Any insight or thoughts on why sleep clinic result is very different from autotitration by APAP machine?
I had a tritration done at a sleep clinic and was told to set the pressure to 7.
I was not sleeping well with pressure at 7 (AI up to 10) after 2 months.  
For a few nights, autotitration using my resmed autoset II, set at 7 to 10, indicates a pressure reading of 9.2 to 9.8 off the display of my machine; (AI is less than 1).   I'm wondering if my pressure has to be changed to a higher one, based on this autotitration data.

My leak rates has been in the range of 0.22 to 0.38, reading off the display of my machine.  

Info:  Resmed Autoset II, Mrage Active LT.

I would appreciate any help or advise.

Thank you.

Is your AHI < 5?  If so, it sounds like your clinical titration was not accurate.  AutoPAP titration is usually quite accurate if the range is set tightly, as yours is.  Do you think that you slept for more than a few hours during your titration?   Did you sleep in a different position during your titration than you are now?

APAP titration DOES have the advantage of detecting the TRENDS in your sleep from night to night rather than basing its response on just ONE night of sleep in strange surroundings w/a lot of extra equipment attached to you.


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Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed VPAP Auto. Humidaire 3i, Simplicity mask, ResScan 3.7, S8 ResLink, Embla oximeter.

I appreciate the responses.
I was lying on my back for both clinical and APAP titration.
I felt that I did not sleep well during my clinical titration (felt like I did not go into deep sleep).  For my APAP titration, I slept for around 5 hours (still tired that day but felt that I went into deep sleep).
AHIs were between 2 and 3 for APAP titrations.

What would you advise ?   Operate my machine on APAP mode permanently.  Or operate my machine as CPAP at the higher pressure of around 9.2.   What would result in a lower AI ?    I would appreciate your thoughts.

Again, thank you the support.

It is against the policy of this forum to give advice regarding the setting of your pressure.   It really would be a good thing to bring this situation up with your sleep doctor because it appears that your titration may be incorrect and something may need to be corrected at the sleep laboratory.  

You have a better AHI with the pressure that your autoPAP has determined that you need.  For people who do not have positional apnea, it is generally better to use a fixed pressure; and your machine seems to indicate that you do not have positional apnea.

I appreciate and fully understand the policy.   And yes, I have an appointment with my doctor a week from now.  I trying to get as many opinions as I can (not necessarily about the pressure but about CPAP versus APAP, clinical tritration versus APAP titration)  and educate myself so that I could ask appropriate questions when I see my doc.

I'm curious why you think that I do not have positional apnea though.  

Thank you.

Once you have an accurate pressure, which mode is best for you is pretty much which mode you feel best in.  Some people (like me) are sensitive to the constant pressure variations of an APAP and even if their AHI is low, they still have disrupted sleep because of their sensitivity.  Get a copy of your sleep study (which is a good idea to have anyway to be educated about your disorder) and/or discuss with your doc. whether or not your OSA is positional.

Vicki


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Being defeated is often a temporary condition. Giving up is what makes it permanent.
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That which does not kill you makes you stronger-Friedrich Nietzsche
Friedrich must of had apnea.

I will.  Thank you Vicki.

It didn't appear that you had much difference in position because your range is pretty small; 9.2 to 9.8.  I read of a study that indicated that autoPAP titration is quite accurate.   Home titration is done under real-life conditions in your own bed, it is done for a long period of time; it is not done for a few hours under quite stressful conditions.  First timers have an especially difficult time with their first titration, and an autoPAP gives them time to become more comfortable with CPAP before the pressure is determined.

Current autoPAPs have some problems.  One problem is that if the pressure range is too wide, they can run away and raise the pressure far too high, they need to be set within a narrow range, as yours is.  Another problem is that autoPAPs can cause arousals when they change pressure.

Thank you.  A related question ... I got an AI of around 0.6 (AHI of around 3) when using the APAP.    Is it correct to  assume that the reason why the AI is not lower (e.g. 0.1 or 0.2) is because apnea events occur when the pressure is at the lower limit of the APAP pressure range.   Is AI = 0.6 for APAP a good number ?