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Ach, Duane. You are being too too critical of APAPs. They have their use and their place in xPAP therapy and even Dx'ing.
There is absolutely NO DOUBT in my mind that an in-lab evaluation PSG and an in-lab titration PSG are the BEST way to go. There are more sleep problems than "just" OSA ... BUT - if a person has severe sleep problems that indicate the problem may be OSA AND no insurance and limited financial means a PROPERLY setup APAP trial is better than nothing at all.
If a person absolutely can NOT sleep in the lab sufficiently long to get a decent titration - better an APAP at home set somewhere near the best that could be titrated, if any titration at all was possible, in the lab again is better than no CPAP therapy and you can't just keep people coming in for titration after titration. Its just not economically feasible.
I only slept 42 minutes out of 6 hours bedtime for my first titration so they brought me in for a second titration. I only slept 98 minutes out of 6 hours bedtime the second titration. There were two additional "by guess and by gosh" pressure changes and then I INSISTED on a loaner APAP and we FINALLY found a pressure that worked for me.
It has NOTHING to do w/"dumb" sleep techs, or incompetent sleep techs. I make no secret of the fact that I'm not too impressed w/sleep doctors or local DME supplier RRTs or RTs and that I consider the RPSGTs the only true heroes in the sleep profession. But I still feel there is a place for APAPs in OSA therapy.
Ah, but there again, Rock Hinkle, WHAT was the pressure range of those started out on an auto who were having the most problems?? Wide open? 4 cms to 20 cms? Ridiculous! I have COPD which my sleep pulmo/critical care doctor was well aware of and even so when I received the loaner auto it was set at 4 cms to 20 cms. Sheesh! Did he not know any better or did he leave it up to the local DME's RT to set the range or did the local DME's RT take it upon herself to set it at that range?? DUMB! I had had an in-lab titration. True it was an insufficient one (thru NO fault of the tech or lab or doctor) but nonetheless they had SOME idea of pressure to work with. Even w/NO previous in-lab titration I would have thought a pressure range of 6 cms to 15 cms would have been a wiser choice.
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