What Is a CPAP Titration Study and Do You Need One? How Often? What About APAP?

💡 Key Takeaways

• Understanding CPAP Titration: CPAP titration is a process to find the ideal pressure setting for treating Obstructive Sleep Apnea. It usually occurs after or during a sleep study and may be scheduled as a separate appointment.
• Difference from Sleep Study: A sleep study is the initial diagnostic phase, while CPAP titration focuses on fine-tuning the pressure settings on your CPAP machine. They are not the same and may occur on different nights.
• What Happens During Titration: During the titration study, a sleep technician will monitor various parameters like brain waves, heart rate, and oxygen levels while adjusting the CPAP machine's pressure to find the optimal setting for you.
• Home Titration Options: Traditional titration studies are generally conducted in a lab, but if you have uncomplicated Obstructive Sleep Apnea, an APAP machine can automatically adjust the pressure and may eliminate the need for a separate titration study.
• Cost and Frequency: The cost of a CPAP titration study can vary widely depending on various factors like insurance and location. It's generally recommended to undergo titration every one to two years, especially if you've experienced significant health changes.

If you’ve talked to your healthcare provider about low energy levels and restless nights, there’s a good chance that they have recommended or scheduled a sleep study. The sleep study is when you would receive a diagnosis and determine how mild or severe your sleep apnea is. After your sleep study, your healthcare provider will review your results and determine the best course of treatment. If you’re diagnosed with sleep apnea, you’ll be sent back to the sleep lab for a CPAP titration study.

CPAP titration is the process of using a Continuous Positive Airway Pressure (CPAP) machine to find the ideal pressure setting for treating your Obstructive Sleep Apnea. Your sleep technician will test various pressures to find the lowest setting at which you experience the least amount of apnea events like choking, not breathing for up to ten seconds, and gasping for air.

CPAP titration that happens on the same night as your sleep study is known as a split-night sleep study, although these typically only occur if you have Severe Obstructive Sleep Apnea. Typically, a separate CPAP titration study will be scheduled at a later date after your healthcare provider has had time to review the results of your sleep study.

In this article, we’re going to take a closer look at CPAP titration, answering questions like, “What is CPAP titration?; How is titration done?; How is CPAP titration different from a sleep study?” and more. If you’re curious about CPAP titration and want to know more, then keep reading.

CPAP titration is the process of finding the lowest flow rate at which your airway is held open by Continuous Positive Airway Pressure (CPAP). Your sleep technician will manually test different therapy pressures to find the ideal pressure setting to minimize your sleep apnea symptoms, allowing you to sleep through the night without waking up choking or gasping for air.

CPAP titration is typically scheduled as a separate appointment from your sleep study. This will give your healthcare provider time to review and assess your results before recommending further action. If you’re at risk for Severe Obstructive Sleep Apnea, you may experience a split-night study where CPAP titration takes place after the first few hours of the sleep study itself. If you have very mild sleep apnea, a split-night study may not be long enough for your symptoms to manifest, which is why a CPAP titration study is typically scheduled a few days later.

If you’re new to CPAP therapy, it’s important to note that a CPAP titration appointment and a sleep study are not the same thing. A sleep study is the investigative phase where you’ll be connected to various sensors and monitored for signs of sleep disorders. If during your sleep study, you show signs of Severe Obstructive Sleep Apnea, you may experience a CPAP titration study in the same night. If this is the case, you’ll be woken up after the initial sleep study phase and fitted with a CPAP mask for the titration phase before going back to sleep. More commonly though, a separate CPAP titration study will be scheduled to determine the ideal pressure settings for your CPAP machine prescription.

CPAP titration will make up a portion of a sleep study if you’re suspected to have Severe Obstructive Sleep Apnea, but a sleep study can also identify many types of sleep disorders that aren’t treated with a CPAP machine such as insomnia, REM sleep behavior disorder, and narcolepsy.

When arriving for your initial sleep study to determine if you have sleep apnea, the sleep lab will typically be set up like a hotel room and have a bathroom for you to brush your teeth, wash your face, and take care of any other pre-bedtime routines you may have. The goal of the sleep lab is to make you as comfortable as possible to get a clear picture of your typical night of sleep. You’ll arrive an hour or two before the study in most cases, allowing you plenty of time to get ready for bed. Once you’re ready to get settled, your technician will connect the necessary sensors to various points on your body with a gentle adhesive, typically including the face, neck, scalp, legs, and chest, along with an oxygen sensor for your finger and a chest belt to measure your volume of breath.

Sleeping with a bunch of sensors attached to you can be an intimidating sensation, so we recommend bringing a familiar pillow or blanket from home to put you a bit more at ease. Be sure to let your technician know about any discomfort, so they can assess if a sensor isn’t connected right or needs to be re-applied. Having a book or e-reader is also a great idea for taking your mind off things and winding down before sleep. Your favorite sleepwear is equally recommended.

Assuming that you’ve already undergone a sleep study and are now entering the CPAP titration phase of your study, your technician will get you set up with a CPAP mask. The mask will be either a nasal, nasal pillow, or full face CPAP mask, and you may even have the option to choose between the three. Once your mask is on and sealed properly, you’ll be asked to go to sleep for the titration process.

Your sleep technician will start at a lower pressure, typically at or around 5 cm H2O, and incrementally raise your pressure over time while observing the frequency of apneas, hypopneas, and respiratory effort-related arousals (RERAs). Your technician will also monitor your brain waves, heart rate, volume of breath, eye movement, facial and leg muscle movement, and oxygen saturation in your blood to get a more accurate picture of how you’re responding to different pressure settings.

You’ll likely be asked to change sleeping positions during the titration study, so your sleep technician can observe how different positions affect your apneas. Your titration will conclude when your sleep technologist has found the pressure setting that eliminates or most significantly reduces apneic events like gasping for air, choking, and repeated nighttime awakenings.

If you are suspected to have Complex or Central Sleep Apnea, a CPAP machine alone may not be enough to adequately treat your apneas, and the pressure setting during your exhalation will also need to be determined. If this is the case for you, you’ll be connected to a BiPAP machine, which has a set pressure for both inhalation and exhalation. Your sleep technician will then perform titration with the BiPAP to determine your ideal settings for both inhalation pressure and exhalation pressure.

On the day of your CPAP titration study, you’ll want to:

• Keep a Normal Routine
• Avoid Caffeine and Naps in the Afternoon
• Shower and Shampoo Beforehand
• Bring Nighttime and Morning Medications
• Bring Comfortable Clothes and/or PJs
• Bring Any Usual Routine Items Like Your Toothbrush and/or Face Wash
• Bring Comfort Items Like a Familiar Pillow or Blanket
• Remove Nail Polish (Contact Your Sleep Lab First As This May Not Be Necessary)

The only side effects you may experience from a CPAP titration study are a sore or dry throat from the CPAP machine and some facial irritation or soreness from the CPAP mask. If you do experience irritation and soreness, it’s actually a good indication that the mask type you used during titration may not be the best mask type for you. The titration process itself is safe and painless, but you will likely have some adhesive residue left over from the sensors attached during your sleep study. You’ll definitely want to shower afterward, but you shouldn’t notice any lasting effects.

A home sleep test is a common and capable tool for confirming sleep apnea at home. While the sleep study portion can be done just about as effectively in the comfort of your home as in a sleep lab, a titration study cannot be done at home in the traditional sense. However, if you complete a home sleep study and it is determined that you have Obstructive Sleep Apnea (OSA), you will be prescribed an APAP machine, skipping the CPAP titration process entirely.

APAP stands for automatic, auto-adjusting, or auto-titrating positive airway pressure. An APAP machine will actively adjust to your breathing needs on a breath-by-breath basis and will deliver the lowest necessary pressure on each breath, actively performing titration throughout the night.

It’s not uncommon to undergo CPAP titration once every one to two years, and it’s especially common if you’ve experienced a heart attack or stroke or if your healthcare provider wants to monitor you more closely.

If, however, your therapy still seems to work for you after a year or two and you haven’t experienced any major lifestyle changes that would affect your therapy, it’s unlikely that your healthcare provider would recommend another CPAP titration study. You may need to reach out to your healthcare provider to schedule one if you begin to experience choking, gasping for air, or repeatedly waking up in the night despite using your CPAP machine as these are indicators that you need a higher therapy pressure to keep your airway open.

If you’re prescribed an APAP machine and have OSA that isn’t complicated by any other preexisting conditions or sleep disorders, you’ll never need to be titrated in a sleep lab since the machine is automatically determining the best pressure for you in real-time. Below are just some of the factors that can complicate OSA:

• Biological Factors: Age, Sex, or Family History of OSA
• Lifestyle Choices: Smoking, Drinking Alcohol, Weight, Exercise, and Diet
• Medications: Barbiturates, Antihistamines, Benzodiazepines, Opiates, Analgesics, or Medication With a Drying Effect
• Pre-Existing Conditions: Thyroid Disorders, Cardiovascular Disease, Other Sleep Disorders, History of Strokes, Nervous System Disorders, and/or Respiratory Diseases

CPAP titration is a reliable diagnostic tool for determining the ideal pressure settings for an individual diagnosed with Obstructive Sleep Apnea. That said, APAP machines automatically titrate the amount of necessary pressure for those with OSA that don’t have any other underlying medical conditions. A 2021 study confirmed the efficacy of APAP machines for titration, finding that manual CPAP titration often resulted in a pressure setting that was 1 to 2 cm H2O higher than the pressure administered by an APAP machine.

However, it should not be understated that those who have OSA and other underlying medical conditions would benefit from a manual CPAP titration study because the sensors and equipment used in the lab will be able to detect more nuanced anomalies in your breathing, oxygen levels, and muscle movements during the night.

Absolutely. CPAP titration is a necessary part of the process of treating sleep apnea. Not only is everyone’s body different but factors like those listed above can complicate your sleep, affecting what your ‘ideal’ pressure setting is. If you have OSA that’s uncomplicated by other medical conditions, then a home sleep study and an APAP machine are sufficient, but your healthcare provider has the final say in what’s best for you. Be sure to consult them if you’re interested in trying a home sleep test or APAP machine instead of the traditional sleep study or CPAP titration study.

The cost of your CPAP titration study will largely depend on the nature of your sleep study as well as your insurance policy and whether or not the sleep lab is in-network. If you’re undergoing a split-night study where the sleep study and CPAP titration occur on the same night, your bill before insurance will likely be $2,500 to $6,000 on average. National averages vary widely from location to location, and there are many variables that will affect this cost such as your deductible, the type of test ordered, how many nights you spend in-lab, and any complications that may arise during testing.

Be sure to consult your healthcare provider to determine exactly what tests are being ordered. You’ll then want to contact your insurance provider to get a better idea of what you can expect to pay out of pocket. Some people pay under a thousand dollars while others pay a couple thousand. There is simply no one-size-fits-all answer to the question of sleep study costs.

However, if you’re suspected to have OSA that is not complicated by other medical conditions, an affordable home sleep test is likely a great option to get you diagnosed and prescribed an APAP machine. Home sleep tests are typically available for under $200 if you don’t require more in-depth sleep testing for other sleep conditions or comorbidities.

A CPAP titration study is performed to determine the best pressure setting for treating your Obstructive Sleep Apnea and is a necessary part of the diagnosis process. While home testing methods exist for those with uncomplicated OSA, people with underlying conditions and complicated medical histories would benefit from a manual CPAP titration study in a sleep lab.

With uncomplicated OSA, an APAP machine is capable of successfully titrating and treating your sleep apnea. The automatic titration offered by APAP machines is just as, if not more, effective than manual titration. Cost may vary widely, so you’ll want to consult your healthcare and insurance provider to better understand the payment amount that you’ll be responsible for.

We hope this guide to CPAP titration has helped answer your questions and address your concerns. If you have additional questions, feel free to reach out to our award-winning customer service team at 1-800-356-5221 Monday through Friday from 8 a.m. to 8 p.m. or Saturday and Sunday from 8 a.m. to 5 p.m. They’ll be able to give you some more personalized guidance.