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What Is A Titration Study For Sleep Apnea

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Positive Airway Pressure Titration Study

What is a titration study

As a result of your initial sleep study , you may be diagnosed with obstructive sleep apnea , and may be sent by back to the sleep center for another sleep study with continuous positive airway pressure or bi-level positive airway pressure . These forms of therapy are the most effective and widely used methods of treating sleep apnea.

What Is Cpap Titration

CPAP titration studies are conducted overnight in the sleep laboratory. During the study, you will monitor your patient’s breathing and adjust the CPAP pressure to determine the proper air pressure required to prevent upper airway blockage, eliminating pauses in their breathing while they sleep.

You’ll fit your patient with a nasal mask that connects to a tube on a small pressure generating device. During a CPAP titration you will monitor their sleep just like you would during an in-lab diagnostic sleep study. You’ll measure their:

  • Breathing
  • Brain waves
  • Arm and leg movements

You’ll change your patient’s CPAP pressure remotely as needed during the night. The patient starts at low levels of pressure, which are then gradually increased when events are seen.

A patient may need a CPAP re-titration study if their previous symptoms like snoring, apnea, or daytime sleepiness come back despite their CPAP treatment. This allows for determination of their correct pressure setting.

A Sleep Center Shares Its Sleep Technologist

Sleep-disordered breathing is defined as the repetitive cessation or decrease of airflow during sleep and encompasses both obstructive sleep apnea , characterized by occlusion of the airway with continued effort to breathe, and central sleep apnea , characterized by the absence of respiratory drive to breathe and absence of respiratory effort on the polysomnogram . Whereas OSA is quite common, CSA comprises a small percentage of patients referred to the sleep laboratory and accounts for about 5% to 10% of patients with SDB.1 Though the treatment of OSA with positive airway pressure therapy is relatively straightforward with well-defined protocols, treatment protocols for CSA are less well established. In the sleep laboratory, the technologist is tasked with initiating therapy for both types of sleep apnea and determining an optimal treatment level.

At our sleep laboratory at the University of Kansas Health System, we have utilized a number of suggested protocols and have had varying success in the use of PAP in treating CSA in a split-night protocol. We contacted several sleep laboratories in our region and found no consensus on a PAP titration protocol for CSA in some sleep labs, a written protocol did not even exist. Our goals were to better understand characteristics of CSA, review the literature related to using PAP therapy in the treatment of CSA, and develop a more effective titration protocol.

Robert Whitman, PhD, DABSM, RRT, RPFT

References

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Types Of Sleep Disruptions

While apneas, which occur when you stop breathing for at least ten seconds, are typically the most common characteristic of sleep apnea, there are other types of sleep disruptions that will be charted during your sleep study. A hypopnea, a partial cessation of airflow, can be just as serious as an apnea, or you may have a respiratory effort-related arousal that can disrupt the depth of your sleep without qualifying as an apnea or hypopnea. The sleep study should note other arousals or partial awakenings or excessive movements, which will help your doctor assess your sleep quality and select the most appropriate treatment option.

Sleep disruptions create significant short-term and long-term health consequences ranging from mild stress to serious cardiovascular and metabolic issues, so the quality of your sleep is very important.

The Split Night Sleep Study: Challenges And Problems

Titration study in sleep lab

To someone who may be suffering from obstructive sleep apnea , the two-night overnight/nocturnal polysomnogram plus continuous positive airway pressure Titration Study is considered the gold standard of sleep studies.

But what if, for some reason, you are unable to devote two nights at a sleep clinic? For example, an insurance provider may only choose to cover one night, leaving you to pay the full bill for the other. Or you may find it difficult to sleep in the unfamiliar environs of the sleep study center. Or other personal, financial, or work-related issues may make it difficult to commit to the two-day, non-contiguous window required for the NPSG/Titration studies.

A compromise option is available to diagnose and to treat obstructive sleep apnea: the split night sleep study. However, like most compromises, it solves one problems but potentially creates more serious issues, including possibly missing out on gathering the most complete information about your OSA and being unable to asses the correct treatment for your individual sleep impairment.

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Interpreting The Study And Results

MySleep maintains a network of sleep specialists to review and interpret the test data received. Immediately after the data has been interpreted, the final recommendation report will be e-mailed or faxed to your healthcare practitioner.

Consult with your doctor on the results and treatment options. Please SMS or for a copy of the report.

Once you have been diagnosed and begins therapy, aftercare should include routine follow ups. It is common for patients to adjust the pressure during their years of CPAP or BiPAP therapy, and you may be tested routinely to ensure your PAP machine is calibrated correctly.

Please contact us for more information on the testing procedure, medical aid authoritarian and pricing.

Nocturnal Polysomnography With Cpap Titration At The Sleep Disorders Institute

If youve been diagnosed with a sleep-related breathing disorder, doctors can perform a sleep study to help determine the best course of treatment. This specific type of sleep study is called nocturnal polysomnography with CPAP titration and is commonly used for the following disorders:

  • Obstructive sleep apnea a partial or full blockage of air flowing through your upper airway
  • Central sleep apnea breathing repeatedly stops and starts during sleep
  • Hypoventilation and hypoxemia too little oxygen in the blood

During the sleep study, a series of electrodes will be attached to your scalp, face, chest and lower legs to monitor your breathing and other data indicators while you sleep. Next, something called a CPAP or a BiPAP device will be placed over your face. Then, youll be left alone to sleep in a private room thats designed to look like a comfortable, furnished bedroom while your data are recorded.

What Are CPAP and BiPAP Devices?

CPAP stands for continuous positive airway pressure, and BiPAP stands for intermittent positive airway pressure. These two devices are both used to treat sleep-related breathing disorders the signs of which become more prevalent as you age, starting in your 30s. By sending pressurized air into your nasal passage throughout the night, they help keep your airway open, so that you can get the oxygen you need. As a result of using a CPAP or BiPAP device, youll be able to start enjoying more restful nights and improved overall health.

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Offering A Wide Range Ofsleep Disorder Services

Our respiratory team offers a high quality, cost-effective service and clinical expertise to patients suffering from sleep problems. Our innovative laboratory services enhance sleep health.

Our respiratory team offers a high quality, cost-effective service and clinical expertise to patients suffering from sleep problems. Our innovative laboratory services enhance sleep health.

Once it has been determined that you have sleep apnea, a pap titration study is performed to determine the level of pressure that is necessary to keep your airway open.

What Is The Testing Process For A Cpap Titration Study

OSA Journey Chapter 1 – What to expect during and after your sleep study

During a CPAP titration study, members of the sleep team will calibrate your CPAP. The goal is to find the right amount of air pressure to prevent your upper airway from becoming blocked. This eliminates breathing pauses in your sleep.

When you show up for the study in the early evening, you will be fitted with a nasal mask or a full face mask that is connected by a tube to a small electric unit. The fitting process is an important first step in the CPAP titration. Be sure to tell the technologist if the mask is uncomfortable or if there are air leaks around the edges of the mask. The electric unit has a fan that blows air through the tube, into your mask. When you wear the mask, the air will gently blow into the back of your throat.

You will have some time to make yourself at home. There will not be any other patients in your room. You will have a bathroom available to use, and you may have a television that you can watch.

When you are ready to go to sleep, tell the sleep technologist. The technologist will attach sensors to your body to monitor your sleep just like a sleep study. These sensors measure your brain waves, heartrate, breathing, oxygen levels and leg and arm movements. The wires are long enough to let you move around and turn over in bed. You will be asked to move your eyes, clench your teeth and move your legs to make sure that the sensors are working.

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What Types Of Tests Are Performed In A Sleep Study

An in-lab sleep study or polysomnogram is a comprehensive test used to diagnosis sleep and wake disorders. These tests are conducted overnight at a sleep study center, hospital or other designated site and are under the direct supervision of a trained sleep technologist.

Common types of in-lab sleep studies are:

What Is Obstructive Sleep Apnea

Obstructive sleep apnea , commonly called sleep apnea , or simply apnea , is a condition that occurs when a persons upper airway becomes so obstructed during sleep that they actually stop breathing.

OSA is most often caused by the most natural of all occurrences: when you sleep, all of your muscles relax, including those in your throat. If those throat tissues relax too far, or are heavier than your neck can support, they may end up squeezing your windpipe shut.

Since you are asleep, you are completely unaware that your own neck is choking off your air. Fortunately, our bodies are capable of rescuing us by waking us up every time this occurs: this restores our waking muscle tone, lifts the relaxed muscles off our throats, and allows us to gasp for air successfully. Unfortunately, this interrupts our sleep and then when we almost immediately fall back into it, the apnea cycle repeats, sometimes hundreds of times in a single night.

OSA is measured by using the Apnea-Hypopnea Index : an hourly measure of the number of completely blocked instances of breathing and partially blocked instances . An apnea lasts at least ten seconds reduces blood oxygen levels up to 4% and literally forces a person to be jolted awake by their autonomic nervous system, which interprets a full-blown apnea as being choked to death.

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How Do I Prepare For My Sleep Study

You will receive specific instructions about how to prepare for your sleep study. Some general information is as follows:

  • Do not drink alcohol or consume caffeine-containing beverages and foods for at least eight hours before your study.
  • Tell your doctor about all medications you are taking. You may be asked to temporarily stop taking a medication before your study.

On the day of your study:

  • Keep to your normal meal times.
  • Do not take any naps.
  • Shower and wash your hair but do not apply conditioner, hair spray, gels, or other hair products. Do not apply creams, lotions, powders, perfume, aftershave/cologne, cosmetics or any other products to your face or body. These products can interfere with the recording by electrodes that are placed on your skin.

Typically you do not arrive at your sleep study location until early evening.

+ Split Night Polysomnography

Home Unattended Portable Monitoring and Automatic CPAP ...

A split night, or 50/50 test, is an in-center type of sleep test that begins with diagnostic polysomnography, to monitor your vitals and movements. Once there is enough data to show that you have sleep apnea, you will be placed on CPAP and the test switches to titration to monitor your PAP settings.

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What To Expect At Your Overnight Sleep Study

The information presented in this post is for informational and entertainment purposes only. It does not replace advice from a medical professional. Please consult a medical professional prior to starting any new diet or exercise program. I am not a medical professional nor a fitness trainer. Every effort is made to ensure the information presented in the following post is accurate and true. Always follow your doctors instructions and advice first and foremost. Post may contain affiliate links, which means I make a small commission if you make a purchase at no additional cost to you. As an Amazon Associate I earn from qualifying purchases. For more information, please read my full terms of use, disclosure policy and privacy policy by clicking on the appropriate links.

An overnight sleep study could be one of the pre-op tests your doctor orders for you. They want to see if you have sleep apnea or another sleep disorder. They perform this test for a variety of reasons, but they want to be able to treat you if you have a dangerous sleep disorder. You wont need to bring much, just a few essentials. Theyll hook you up to a few electrodes and have you relax. The room inspires relaxation, as they want you to be as comfortable as possible. I had an overnight sleep study as part of my pre-op testing, and it was an interesting experience. The overnight sleep study is a necessary diagnostic test to determine if you have sleep apnea or another sleep disorder.

Pap Titration What Is It

This study is done at the lab and measures the same parameters as the polysomnogram with the addition of pap treatment. A continuous positive airway pressure machine is typically used once the pressure has been determined.

If you have difficulty tolerating the cpap pressure you may qualify for a bi-level machine. A bi-level machine has an inspiratory pressure and an expiratory pressure. This alternating pressure may allow more comfort in efforts to achieve compliance.

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What Can I Expect During An In

On the night of your sleep study, you will be assigned to a private bedroom in a sleep laboratory. Near the bedroom will be a central monitoring area, where the technologists monitor sleeping patients.

You will be hooked up to equipment that might look uncomfortable. However, most patients fall asleep with little difficulty.

The equipment used in a sleep test includes:

  • Electrodes. Electrodes on your face, scalp and body send electrical signals to the measuring equipment. These signals, which are generated by your brain and muscle activity, are then recorded. EEG electrodes measure and record brain wave activity. EOG electrodes record eye movements. These movements are important in determining the different sleep stages, particularly rapid eye movement sleep. EMG electrodes record muscle activity from the chin area and legs to identify abnormal movements in sleep and help in determining the presence of REM sleep.
  • A nasal-oral airflow sensor records airflow through your nose and mouth.
  • Belts placed around your chest and abdomen measure your breathing.
  • A bandage-like oximeter probe on your finger measures the amount of oxygen in your blood.
  • An ECG records heart rate and rhythm.
  • A snore microphone records snoring activity.
  • A video recorder records body movements, which will be matched against the electrical signals recorded by the electrodes.

Multiple Sleep Latency Test

Key Points – CPAP Titration Report

CPT Code: 95805

MSLT is the standard tool used to diagnose narcolepsy and excessive sleepiness that is not caused by another sleep disorder, like sleep apnea. MSLT testing is a series of daytime naps that measures how long it takes you to fall asleep. The test is based on the idea that the sleepier people are, the faster they will fall asleep. Sleep apnea or excessive leg movements are much more likely to be the cause of excessive daytime sleepiness. Narcolepsy is rare. The four most common symptoms of narcolepsy are hallucinations, sleep paralysis, excessive daytime sleepiness, cataplexy .

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What Is A Cpap Titration Study

A CPAP titration study is an overnight sleep study used to properly set continuous positive airway pressure therapy. CPAP is a common treatment used to manage sleep-related breathing disorders including sleep apnea, hypoventilation, and hypoxemia. Once you are diagnosed with one of these disorders, you may need a CPAP study before you can begin treatment.

In some cases, members of the sleep team may perform a CPAP titration study on the same night as a sleep study. This is known as a split-night sleep study. The CPAP titration occurs in the second half of the night. This is usually only offered if the sleep apnea is severe and the diagnosis is clear.

In more mild cases, the CPAP titration study may occur after a physician reviews the results of the sleep study. The doctor will decide if you need to come in for a CPAP study.

What To Expect During A Cpap Titration Study

If youve already had one sleep study, then you already know what to expect in terms of the preparation required to launch your test. However, theres one key difference: you will start your test using your CPAP therapy from the moment it begins.

Your sleep technologist will be available to you throughout the night to ensure you are comfortable and that all of your sensors are connected and functional.

They will be remotely changing the pressure on your machine as you sleep until it reaches the level that prevents the pauses in breathing the apneas from happening.

The pressure will start at a low level and will be very gradually increased in order to help you remain comfortable. If you experience discomfort, they can help you by adjusting other factors, like pressure relief or humidity, all from their station in the lab.

Remember, everyone is different in terms of how much pressure they need you may need a lot more than your friend, or you may need far less than your coworker.

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