Sleep Tech Tip of the Week

By Michael Miller, RPSGT
This week’s sleep tech tip is intended to serve as an aid when performing CPAP titrations. I have heard it said that the act of titrating a patient is an “art form” that is acquired over time. I have also heard it said that CPAP titrations are strictly objective and the “scientific guidelines” in place are to be followed without deviation. In my personal opinion, I think that titrations embody both theories. I believe that when performing a titration you should apply logistical guidelines for a point of reference, while intuitively being able to recognize when conditions warrant slight deviations from protocols.

The intention is that the following suggestions are to serve as a guide when titrating your patients:

1) Check the interface—ensure that the “mask” size is correct for the patient. If the mask does not fit, a leak of air pressure will occur. It is nearly impossible to achieve an accurate titration pressure with the presence of unacceptable leak values.

2) Precipitation is key—no matter whether you add cool pass over or humidity to the CPAP circuit, precipitation/moisture is essential for comfort. Most often a patient’s first experience with CPAP is while under our care. First impressions are extremely important for future compliance to CPAP therapy. Precipitation can also reduce the amount of pressure needed to accurately titrate your patient. A persistent pesky snore can often be eliminated with a slight amount of moisture rather than with a pressure increase.

3) Adaptation to circumstances is crucial—as all sleep professionals know there is no calculated procedure for titrations that will apply to all of your patients. The ability to apply objective procedures along with subjective techniques is necessary for dealing with unique patients who don’t fit the mold of a typical OSA candidate. Complex sleep related breathing disorder patients may require a deviation from standard OSA protocols when considering back up rates, comfort settings, and IPAP/ EPAP combinations.

4) Perseverance is paramount—perseverance can be defined as “steady and continued action or belief, usually over a long period and especially despite difficulties or setbacks”. In my opinion, the definition of perseverance is demonstrated in every CPAP titration performed. Titrations often contradict our natural instinct to abandon a course of action that is not producing immediate and favorable outcomes. When conducting a titration it may take several hours to obtain an adequate and tolerable pressure.

No matter which position that you support I believe that we all can agree that ultimately our goal is to aid in the diagnoses and treatment of sleep disorders while providing the most comprehensive patient care possible.

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Tags: apnea, cpap, cpap acclimation, cpap desensitizing, cpap mask, sleep apnea, sleep study, Sleepvirtual