Titration Sleep Study: Can It Be Done At Home?

A CPAP titration sleep study is used to determine the ideal rate of airflow needed to treat a person with a sleep-disordered breathing disorder. While traditional titration studies are generally conducted in a lab, they can be done at home in certain cases. If a person has uncomplicated obstructive sleep apnea (OSA), an APAP machine can be used to automatically adjust the pressure and may eliminate the need for a separate titration study. At-home CPAP titration with an APAP machine is only recommended for people with uncomplicated OSA, as evidence suggests it is as successful as laboratory CPAP titration for this specific group.

What is a CPAP titration sleep study?

A CPAP titration sleep study is used to determine the ideal rate of airflow needed to treat a person with a sleep-disordered breathing disorder, such as obstructive sleep apnea (OSA) or central sleep apnea (CSA). This type of sleep study involves connecting a person to a CPAP machine while they spend the night in a sleep laboratory.

During a CPAP titration sleep study, the sleeper undergoes polysomnography, a standard overnight sleep study that measures various physical markers such as heart activity, breathing, blood oxygen levels, snoring volume, and body position. The CPAP machine is connected to the sleeper and turned on at a low air pressure rate. As the person sleeps, the rate of airflow is increased in small increments until a rate successfully opens the person's airway so that they no longer have lapses in breathing. This number is then chosen as the fixed rate for the sleeper's CPAP machine.

CPAP titration sleep studies can be performed as a full-night study or a split-night study. A full-night CPAP titration study is prescribed for people who have already been diagnosed with a sleep-related breathing disorder, and the sole purpose is to calibrate the CPAP machine's airflow rate to the sleeper's needs. In a split-night study, the first portion of the night is used to diagnose the cause of sleep-related breathing issues, and the remaining time is used to titrate a CPAP machine.

A CPAP titration sleep study is typically given to people who have been diagnosed with a sleep-related breathing disorder and is used to calibrate the CPAP machine to the individual's needs. At-home CPAP titration is another option, using an auto-CPAP or APAP machine that can automatically adjust the airflow to maintain unobstructed breathing. However, at-home CPAP titration is only recommended for people with uncomplicated OSA.

What happens during a CPAP titration sleep study?

A CPAP titration sleep study is used to determine the ideal rate of airflow needed to treat a person with a sleep-disordered breathing disorder, such as sleep apnea. This involves connecting the person to a CPAP machine while they sleep in a sleep laboratory. The process is as follows:

Firstly, the CPAP machine is connected to the sleeper and turned on at a low air pressure rate. As the person sleeps, the rate of airflow is gradually increased in small increments. When a rate successfully opens the person’s airway so they no longer have lapses in breathing, that number is chosen as the fixed rate for their CPAP machine. If a person continues to have trouble sleeping, humidity might be added to the CPAP air. If they are still experiencing breathing issues or are struggling to tolerate the therapy, they may be put on a bilevel positive airway pressure (BiPAP) machine, which uses different air pressures for inhalation and exhalation.

There are two types of CPAP titration sleep studies: full-night and split-night. A full-night study is used to calibrate the airflow rate of the CPAP machine for people who have already been diagnosed with a sleep-related breathing disorder. In a split-night study, the first portion of the night is used to diagnose the cause of sleep-related breathing issues, and the remaining time is spent titrating the CPAP machine. If there is not enough time to calibrate the machine properly, a follow-up full-night titration study may be ordered.

During a CPAP titration sleep study, the sleeper’s body is connected to various monitoring tools, such as those that measure heart activity, breathing, blood oxygen levels, snoring volume, and body position. A technologist watches and listens to the sleeper from another room, using an infrared camera and microphones. The technologist connects the sleeper to a nearby CPAP machine using a tube and mask, and in a full-night study, the sleeper is connected to the CPAP for the entire study. In a split-night study, they are connected for at least three hours. The technologist may swap out masks throughout the night to see which type works best, taking notes on how well each mask fits and if it leaks air.

Types of CPAP titration sleep studies

A CPAP titration sleep study is used to determine the ideal rate of airflow needed to treat a person with a sleep-disordered breathing disorder, such as sleep apnea. This involves connecting the patient to a CPAP machine while they sleep in a sleep laboratory, and gradually increasing the airflow rate in small increments until their airway remains open.

The gold standard for CPAP titration is a full-night study at a medical facility. However, there are several types of CPAP titration sleep studies:

Full-Night CPAP Titration Study

This is prescribed for people who have already been diagnosed with a sleep-related breathing disorder. The sole purpose of this study is to calibrate the CPAP machine’s airflow rate to the sleeper’s needs.

Split-Night CPAP Titration Study

In a split-night study, the first portion of the night is used to diagnose the cause of sleep-related breathing issues. If a sleep-related breathing disorder is diagnosed, the remaining time is used to titrate a CPAP machine. This type of study is usually only offered if the sleep apnea is severe and the diagnosis is clear. If there is not enough time to calibrate the CPAP machine to the sleeper’s needs, a follow-up full-night titration study might be ordered.

At-Home CPAP Titration Study

In some cases, titration can be done at home using an automatic positive airway pressure (APAP) device. These machines automatically adjust air pressure to maintain unobstructed breathing for the user. At-home CPAP titration with an APAP machine is only recommended for people with uncomplicated obstructive sleep apnea. Evidence suggests at-home titration with APAP is just as successful as laboratory CPAP titration for those with uncomplicated OSA.

Who needs a CPAP titration sleep study?

A CPAP titration sleep study is generally prescribed for people who have been diagnosed with sleep apnea or another sleep-related breathing disorder, such as hypoventilation or hypoxemia. The study is used to determine the ideal rate of airflow needed from a CPAP machine to treat the individual's sleep-disordered breathing.

During a CPAP titration sleep study, the sleeper undergoes polysomnography, a standard overnight sleep study that measures various physical markers, such as heart activity, breathing, blood oxygen levels, snoring volume, and body position. The CPAP machine is connected to the sleeper and turned on at a low air pressure rate. As the person sleeps, the rate of airflow is gradually increased in small increments until a successful rate is found that opens the person's airway and prevents breathing lapses. This number then becomes the fixed rate for the sleeper's CPAP machine.

A CPAP titration sleep study may be recommended for individuals with certain characteristics or situations, such as:

• Obstructive sleep apnea complicated by coexisting conditions like pulmonary disease or congestive heart failure.
• Facial features that may cause a CPAP mask to leak.
• Suspected central sleep apnoea caused by the brain.
• The need to test out various CPAP mask types due to discomfort or air leaks.
• Previous unsuccessful at-home titration attempts using an auto-CPAP (APAP) machine.
• The presence of mental or physical health issues that might interfere with at-home CPAP titration.
• Situations that make at-home titration difficult, such as homelessness or living in a nursing home.

Additionally, a CPAP titration sleep study may be considered if an individual is already using a CPAP machine but feels that the airflow pressure is too high or too low, and adjustments are required to improve their sleep quality.

How to prepare for a CPAP titration sleep study

A CPAP titration sleep study is an overnight procedure that helps determine the correct air pressure for your CPAP machine. This machine is used to treat sleep-related breathing disorders such as sleep apnea, hypoventilation, and hypoxemia. Here are some tips on how to prepare for a CPAP titration sleep study:

Before the Study:

• Follow your normal daily routine as much as possible.
• Avoid caffeine after lunch or noon.
• Avoid alcohol and any other stimulants.
• Refrain from using hair products such as sprays or gels that can interfere with sleep recording.
• Inform your doctor about any medications you are currently taking. They may advise you to stop or adjust your dosage temporarily.
• If you feel anxious about the study, ask your doctor if you can visit the sleep lab beforehand to familiarise yourself with the environment.

What to Bring:

• Pack comfortable, loose-fitting pyjamas or clothes to sleep in.
• Bring a toothbrush, toothpaste, and dental floss for your nightly routine and the next morning.
• Bring clean clothes to change into for the next day.
• You may also want to bring items that help you relax, such as a book.
• If desired, bring your pillow from home.

During the Study:

• Inform the technologist if the CPAP mask is uncomfortable or if there are any air leaks.
• Tell the technologist if you experience any discomfort during the CPAP treatment.
• Communicate with the technologist if you are ready to sleep.

Remember, it is important to follow any specific instructions provided by your doctor or sleep specialist, as each person's case is unique.

Frequently asked questions