Titratation
After a patient has been diagnosed with Obstructive Sleep Apnea (OSA), the next step is to determine the treatment pressure required to help keep the airway open.
This can be done in a sleep lab setting where a sleep technician performs an attended polysomnography (PSG) sleep study.
During sleep, positive airway pressure is adjusted throughout the recording period to determine the optimal pressure for maintaining the best possible unobstructed upper airway performance.
Often an automatic machine is used instead of the sleep lab titration.
Once this titrated treatment pressure is known, it is sometimes referred to as the P90, P95 or the patients treatment pressure.
The BMC RESmart and Luna Auto Machines have two versions of Automatic (Titrate and Auto) and also CPAP Mode
Auto Mode
The machine will start at the initial pressure and ramp up to the treatment pressure over the ramp time.
After the ramp time has elapsed, the machine will automatically vary between the treatment pressure and the maximum pressure as the machine determines is necessary.
It will not go below the treatment pressure unless the ramp button is pressed to reduce the pressure back to the initial pressure.
Note: Auto mode can only be used if the Treatment Pressure is already known.
Titration Mode
The pressure will automatically vary between the Initial Pressure and the Maximum Pressure, depending on what the machine determines is necessary to help keep the upper airway open during sleep.
In this mode, the ramp is not used as the machine stays at the initial start pressure and then will automatically increase as required.
(On the Resmart screen, the minimum and initial pressure are set to the same low value. The maximum pressure is not shown on the screen.)
Note: Titrate is the version of automatic mode we usually use.
CPAP Mode
The machine will start at the initial pressure and ramp up to the treatment pressure over the ramp time.
After the ramp time has elapsed, the machine will stay at the treatment pressure. It will not increase or reduce. If the ramp button is pressed, the machine will go back down to the initial pressure and start the ramp cycle again.
The ramp time can be set between 0 mins and 60 Minutes, in 5 minute increments.
The ramp time is used so that the patient can fall asleep slightly before the full pressure is reached.
Note: Setting the ramp time can be a delicate balance.
Too long a ramp time and the patient may fall asleep and suffer apnea/hypopnea events before the treatment pressure is reached.
Too short a ramp time and the treatment pressure may be reached before the patient falls asleep. If the treatment pressure is uncomfortable when the patient is awake, they will have to manually press the ramp button to start the ramp cycle again.
Last updated: 8th December 2017