​Sleep Disorders Center of Santa Maria

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PAP or positive airway pressure treatment is used to manage sleep-related breathing disorders including obstructive sleep apnea, central sleep apnea, complex sleep apnea and hypoventilation and hypoxemia.  Once you are diagnosed with one of these disorders, you may need a CPAP titration study before you can begin treatment.  A CPAP titration study is a type of in-lab sleep study used to calibrate continuous positive airway pressure (CPAP) therapy.  The titration polysomnogram will also allow the sleep technician fit you for a comfortable fitting mask that will work well for your needs.

Although we generally refer to all forms of positive airway pressure therapy as “CPAP” there are a number of other variations on PAP therapy which are different ways of delivering the air pressure.  A PAP titration polysomnogram will allow your sleep specialists to determine which type of PAP device is best for your.  Some of the types of PAP devices include: CPAP, Bilevel PAP, APAP, VPAP, VPAP-ASV, VPAP-ST, and IVAPS. 

In some cases, members of the sleep team may perform a CPAP titration study on the same night as your diagnostic in-lab 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 moderate to severe and the diagnosis is clear early on in your diagnostic polysomnogram.

In more mild cases of sleep apnea, the CPAP titration study may occur on a second night after the sleep specialist reviews the results of the diagnostic in lab sleep study. 

CPAP Titration Study - Preparing for your study

Your CPAP titration study involves an overnight stay at a thesleep center.   The testing environment at the Sleep Disorders Center of Santa Maria is set up so you will be comfortable during your stay.

On the day of your in-lab sleep study, you should:

Try to follow your regular routine as much as possible.
Avoid napping
Eliminate use of caffeine after lunch
Shower or avoid using hair sprays or gels that can interfere with the monitors for your sleep recording

If you are on a regular medication, speak with your board-certified sleep medicine physician. Your doctor may recommend for you to temporarily discontinue using the medication.

When it is time to report for your CPAP titration study, bring any items that you need for your nightly routine. Prepare for the sleep study as if you are staying at a hotel for a night. You may want to bring:

1. Comfortable pajamas or clothes to sleep in
2. A toothbrush, toothpaste and dental floss
   
3. Makeup remover
   
4. Reading material
   
5. Clean clothes for the morning
   

CPAP Titration Study - Testing

The main goal of your titration polysomnogram is to find the right amount of air pressure to prevent your upper airway from becoming blocked. This eliminates breathing pauses in your sleep and should allow you to breath easily while you are sleeping.During a CPAP titration study, members of the sleep team will calibrate your CPAP and adjust your pressures.  The polysomnogram technician will also fit you for a comfortable mask.

When you show up for the study in the early evening, you will be fitted with an appropriate mask that is connected by a tube to a small electric PAP 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 PAP unit has a fan that blows air through the tube, into your mask. When you wear your mask, the air will gently blow into the back of your throat acting as a pneumatic stent to keep your airway from collapsing while you are sleeping. 

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 will have a television that you can watch for a short time before your fall asleep.

The sleep technologist will attach sensors to your body to monitor your sleep in just the same way as in the in-lab sleep diagnostic study. These sensors measure your brain waves, heart rate, 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. This will make sure that the sensors are working and to calibrated all of the equipment.

Using a computer in the control room, the technologist will be able to control the PAP air pressure and the way the pressure is delivered to you.  At certain intervals throughout the night, the technologist will remotely change the air pressure you receive through your mask. Pressure starts at a very low level and gradually increases. If problems are detected, the technologist may come into the bedroom to adjust or replace the CPAP mask. Tell the technologist if you are experiencing any discomfort with the CPAP treatment.

Many patients do not sleep as well as they would at home. This may be because of the sensors or the unfamiliar environment.   Occasionally, you may be prescribed medication to help you sleep during the titration sleep study.

In the morning the technologist will test and then remove the sensors. The CPAP titration study is complete once you are awake and the sensors have been removed. You are free to leave and return to your normal activities.

CPAP Titration Study - Results

The board certified sleep physician will review the information gathered during the CPAP titration study to determine what level of CPAP treatment will work best for you on an ongoing basis. The physician will contact you when the results are ready.  At a follow up visit your results will be discussed and a CPAP will be prescribed for you.  You will be given instructions on how to get a CPAP unit and mask for use in your home.  

CPAP Titration Study - Follow-up

On rare occasions, a CPAP titration study may fail to find the right pressure to treat your sleep apnea. In these cases, you may need a variable pressure device (or one of the other types of devices described above) instead of continuous pressure. The sleep physician may recommend a second titration study.

Follow up in the office is very important to confirm the efficacy and compliance you’re your PAP treatment.  When you come in for your follow up visit at the Sleep Disorders Center of Santa Maria it is important to bring in your PAP unit with the tubing mask etc.  The CPAP will be downloaded at the follow up visit and the data reviewed.  You should also have a list of any problems or complaints that you have with the CPAP so that these issues can be addressed.  Changes in pressure, air temperature, air humidity, mask size or type  and device type may be needed during the first few months of treatment.

Sometimes the CPAP titration study may not determine your ideal set-up. If you have problems with the masks, straps, pressure or air temperature of your machine, contact the Sleep Disorders Center of Santa Maria as soon as possible.   The sleep specialist may suggest a new mask, a machine that provides a different algorithm of pressure delivery or a change in your humidifier to make your treatment more comfortable. A nasal spray in some cases may help CPAP users with nasal congestion problems. Always talk to your sleep medicine physician before making any changes to your treatment.

 

CPAP TITRATION POLYSOMNOGRAM