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A while back we had a discussion about patients getting re-titrated. I am looking for data or studies behind the need to take a break from therapy before the study. if anyone hass anything I would appreciate it.

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Rock,
Taking "a break from therapy" is a big "no-no." When you stop using your machine you will obstruct your airway. This will result in (1) a drop in blood oxygen, (2) sympathetic nervous system surges and (3) sleep deprivation. When you have enough of these apneas night after night they cause diabetes, high blood pressure, heart problems including heart attack, heart rhythm abnormalities, stroke, and the list goes on..., not to mention it can kill you. Bottom line: Never stop your treatment, under any condition, no matter what.

Re-titration is done to be sure the pressure setting is the correct one for your current needs. I have a few words to say about this subject in my book. Feel free to ask questions or make comments if you get a chance to read it.
So there are no studies that say a patient should take a break from therapy prior ti a titration? Say of a night or 2? The rumor that I have heard is that the patient's AHI may not be as high. Is it just heresay or might there be some science behind this? That is what I am trying to find out Dr. Mack. I do appreciate your response.
Rock, I'm no expert by a long shot, but my understanding is that re-titration is to possibly re-set pressure if necessary. Wouldn't going off PAP prior mess up sleep and confuse the issue during titration? Just wondering....

McCord :-)
The rumor is that the pressure from the CPAP does something to the muscles in your airway. Your muscles actually get used to the air splint created by the positive air pressure. This muscle memory might last from one day to a week. This effect in theory would lower your AHI. By lowering your AHI it could hurt your chances of getting split during your study, or in rare cases cause insurance to turn you down for therapy. Like I said this is just some net talk so far. I have found several people who say it is so, but no evidence, studies, or science behind this. I am looking to find the evidence or squash the theory.
Okay Rock,

I have heard this same theory. I do not have anything to back up the claim -- just that I have heard it. Like you I have wondered about this since we are told even one night without our machine is dangerous. It would appear to me, when scheduling a retitration and IF you are told to NOT to use your cpap and the unthinkable happens it would place liablity on the person who instructed the patient to do this. How would this be handled?
yes, Thank you Cindy. Re-qualification. That sounds better. Thank you. The more i dig, the more I believe it is just a rumor.

Cindy Brown said:
Sounds like you're looking for information on re-qualification rather than re-titration. I've not heard this and it's not been my experience either.
I've read some of the same discussions about this that you have, Rock Hinkle.

I've only read of one person in the various apnea support forums being asked to do so and this person was concerned on whether he/she should do so or not or whether to find another sleep doctor and sleep lab.

My thought, though I didn't express it, was it would depend on my health and my OSA severity whether I would be willing to comply or not.
Could you please send me the links if you still have them.
mollete,
Give us the skinny would you please? If any of us patients end up in this situation, how should we handle it? I happen to have a Sleep Doctor I trust.... but, I wouldn't go off my various meds for a day or two with out a doctor's order, or ok, from each doctor I see. I'm afraid to not use my BiPap every night.
I have well documented sleep apnea. Are we talking about a medical issue here- retitrating pressures, or an insurance/disability issue?

Thanks,

Mary Zimlich

mollete said:
Rock Hinkle said:
. ..the more I believe it is just a rumor...

Nope! Not a rumor!

mollete
Rock,
It's just hearsay. If you have evidence to the contrary, we would definitely like to see it. I have not seen it myself. Wouldn't it be great if it were so. We could teach our muscles to stay open and eventually we wouldn't need out PAP machines at all. Those on APAP can answer the question for us. Their downloads should show progressive drops in their apneas over time, assuming everything else remains unchanged.
The AHI is not a fixed number that remains the same from night to night. It is dynamic and subject to change, depending on positioning of the body, head and neck, the presence of allergies, upper respiratory infections, weight gain or loss, hydration status, and the aging process itself. That's one of the reasons I prefer auto-titrating CPAP machines over regular CPAP machines. You don't have to keep going back to the sleep lab for re-titration$.

Rock Hinkle said:
So there are no studies that say a patient should take a break from therapy prior ti a titration? Say of a night or 2? The rumor that I have heard is that the patient's AHI may not be as high. Is it just heresay or might there be some science behind this? That is what I am trying to find out Dr. Mack. I do appreciate your response.
Be very careful in what you decide

i would only reccommend that course under lab conditions while bein closely monitored
As of right now I would not recommend it to anyone. It has been mentioned on this site as well as others. I was looking for evidence to back it up. Sorry if I confused anyone. Thanks for your help Dr. Mack.

mollette do you feel that down titration protocol should be used in titrations.

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