Review the following titration scenarios and discuss the progression of titration. If you were the sleep technologist, what would you do? How high would you increase pressures? Answer the prompts in the assignment. Assignment should be at least 500 words long and address each question with thoughtful responses, free of grammatical or spelling errors.

Titration Scenarios
Split-night Titration with CPAP:
Patient begins in diagnostic mode, with nadir of 85% and AHI=28 by midnight, after REM sleep. Patient
has events while supine only, and in REM sleep in all positions. What do you do?
Start patient on CPAP 5cm with nasal mask that was previously fitted. Patient continues to have events
while supine. You ask pt to move to sides, but patient states they have back problems and cannot sleep
on their side. Do you continue the titration? How high do you go on CPAP? Do you ever back down on
the pressure?
CPAP to BPAP:
Patient comes in for a split night sleep study. Patient AHI = 38 during dx portion. You have already
fitted a mask and shown the patient the device prior to lights out. Patient starts having apneas and
hypopneas during REM sleep, with nadir of 82%.
What do you do? What pressure do you start patient on?
After titrating up to a pressure of 10, obstructive apneas are resolved, but snoring and hypopneas
persist. What do you do?
After titrating up to a pressure of 12, OAs and hypopneas are resolved, but there is residual snoring.
What do you do?
On pressure of 13, after a REM cycle, patient wakes up and rips off the mask and complains that the
pressure is too high and does not want to continue. What do you do?
Add O2:
Patient has COPD and has baseline O2 sat of 85% on room air. Do you start CPAP or BPAP alone,
without adding supplemental O2? Discuss the Qualification rules, CMS, and standing order protocol.
Other tools to consider:
 Raise HOB:
Would you ever consider elevating HOB as part of the treatment? Why or why not?
 Lower pressure:
This can be accomplished through using BPAP or auto CPAP (titrates automatically with the needs of
the patient).
 Add chin strap:
Chin straps can sometimes be useful for mouth breathers. What circumstances do you think a chin
strap would not be advised?

REFERENCE

Carno, B.R.B.M. M. ([Insert Year of Publication]). Polysomnography for the Sleep Technologist. Elsevier Health Sciences (US). <link is hidden>