CPAP Titration: Is It Necessary?

Continuous positive airway pressure (CPAP) therapy is a leading treatment for obstructive sleep apnea. If CPAP is considered the best treatment option for obstructive sleep apnea, a CPAP titration study will be required.

What Is CPAP Titration?

CPAP titration is used to calibrate the pressure setting required on a CPAP machine in order to maintain clear airways overnight. Titration also helps to eliminate the disturbance to sleep from frequent mini arousals.

There are different levels of severity from obstructive sleep apnea, ranging from mild to severe. A titration study is performed to assess the correct pressure setting to keep airways open during sleep – as breathing difficulties will be eliminated.

How Is CPAP Titration Performed

Once sleep apnea is suspected, a sleep study is required to determine the diagnosis. This can involve an overnight stay at a sleep lab, where technicians monitor your sleep. Where possible, the titration study will be performed on the same night, but it may require a second overnight stay.

During a titration study, you will be provided with a mask to wear while you sleep. The technicians will work with you to find the most suitable mask. 

This is key to calibrating the correct pressure setting of the machine -- and for the successful treatment of obstructive sleep apnea. There are three main types of mask - full face mask, nasal mask and nasal pillow mask.

It is essential the mask feels comfortable as any discomfort is more likely to reduce adherence with the therapy. Once a mask has been selected, it will be connected to the CPAP machine via a tube for air flow. 

This may sound a little daunting, but the technicians will monitor your sleep and comfort throughout the study. As you sleep they will gradually adjust the pressure setting on the machine until they find the point where you do not experience any arousals. 

The titration study will monitor the different stages of sleep and the positions you may sleep in, as these can be factors that influence your breathing and how many arousals you experience.

It is understandable if someone would be a little nervous in such lab conditions. Therefore, the technicians will start off the machine at a very low pressure setting to help reduce any anxiety. 

They will gradually increase the pressure as you sleep -- until they arrive at the optimum setting where your airways remain unblocked.

You will wear sensors while sleeping, which the technicians can monitor from another room. They may need to enter your room if they suspect an issue with the mask, but otherwise all monitoring is performed remotely. 

It is also important to note that the CPAP machine does not breathe for you, but merely supplies the pressurized air you breathe through the mask.

Once the titration study is complete, it will be reviewed by your physician or sleep specialist, who can then prescribe the most suitable therapy machine and mask for you.

Is it Necessary to Perform CPAP Titration?

A titration study is an important part of the diagnosis process, one which ensures the correct pressure setting is supplied to a CPAP machine to prevent the breathing difficulties caused by sleep apnea. 

With the right level of pressurized air being supplied, you can return to proper nights of uninterrupted sleep.

As having the right pressure setting is key, follow up titration studies may be required. Indeed, some physicians may request a titration study every year or two to ensure there has been no change in the degree of your sleep apnea. 

This will require an adjustment of the pressure setting to maintain the effectiveness of the therapy.

If you start to notice a return of your obstructive sleep apnea symptoms, this is a clear sign you may need your pressure setting adjusted. At this point a further titration study will be required. The symptoms of sleep apnea to remain aware of include:

  • Frequent awakenings overnight
  • Loud snoring
  • Morning headaches
  • Excessive daytime fatigue
  • Poor concentration levels
  • Increased irritability

Treating sleep apnea should remove or significantly reduce these symptoms, helping you sleep better and feeling more refreshed when you awake. If you start to experience symptoms again it is important to consult with your physician or sleep specialist who can refer you for a follow up titration study.

As with any health issue, keeping track of your sleep apnea is vital in ensuring your treatment remains effective. Left untreated, obstructive sleep apnea results in sleep deprivation and can increase the risk of further serious health problems including heart disease, stroke, high blood pressure and type 2 diabetes.

If you are continuing to feel refreshed every morning and are not displaying any signs your sleep apnea symptoms are returning, then you may only require a follow up titration study every couple of years. 

However, if you are starting to feel your sleep apnea symptoms returning, do not wait until you are invited to your next CPAP titration study and contact your physician as soon as possible.

Obstructive sleep apnea is treatable, but the treatment needs persistent adherence to see the benefits. 

A CPAP titration study provides the optimum pressure setting for a CPAP machine, allowing it to supply the pressurized air to keep your airways open as you sleep and remove the debilitating symptoms linked to sleep apnea.