Tracy R. Nasca
When sleep apnea is diagnosed during the overnight sleep study, a titration is then performed to determine the optimal CPAP pressure setting required to resolve apnea episodes. Sometimes the titration is performed during the second half of the overnight sleep study; this would be called a split night study. Your doctor may prefer a 2 night sleep study with the first night reserved for the thorough monitoring and collection of sleep architecture and data, followed by another full night for CPAP titration.
During the titration, the patient wears a mask and CPAP pressures are trialed up and down during sleep to find a single best pressure delivery and setting to control apnea events. Apneas can occur with different levels of severity during the varying sleep stages, body and sleeping position and other factors. This is why you are asked to sleep on your back, sides and stomach during the titration. The titration should include enough time to allow you to cycle through the sleep stages. Once a patient has been diagnosed and begins CPAP therapy, follow up and aftercare should include routine titrations. It is common for patients to need pressure changes during their years of CPAP therapy.
Each treating physician may have his own protocol and require a titration every year or two. Annual or frequent titrations most often occur when the patient has co morbidities such as hypertension or has previously suffered a heart attack or stroke and when closer monitoring is needed.
How will you know when it’s time for another titration? Successful CPAP therapy keeps the airway open and should cause you to awaken feeling refreshed. It should eliminate all snoring, gasping or choking sounds and sensations. When sleep apnea symptoms reappear, this would indicate that you probably need a pressure change. Old symptoms vary from patient to patient and you will remember what yours were, but they might include:
- Snoring – CPAP treatment should totally eliminate snoring when sleeping wearing the mask and using the machine.
- The return of frequent nighttime awakenings; gasping or choking on CPAP might indicate insufficient CPAP pressure
- The return of headaches and especially morning headaches – this might indicate low oxygen levels and insufficient CPAP pressure
- The return of excessive daytime sleepiness and fatigue which might indicates sleep deprivation
- The return of a decreased ability to focus and concentrate which might indicate sleep deprivation
- The return of memory loss which might indicate sleep deprivation
- The return of moodiness or depression which might indicate sleep deprivation
Personally, I liken my sleep apnea to having a heart condition. Although I am fortunate to have good heart health, I know that my CPAP therapy is important and partly responsible for that. A heart patient would routinely schedule a cardiac physical every year or two because it is the prudent thing to do.
Just as you would want to keep track of your heart health, you need to monitor your apnea condition. Sleep apnea, if left improperly treated, can lead to heart attack or stroke. Think of your initial overnight sleep study and titration as your baseline. Get organized and keep a copy of your sleep study report and all subsequent titrations as a method to track your treatment and progress over your lifetime of CPAP therapy.
Don’t assume your sleep doctor or CPAP supplier will contact you to suggest a titration. If your CPAP therapy seems to be working well and you are waking each morning feeling fully refreshed, then a titration might be needed every two years. Ask your sleep doctor what he recommends. But when you notice old symptoms reappearing, contact your doctor immediately to schedule a titration. A simple machine pressure change may be all that stands between healthy and restorative sleep versus an unrefreshed, restless sleep and even a heart attack or stroke. Don’t take chances!
The information included on this site is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice. Contact your physician or health care provider when you have health related questions. Never disregard or delay medical advice because of information you have obtained on this site.