green light to self-titrate, in my opinion. After all, I ain't no genius, but I'm smarter than the average auto algorithm that docs are trusting patients with in machines set wide open at 4 to 20 cms. Now THAT is dumb. On the other hand, self-titrating plain vanilla OSA is the best way for any patient to optimize treatment for the best health possible.

Only one man's opinion.

It may be worth noting, though, that many sleep docs advocate allowing the patient to adjust pressures. It's the way the industry is headed, I believe.

Here's an interesting article on simplified protocols too:

http://www.sleepreviewmag.com/sleep_report/2009-03-18_03.asp

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